Department of Urology, University of Connecticut Health Center, Farmington, Connecticut, USA.
Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA.
Can J Urol. 2021 Dec;28(6):10941-10945.
Resident training in vasectomy, especially in the office setting on the awake patient, may be limited. The aim of this study is to understand resident exposure to vasectomy and to identify barriers to learning.
An anonymous 18-question survey was distributed to urology residents of the 135 ACGME-accredited urology residencies in the United States. Residents were asked to specify the total number of vasectomies they had performed and in what environment (operating room versus office), their comfort performing vasectomy independently, and any barriers to learning the procedure.
In total, 119 residents responded to the survey, representing a 10% response rate. Vasectomy case volumes were variable, with 36.7% of residents logging ≤ 20 vasectomies by their final year of training. Total of 23.4% indicated they did not receive training in perioperative counseling for patients considering vasectomy. Only 64.7% of all residents felt comfortable in the office setting versus 89.1% who felt comfortable in the operating room (p < 0.001). This difference persisted throughout training, and 16.7% of residents in their final year of residency were uncomfortable performing office vasectomy. Total of 60.5% of respondents cited one or more barriers to training, with lack of surgical volume (38.7%), lack of vasectomies in the resident clinic (29.4%), and lack of autonomy when performing the procedure (22.7%) being the most common.
Residents are significantly less comfortable performing vasectomy in the office setting versus in the operating room, including in their graduating year. Residents describe low volume and lack of autonomy as barriers to vasectomy training.
住院医师在输精管切除术方面的培训，尤其是在清醒患者的办公室环境下，可能受到限制。本研究旨在了解住院医师接受输精管切除术培训的情况，并确定学习的障碍。
我们向美国 135 个 ACGME 认证的泌尿科住院医师培训项目的泌尿科住院医师发放了一份匿名的 18 个问题的调查问卷。要求住院医师具体说明他们总共进行了多少例输精管切除术，以及在什么环境下进行（手术室与办公室），他们独立进行输精管切除术的舒适度，以及学习该手术的任何障碍。
共有 119 名住院医师对该调查做出了回应，回应率为 10%。输精管切除术的例数各不相同，36.7%的住院医师在培训的最后一年完成的输精管切除术数量≤20 例。共有 23.4%的人表示他们没有接受过考虑输精管切除术患者围手术期咨询的培训。只有 64.7%的住院医师在办公室环境中感到舒适，而 89.1%的人在手术室中感到舒适（p<0.001）。这种差异贯穿整个培训过程，在住院医师培训的最后一年，有 16.7%的住院医师在办公室进行输精管切除术时感到不舒服。共有 60.5%的受访者表示存在一个或多个培训障碍，其中包括手术量不足（38.7%）、住院医师诊所中没有输精管切除术（29.4%）以及在执行手术时缺乏自主权（22.7%）。
住院医师在办公室环境中进行输精管切除术的舒适度明显低于手术室，包括在毕业年。住院医师描述低手术量和缺乏自主权是输精管切除术培训的障碍。
