Department of Urology, Montefiore Medical Center, Bronx, NY, USA.
Department of Urology, Nationwide Children's Hospital, Columbus, OH, USA.
J Pediatr Urol. 2024 Dec;20(6):1035-1043. doi: 10.1016/j.jpurol.2024.08.013. Epub 2024 Aug 31.
North American Pediatric Urology fellowship programs underwent a structural change in 2021 that allows more flexibility in training. Given this opportunity as well as widespread concern about the development of contemporary surgical trainees, it is prudent to understand in detail the current state of preparedness of pediatric urology fellowship graduates for independent practice.
The study aimed to determine recent pediatric urology graduates' reported levels of comfort both at graduation and following the start of clinical practice in performing select index procedures. We also queried the aspects of training and clinical practice perceived to be the most valuable for the development of surgical confidence.
Graduates of ACGME approved pediatric urology fellowships from 2016 to 2021 were surveyed. Index procedures were described via brief case vignettes. Respondents were asked to indicate their comfort level with each index procedure following fellowship graduation and at the current time point. Comfort levels were defined by the degree of support that respondents would seek from senior colleagues in preparation for case booking. Respondents were also asked about the most helpful operative settings during training and factors contributing to high and low comfort.
Fifty-three pediatric urologists (49%) completed the survey out of 109 invited. Most respondents practiced at an academic center. Perceived comfort was very high for low complexity procedures. The responses varied more widely for procedures of moderate and significant complexity (Figure). Across the cohort, there was a substantial increase in comfort between graduation and the current time point for all procedures queried. The most highly valued operative settings in fellowship were those offering real or simulated independence. Respondents most often attributed high comfort to robust case volumes and overall surgical skill gained in fellowship.
New pediatric urology faculty differ widely in surgical confidence, particularly for more complex procedures. There is meaningful growth in the confidence and self-perceived independence of pediatric urologists during their initial years of practice. The early years are a critical time of continuing maturation and development that should be supported with structured systems of mentorship. Future challenges include low case volumes for rare conditions and the centralization of complex care.
These findings will provide valuable context for pediatric urology fellowship directors as they evaluate and redesign their programs under the new, more flexible structure. There are opportunities to formalize early practice mentorship to support the growth of new faculty.
2021 年，北美小儿泌尿外科住院医师培训计划发生了结构变化，为培训提供了更大的灵活性。鉴于这一机会以及对当代外科住院医师发展的广泛关注，详细了解小儿泌尿外科住院医师毕业后独立实践的准备情况是谨慎的。
本研究旨在确定最近的小儿泌尿外科毕业生在毕业时以及开始临床实践后报告执行某些指数程序的舒适度。我们还询问了他们认为对建立手术信心最有价值的培训和临床实践方面。
调查了 2016 年至 2021 年接受 ACGME 批准的小儿泌尿外科住院医师培训的毕业生。指数程序通过简短的案例描述。要求受访者表明他们在毕业后和当前时间点对每个指数程序的舒适度。舒适度水平由受访者在准备预订病例时寻求资深同事支持的程度来定义。受访者还被问及在培训期间最有帮助的手术环境以及导致舒适度高或低的因素。
在邀请的 109 名受访者中，有 53 名小儿泌尿科医生（49%）完成了调查。大多数受访者在学术中心执业。对于低复杂性的程序，感知舒适度非常高。对于中度和高复杂性的程序，反应差异更大（图）。在整个队列中，所有询问的程序在毕业和当前时间点之间的舒适度都有了实质性的提高。住院医师培训中最有价值的手术环境是提供真实或模拟独立性的环境。受访者最常将高舒适度归因于大量病例和在住院医师培训中获得的整体手术技能。
新的小儿泌尿科医生在手术信心方面差异很大，特别是对于更复杂的程序。小儿泌尿科医生在他们实践的最初几年中，信心和自我感知的独立性有了显著的增长。早期是一个关键的成熟和发展时期，应该通过有组织的指导系统来支持。未来的挑战包括罕见疾病的低病例量和复杂护理的集中化。
这些发现将为小儿泌尿外科住院医师培训计划的评估和重新设计提供有价值的背景，因为它们在新的、更灵活的结构下进行。有机会正式开展早期实践指导，以支持新教员的成长。
