Medical–surgical activity and the current state of training of urology residents in Spain: Results of a national survey

Abstract

Objectives

To determine the actual state of medical–surgical activity and training for urology residents in Spain.

Material and method

We designed 2 anonymous surveys, which were uploaded with the Google Docs^© tool so that the respondents could answer the surveys online. The online collection period was September 2015–January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3.

Results

The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20 h a week, and 43 of these even less than 10 h. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate.

Conclusions

Efforts should be directed toward standardizing the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

Resumen

Objetivos

Conocer el estado actual de la actividad médico-quirúrgica y de la formación de los residentes de urología en España.

Material y método

Se diseñaron 2 encuestas anónimas y fueron cargadas en la herramienta Google Docs^© para ser contestadas vía online. El periodo de recolección online fue de septiembre de 2015-enero de 2016. Los datos recolectados fueron procesados utilizando el programa estadístico IBM SPSS para Windows, Versión 21.0 y el programa R versión 3.2.3.

Resultados

El número de total de respondedores fue de 163. En referencia al número de guardias de presencia física la mayoría de los residentes realizan entre 4 y 6 guardias al mes. Ochenta y cuatro de los encuestados refieren estar menos de 20 horas semanales en quirófano y 43 de estos incluso menos de 10 horas. El 30% de los encuestados no ha realizado ninguna resección transuretral, la mayoría ha realizado al menos una adenomectomía prostática, pero a su vez no ha realizado ningún procedimiento oncológico mayor, ya sea por vía laparoscópica o abierta. En las preguntas destinadas a entrenamiento y cursos de formación encontramos que la mayoría de los residentes entrena laparoscopia en el hospital o en casa. La satisfacción global de la residencia fue valorada en 2,6. En este sentido podría considerarse la satisfacción global como moderada.

Conclusiones

Se deberían orientar esfuerzos para estandarizar la adquisición de habilidades quirúrgicas y no quirúrgicas, garantizar el acceso a cursos de formación, establecer un mínimo de intervenciones requeridas por año y lograr una evaluación objetiva de la especialidad.

Introduction

Ideally, urology residency programs should provide residents with the knowledge and skills required to make them feel comfortable and confident in making the right therapeutic choices, as well as perform various surgical procedures.1, 2

The urology program in Spain currently has a duration of 5 years and the traditional method is based on the imitation of the skills and behavior of the tutors and other adjuncts of the corresponding urology department, whose surgical opportunities and assessment can be conditioned by the personal relationship, as well as internal protocols and behaviors of each department, creating variability in training between the different centers and giving a passive role to resident medical interns (RMI).³ In this sense, some authors have proposed the implementation of objective evaluation systems such as the Queen's Urology examination skills training program (Canada), the Annual review of competence progression (UK), and more recently in Spain the Evaluation System for Surgical Competencies on Laparoscopy (called ESSCOLap), which is based on the definition, graduation, and evaluation through a validated system of those competences, technical and non-technical, demonstrated by a surgeon according to established parameters, for the surgical techniques of urological laparoscopy, endourology, and microsurgery. A series of general competences are established, others specific for each of the surgical techniques considered in the program, and a rating system from 1 to 5, with specific definition of each of the values.³

On the other hand, Spain is the world leader in kidney transplant; however, a national survey has found that the most common situation is for a resident to complete his training without having performed a complete kidney transplant.⁴

Urology is a specialty that has developed during the last years in diverse areas such as andrology, urolithiasis, endourology, oncology, functional urology, female and urodynamic, uropediatrics, and kidney transplant. In addition, it is a surgical specialty with an affinity for the introduction of new technologies in minimally invasive surgery such as laparoscopy, endoscopy, laser, and robotics, among others.

The theoretical number of residents of urology in Spain is 476, being one of the countries with the largest number of urology residents in Europe. However, the surgical participation of the RMIs, the procedures that they feel confident to carry out, the relation of the care workload, or the degree of satisfaction with their residence are aspects unknown at present.

Therefore, the objective of our study is to know the current state of the medical–surgical activity and of the training of residents of urology in Spain, in order to detect possible improvements and promote the development of objective training programs.