Use of a Workplace-Based Assessment to Evaluate Urology Trainees' Preparedness for Independent Practice

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: There is rising concern that surgical residency graduates are not prepared for independent practice. Furthermore, recent graduates of US urology residency programs express lack of confidence with common procedures in urologic practice. There are no surgical skills assessment tools consistently being used across urology training programs, and little is known about resident performance in urology training. We assessed urology residents' operative performance using a smartphone-based app to better understand how well urology programs prepare future urologists. METHODS: We conducted a prospective observational trial within 7 urology residency programs. Faculty and residents were trained to use the Society for Improving Medical Professional Learning (SIMPL) smartphone app- a workplace-based assessment. The application asks three questions, of faculty and residents separately, on autonomy (Zwisch scale), operative performance, and case complexity immediately following completion of an operative procedure. Data were analyzed using descriptive statistics. RESULTS: Across the 7 programs, 126 attending urologists rated 111 urology residents for a total of 3,377 evaluations. We excluded all procedures in which resident participation was limited primarily to observation (Zwisch level of “Show & Tell”). For operative performance ratings, 39% of PGY1s received the highest rating of a 4 (“Practice Ready”). This decreased steadily down to 21% for PGY2s, 20% for PGY3s, 7.7% for PGY4s, and just 3.2% for PGY5s. Performance was rated significantly lower with increasing PGY level (p<0.001). This effect did not differ significantly by surgery type or by Zwisch level. CONCLUSIONS: Our results indicate that the performance ratings urology residents receive from faculty significantly decrease as they progress through their training. This is likely because senior residents participate more in surgeries, are involved in more complex cases, and have higher expectations in surgical knowledge and skills. Our data suggest that faculty do not perceive senior residents as performing at a level sufficient for independent practice. These results highlight a need for urology programs to continue to refine their training to ensure that graduates are prepared for complex cases.

Volume

211

Issue

5S

First Page

e657

Last Page

e658

Comments

American Urological Association Annual Meeting, May 3-6, 2024, San Antonio, TX

DOI

10.1097/01.JU.0001008644.01945.6c.15

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