Promoting Organizational Change: A Urology Department-wide Wellness Program to Reduce Burnout.

INTRODUCTION: We developed a comprehensive wellness initiative to address burnout with specific interventions targeted at faculty, residents, nurses, administrators, coordinators, and other departmental personnel. METHODS: A department-wide wellness initiative was implemented in October 2020. General interventions included monthly holiday-themed lunches, weekly pizza lunches, employee recognition events, and initiation of a virtual networking board. Urology residents received financial education workshops, weekly lunches, peer support sessions, and exercise equipment. Faculty were offered personal wellness days to use at their discretion at no penalty to their calculated productivity. Administrative and clinical staff were given weekly lunches and professional development sessions. Pre- and post-intervention surveys included a validated single-item burnout instrument and the Stanford Professional Fulfillment Index. Outcomes were compared using Wilcoxon rank-sum tests and multivariable ordinal logistic regression. RESULTS: Among 96 department members, 66 (70%) and 53 (55%) participants completed the pre- and post-intervention surveys, respectively. Burnout scores were significantly improved after the wellness initiative (mean 2.06 vs 2.42, mean difference -0.36, P = .012). An improvement was also observed in the sense of community (mean 4.04 vs 3.36, mean difference 0.68, P < .001). Adjusting for role group and gender, completion of the curriculum was associated with decreased burnout (OR 0.44, P = .025), increased professional fulfillment (OR 2.05, P = .038), and increased sense of community (OR 3.97, P < .001). The highest-rated components were monthly gatherings (64%), sponsored lunches (58%), and employee of the month (53%). CONCLUSIONS: A department-wide wellness initiative with group-specific interventions can help reduce burnout and may improve professional fulfillment and workplace community.

Understanding the Urology Program Directors Perspective on the Current Resident Selection Process: The Society of Academic Urologists National Survey of Urology Program Directors.

OBJECTIVE: The traditional residency selection process was altered dramatically by the SARS CoV-2 (COVID-19) pandemic. For the 2020-2021 application cycle in-person interviews were transitioned to the virtual format. What was thought to be a temporary transition has now become the new standard with continued endorsement from the Association of American Medical Colleges (AAMC) and the Society of Academic Urologists (SAU) for virtual interviews (VI). We sought to assess the perceived efficacy and satisfaction of the VI format from the urology residency program director's (PDs) perspective. DESIGN: A designated SAU Taskforce on "Optimizing the Applicant Experience in the Virtual Interview Era" developed and refined a survey composed of 69 questions on VI and was distributed to all urology program directors (PD) of member institutions of the SAU. The survey focused on candidate selection, faculty preparation, and interview day logistics. PDs were also asked to reflect on the impact of VI on their match results, recruitment of underrepresented minorities and female gender, and what their preference would be for future applications cycles. PARTICIPANTS: Urology residency PDs (84.7% response rate) between January 13, 2022 - February 10, 2022 were included in the study. RESULTS: Most programs interviewed a total of 36 to 50 applicants (80%), with an average of 10 to 20 applicants per interview day. The top 3 ranked criteria for interview selection reported by urology PDs surveyed included letters of recommendation, clerkship grades, and USMLE Step 1 score. The most common areas of formal training for faculty interviewers were diversity, equity and inclusion (55%), implicit bias (66%), and review of the SAU guidelines on illegal questions (83%). Over half (61.4%) of PDs believed that they were able to accurately represent their training program through the virtual platform, while 51% felt that VI did not afford similar assessments of applicant as in-person interviews. Two-thirds of PDs believed the VI platform improve access for all applicants to attend interviews. Focusing on the impact of the VI platform for recruitment of underrepresented minorities (URM) and female gender applicants, 15% and 24% reported improved visibility respectively for their program, and 24% and 11% reported increased ability to interview URM and female gender applicants respectively. Overall, in-person interviews were reported to be preferred by 42%, and 51% of PDs desired VIs to be included in future years. CONCLUSIONS: PDs opinion and role of the VIs into the future is variable. Despite uniform agreement of cost savings and belief that VI platform improves access for all, only half of PDs expressed interest of the VI format being continued in some form. PDs note limitation of VI in the ability to comprehensively assess applicants as well as the in-person format. Many programs have begun to incorporate vital training in the areas of diversity equity and inclusion bias, and illegal questions. There is a role for continued development and research on ways to optimize virtual interviews.

National Implementation and Evaluation of a Virtual Subinternship in Urology.

OBJECTIVE: To conduct a nationwide evaluation of student and program director (PD) perspectives of virtual subinternships that took place during the COVID-19 pandemic. MATERIALS AND METHODS: In December 2020, we distributed anonymous surveys to all 534 urology residency applicants and 161 urology PDs at academic medical centers across the United States to evaluate virtual subinternships. Surveys assessed curriculum composition, goals, satisfaction, barriers, and future reusability. The primary outcome was overall satisfaction with the subinternship, evaluated on a 5-point Likert scale. RESULTS: The survey was completed by 174 students (33%) and 82 PDs (51%), including 81 students (47%) and 32 PDs (41%) who participated in virtual subinternships at 29 institutions. Overall, 77% of students and 78% of PDs rated the electives "excellent" or "very good." On ordinal logistic regression, higher student ratings were associated with duration ≥3 weeks (odds ratio [OR] 4.64, P = .003) and class size ≤4 students (OR 3.33, P = .015). Higher PD ratings were associated with full-time electives (OR 11.18, P = .019), class size ≤4 students (OR 13.99, P = .042), and utilization of the standardized Guidebook from the Society of Academic Urologists (OR 11.89, P = .038). The most commonly reported challenge to the subinternship's efficacy was lack of hands-on learning (87% of students and 81% of PDs). Looking forward, 45% of students and 66% of PDs recommended incorporating virtual components into future electives. CONCLUSION: The virtual subinternship was a coordinated nationwide initiative to provide urologic education to medical students during a pandemic. The most successful courses were structured with longer duration, full-time commitment, and small class size.

Efficacy of an Online Blended Learning Curriculum to Improve Medical Student Urologic Education.

OBJECTIVE: During the COVID-19 pandemic, limitations on in-person medical school clerkships created a deficit in urologic learning opportunities. We sought to develop and evaluate a blended curriculum of interactive online modules with small-group discussion to enhance the educational experience for medical students in urology. MATERIALS AND METHODS: We created a curriculum of four online case-based urology modules. Between July and October 2020, 14 fourth-year medical students completed the modules. Students answered questions on a discussion board and engaged in asynchronous dialogue with 16 physicians, in addition to a weekly live review session. Students and physicians completed anonymous surveys to assess satisfaction and perceived learning outcomes, with questions scored on a 5-point Likert scale. RESULTS: Thirteen students (93% response rate) and 12 physicians (75% response rate) completed the survey. Overall, 12/13 students and 11/12 physicians "strongly agree" or "somewhat agree" that the modules improved the rotation. Students and physicians perceived that the modules were effective for learning/teaching foundational knowledge (average ratings 4.8 and 4.5, respectively) and facilitating performance assessment (4.4 and 4.0). Students reported high learning scores across multiple Accreditation Council for Graduate Medical Education core competencies, and 12/13 students found the modules fun/engaging. The majority of students (12/13) and physicians (10/12) felt that the online modules should be incorporated into future urology electives. CONCLUSIONS: A blended learning curriculum utilizing online modules is an effective tool for enhancing urologic education, improving perceived learning outcomes and facilitating performance assessment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01427-3.

Virtual Urology Education in the Epicenter of COVID-19: Development and Outcomes of the Educational Multi-Institutional Program for Instructing REsidents (EMPIRE) Lecture Series.

INTRODUCTION: Sustaining resident education efforts during the height of the COVID-19 pandemic required innovative, virtual didactic programs. This article reviews the authors' collaborative experience with launching the Educational Multi-institutional Program for Instructing REsidents (EMPIRE) lecture series in the New York Section of the American Urological Association. METHODS: From April 13, 2020 to May 29, 2020, there were 68 EMPIRE lectures delivered via Zoom videoconferencing that were based on a variety of topics highlighted in the AUA Core Curriculum. Tracking tools from Zoom, Google Analytics from the New York Section website and YouTube Analytics were used to assess participant access of didactic materials. Additionally, a survey regarding the content and impact of the series was distributed and advertised to those who had attended the lecture series. RESULTS: The average number of participants was 159±68 per lecture (range 77 to 334) and the recordings received 9,086 total video views (range 42 to 443 views per video) at the time of survey completion. The survey received 170 total responses. The majority of speakers (77%) and participants (58%) were from the New York Section. Half of the participants were residents (50%) and others were attending urologists (35%), fellows (5%), medical students (9%), and advanced practice providers (1%). Survey respondents reported consistently high ratings of the EMPIRE series. Overall, 99% of respondents said that they would recommend the EMPIRE series to a colleague and 98% requested that the series continue after COVID-19 abates. CONCLUSIONS: The EMPIRE didactic series was well received, with the majority of participants positively endorsing its value. Further initiatives pertaining to virtual education for urology trainees should continue to be explored.

Changing the Status Quo: Developing a Virtual Sub-Internship in the Era of COVID-19.

PROBLEM: Subinternships are integral to medical education as tools for teaching and assessing fourth-year medical students. Social distancing due to COVID-19 has precluded the ability to offer in-person subinternships - negatively impacting medical education and creating uncertainty surrounding the residency match. With no precedent for the development and implementation of virtual subinternships, the Society of Academic Urologists (SAU) developed an innovative and standardized curriculum for the Virtual Subinternship in Urology (vSIU). METHODS: The vSIU committee's mandate was to create a standardized curriculum for teaching foundational urology and assessing student performance. Thirty-three members from 23 institutions were divided into working groups and given 3 weeks to develop 10 modules based on urologic subspecialties, Accreditation Council for Graduate Medical Education core competencies, technical skills training and student assessment. Working groups were encouraged to develop innovative learning approaches. The final curriculum was assembled into the "vSIU Guidebook." RESULTS: The vSIU Guidebook contains 212 pages - 64 pages core content and 2 appendices (patient cases and evaluations). It outlines a detailed 4-week curriculum with a sufficient volume of resources to offer a completely adaptable virtual course with the same rigor as a traditional subinternship. Modules contain curated teaching resources including journal articles, lectures, surgical videos and simulated clinical scenarios. Innovative learning tools include reflective writing, mentorship guidelines, videoconference-based didactics, surgical simulcasting and virtual technical skills training. The guidebook was disseminated to program directors nationally. NEXT STEPS: The vSIU is the first virtual subinternship in any specialty to be standardized and offered nationally, and it was implemented by at least 19 urology programs. This curriculum serves as a template for other specialties looking to develop virtual programs and feedback from educators and students will allow the curriculum to evolve. As the pandemic continues to challenge our paradigm, this rapid and innovative response exemplifies that the medical community will continue to meet the needs of an ever-changing educational landscape.