ABSTRACT
INTRODUCTION: The completion of residency and start of fellowship training marks a critical transition for urologists in the pursuit of subspeciality training. Most graduating urology residents are under contract until June 30, and most fellowships are scheduled to begin on July 1. There has been no investigation into the practical implications of fellowship delays in urology from a trainee perspective. Our research study aimed to investigate the incidence and predictors of delays in fellowship starts. METHODS: Pediatric urology fellows that began their fellowship training between 2019 and 2023 and endourologic fellows that began their fellowship training between 2017 and 2022 were surveyed using SurveyMonkey®. A total of 250 endourology (EU) fellows and 90 pediatric urology (PU) fellows were contacted. RESULTS: A total of 26.0% and 14.3% of EU and PU fellows, respectively, experienced a delay in their training, despite many leaving their residency positions early (33.8% vs. 44.9%, p=0.2097); 11.7% and 8.2% of EU and PU fellows, respectively, experienced delays they reported to be "very stressful" and 9.1% and 4.1%, respectively, found them "somewhat stressful." Delays of 2-4 weeks were experienced by 5.2% and 6.1%, 4-6-week delays by 7.8% and 4.1%, and delays >6 weeks by 2.6% and 0% of EU and PU fellows, respectively (p=0.0007). CONCLUSIONS: Delays in fellowship training do occur at a notable rate, despite nearly half of urology fellows leaving their residency training positions early, with unclear impacts on patient care and resident colleague well-being. This research highlights the importance of fellowship programs considering delaying fellowship starts to mid-July or August, with support of the prior fellow cohorts.
ABSTRACT
INTRODUCTION: Failed access ureteroscopy (FA) describes the inability to gain adequate access to a stone to allow for treatment. The purpose of this study was to identify the prevalence of, and factors predicting FA in patients presenting with renal and ureteral stones. METHODS: We conducted a retrospective review of all ureteroscopy (URS) procedures performed for renal and ureteral stones by three endourologists over a six-month period at our center. All patients who underwent URS for the purpose of stone treatment were included. Patients were excluded if they underwent URS for non-stone diagnosis or treatment. FA was investigated in relation to demographics, medical history, stone-specific characteristics, procedure-specific characteristics, etc. Statistical analysis consisted of descriptive statistics, as well as Chi-squared and t-test analysis using SPSS statistical software version 24.0. RESULTS: A total of 188 cases were reviewed, with 8% of patients experiencing FA. Patient age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, emergency cases, previous stone treatment, use of computed tomography (CT) imaging, presence of hydronephrosis, and surgeon did not differ significantly between FA and successful access (SA) groups. Stone size (9.88±5.8 vs. 8.76±4.3 mm; p=0.361) was also not significantly different. However, a significant difference was noted in time from first diagnosis to URS (128 vs. 65 days, p=0.044) between the FA and SA groups, respectively. Similarly, for ureteral stones, the FA group had a significantly greater proportion of stones located in the proximal ureter (62.5% vs. 22.0%, p=0.043). CONCLUSIONS: Proximal ureteric stones were more likely to result in FA URS, and FA procedures were more likely to be preceded by extended time from first diagnosis to URS. Further investigation is necessary, and all endourology centers should track their own personal outcome data to allow for more meaningful analysis to be performed to improve patient outcomes.
ABSTRACT
OBJECTIVES: The objectives of this study have been to: 1) describe and compare urban and rural injured worker populations in Alberta, Canada; 2) identify return-to-work outcomes in urban and rural populations; 3) examine the relationship between geographic location of residence and recovery from work-related musculoskeletal injury; and 4) investigate if this relationship is attenuated after controlling for other known risk factors. MATERIAL AND METHODS: This study was a secondary analysis utilizing data of a population of musculoskeletal injury claimants who underwent clinical/RTW (return to work) assessment between December 2009 and January 2011 collected by the Workers' Compensation Board of Alberta. Descriptive statistics were computed for 32 variables and used for comparing urban and rural workers. The logistic regression analysis was performed to test the association between geographic location of residence and likelihood of return-to-work. RESULTS: Data on 7843 claimants was included, 70.1% of them being urban and 29.9% - rural. Rural claimants tended to have spent less time in formal education, have a blue-collar job, have no modified work available, have a diagnosed comorbidity, and not been enrolled in a specialized rehabilitation program. They were 1.43 (1.12-1.84) times the odds more likely than urban claimants to be continuing to receive full disability benefits 90 days after their RTW assessment, and 1.68 (1.06-2.67) times the odds as likely to report a recurrence of receiving disability benefits. CONCLUSIONS: Rural residence was associated with prolonged work disability, even after controlling for age, job type, education level, health utilization and other potential confounders. Further research is required to explore why injured workers in rural settings experience prolonged reception of disability benefits and have greater rates of recurrence of receiving disability benefits. Int J Occup Med Environ Health 2017;30(5):715-729.
