Improving surgical training by identifying the most common feedback trainees receive for index cases.

BACKGROUND: To make surgical training more effective, a proven method is needed to provide feedback to residents on their surgeries. Residency programs may make up for limited training time in the operating room by improving feedback that trainees receive about cases. OBJECTIVE: The goals of this study were (1) to determine if an online tool to communicate feedback for attendings and trainees shows face validity and (2) to use an online tool to identify the most common feedback trainees receive after performing orchiopexy and hypospadias repair by survey. METHODS: In 2016, determining whether an online tool to provide pediatric urology trainees feedback after surgery shows face validity begun. The tool was launched at the authors' institutions. Then, attendings, fellows, and postgraduate year 4-5 trainees of 65 resident training programs were surveyed for their observations on preparing for and performing orchiopexy and hypospadias repair using the study tool to identify common feedback. RESULTS: The results of using the tool to provide feedback shows face validity are as follows: feedback was exchanged between attendings and trainees on orchiopexy (n = 28) and hypospadias (n = 22). Anecdotally, the tool was easy to use. The results of using the tool to identify the most common feedback trainees receive by survey are as follows: from a pool of 65 institutions, 37 attendings and 28 trainees were enrolled who made 219 observations. Most trainees prepare using undocumented online resources (17/28, 67%) instead of speaking with their attendings or cotrainees (11/28, 33%). For orchiopexy, most respondents reported that trainees need to improve skills for hernia ligation (observations: attending = 28/45, 62%; and trainee = 17/26, 65%) and strategies for hernia exposure (observations: attending = 17/27, 62%; and trainee = 7/12, 58%). For hypospadias, most respondents reported that trainees need to improve skills for neourethroplasty (observations: attending = 31/53, 58%; and trainee = 10/16, 62%) and strategies for repair choice (observations: attending = 15/22, 68%; and trainee = 12/18, 67%) (chi-squared, all P = NS). DISCUSSION: It was shown that both trainees and attendings agree on the areas of surgical strategy and execution which require improvement. With this study, it is also shown that the online feedback tool developed shows face validity in allowing attendings and trainees to communicate before and after surgery. CONCLUSIONS: The most common feedback pediatric urology trainees receive for routine pediatric urology surgery is identified. Online tools that emphasize remediations to address a trainee's specific feedback needs are to be built, so that they will be able to improve their skills at their next case.

Management of undescended testis may be improved with educational updates and new transferring model.

BACKGROUND: To investigate whether management of undescended testis (UDT) may be improved with educational updates and new transferring model among referring providers (RPs). METHODS: The age of orchidopexies performed in Children's Hospital of Chongqing Medical University were reviewed. We then proposed educational updates and new transferring model among RPs. The age of orchidopexies performed after our intervention were collected. Data were represented graphically and statistical analysis Chi-square for trend were used. RESULTS: A total of 1543 orchidopexies were performed. The median age of orchidopexy did not matched the target age of 6-12 months in any subsequent year. Survey of the RPs showed that 48.85% of their recommended age was below 12 months. However, only 25.50% of them would directly make a surgical referral to pediatric surgery specifically at this point. After we proposed educational updates, tracking the age of orchidopexy revealed a statistically significant trend downward. CONCLUSIONS: The management of undescended testis may be improved with educational updates and new transferring model among primary healthcare practitioners.

[Evaluation of a teaching tool for learning the surgical technique of inguinal orchidopexy]. / Évaluation d'un outil pédagogique pour l'apprentissage de la technique chirurgicale d'abaissement testiculaire.

INTRODUCTION: Practical training of the surgery resident is based on the companionship currently hampered in particular by the increase of the number of residents in training. We created a teaching tool to promote learning and validation of a technique of classic urologic surgery, inguinal orchidopexy. The objective is to evaluate the applicability and the relevance of this tool. MATERIAL AND METHODS: The tool is a technical evaluation sheet made from reference documentation. The trainers evaluated the residents at 3 times of the semester (hetero-evaluation at 0, 3 and 6 months). Residents evaluated themselves monthly on the same items. RESULTS: Three trainers and 6 residents in surgery participated in the study between May and November 2013. The initial evaluation confirmed that the theoretical knowledge was acquired prior to the practical learning. The level of residents was very uneven at the beginning of the study but not at the end of the semester. The monthly evaluations gave a progressive and significant increase of notes. The notes of the intermediate and final hetero-evaluations rose gradually and they were always superior to those previous self-assessments (P<0.05). The tool was considered simple and useful for the participants. CONCLUSION: This tool is applicable and relevant to the technical teaching of inguinal orchidopexy in this population. A larger study would be helpful to confirm it. This type of tool could be applied to the simple and common surgery techniques to enrich the educational tools used in the training. LEVEL OF EVIDENCE: 4.

Paediatric orchidopexy: a need for dedicated paediatric surgical training among urologists?

BACKGROUND: Undescended testis (UDT) is one of the most common congenital abnormalities with a prevalence of about 1% at the age of 1 year. UDT is associated with an increased risk of testicular tumours and infertility. AIMS: The aim of this study was to assess who is carrying out paediatric orchidopexy in Ireland. METHODS: A survey was distributed via Survey Monkey to all Consultant Paediatric Surgeons and Urologists in Ireland. RESULTS: Twenty-seven (64.3%) urologists and five (71.4%) paediatric surgeons responded to our online survey. Of the urologists, 100% reported formal training in paediatric orchidopexy. Eight (29.6%) underwent a dedicated paediatric fellowship. 13 (48.1%) currently perform paediatric orchidopexy. Nine (33%) think it should be carried out by a urologist, whereas eight (29.6%) think it should be carried out by paediatric surgeon. The mean age at which urologists think an orchidopexy for UDT should be performed by was 18 months (range 1-4 years). Approximately 400 orchidopexies are performed per year by the surveyed urologists. Of the paediatric surgeons, three (60%) feel it should be carried out by a paediatric surgeon whereas two (40%) feel it does not matter. All paediatric surgeons feel it should be performed by 1 year of age. Approximately 700 orchidopexies are performed per year by the surveyed paediatric surgeons. CONCLUSION: UDT is a concerning condition which requires intervention at an early stage. Dedicated training in core paediatric procedures is required to continue to meet this need for the future to prevent delayed orchidopexy and resultant increased risk of testicular tumours.

Paediatric urology training: what does the future hold?

BACKGROUND: Paediatric urology training is not a mandatory part of higher surgical training in urology in Ireland. It is predicted there will be a shortfall of surgeons trained in paediatric surgery in the coming years leading to a reliance on specialist paediatric surgical centres. AIM: The aim of this study was to assess the attitudes of urological trainees regarding the current state of paediatric urology training and to address the potential future changes to training structures. METHODS: A voluntary anonymous internet-based survey was emailed to all urological trainees. Parameters assessed included sex, level of training, attitudes towards paediatric urology training and levels of competence regarding core paediatric urological procedures. RESULTS: 69.2 % (n = 18) responded to the survey. 94.4 % (n = 17) would favour mandatory paediatric training-of these, 52.9 % (n = 9) would favour this in a dedicated paediatric hospital with a paediatric urologist. 66.7 % (n = 12) would like to provide a paediatric urology service as a consultant. 55.6 % (n = 10) felt they were competent to perform circumcision or scrotal exploration independently and manage all associated complications. No trainee felt themselves to be competent to perform orchidopexy independently and manage all complications. CONCLUSION: Our study demonstrates a promising desire to provide paediatric services in the future. A greater emphasis on structured paediatric urology training is required to maintain the standard currently offered by adult urologists.

Paediatric laparoscopic orchidopexy as a novel mentorship: Training model.

BACKGROUND: Although Laparoscopy is becoming a standard procedure in management of pediatric urology disorders, but its widespread use still limited. This can be attributed mainly to difficulty in acquiring such specialized technique, especially by post graduate practicing urologist. Thus, we herein evaluate the impact of condensed laparoscopic training programme in children hospital with the aim to analyze the feasibility and safety of laparoscopic orchidopexy in training basic laparoscopic skills. The aim of this study was to review experience as a mentor in training laparoscopic skills through condensed training programme based on high volume low risk procedure of pediatric laparoscopic orchidopexy. MATERIALS AND METHODS: In order to implement a condensed laparoscopic curriculum in a short period of time while maintaining utmost patient safety, laparoscopic orchidopexy was used as the technique of choice. The course was conducted over a period of 5 days starting from 1 st November 2010 in a tertiary pediatric surgical center under guidance of an expert mentor. A total of 30 testicular units in 27 pediatric patients of different age group diagnosed with impalpable undescended testis underwent laparoscopic intervention. The course was conducted in three stages with the aim to deliver laparoscopic skills to trainee. In stage one out of eight cases operated by mentor with assistance of trainee six were operated on day 1 and two cases were operated on second day. The trainee performed 12 cases of laparoscopy independently with assistance of mentor in stage two which was carried out on day 2, 3 and 4. Finally all 7 cases including two second stage laparoscopic orchidopexy procedures were carried out independently by trainee under observer ship of mentor in stage three during day 4 and 5 of training programme. The feasibility and efficacy of laparoscopic orchidopexy in training laparoscopic skills through condensed training programme was assessed through analysis of mentorship experience.