Advanced Urology Boot Camp: A Simulation-based Curriculum to Enhance Fourth-year Medical Student Procedural Competency.

INTRODUCTION: Simulation-based medical education continues to gain popularity as the clinical environment requires exemplary patient safety while simultaneously maximizing the learner's educational experience. There is a current lack of urology-focused medical student education curricula in the literature. Here, we present the findings of a didactic and simulation-based medical student advanced "urology boot camp" curriculum, which was designed for learners interested in pursuing careers in urology. METHODS: Twenty-nine fourth-year urology-dedicated medical students completing their subinternship at our institution during the 2018-2019 academic year participated in an advanced hands-on simulation "boot camp," which taught both simple and advanced Foley catheter placement, manual and continuous bladder irrigation, and diagnostic cystoscopy. Knowledge acquisition was assessed through quizzes administered before and after completing electronic modules, and a post-simulation survey assessing learners' confidence in their knowledge and skill set, as well as their satisfaction with the curriculum. RESULTS: Medical students demonstrated significant gains in knowledge from pre-test (mean 73.7%) to post-test (mean 94.5%, P < .001), which was consistent across each simulation procedure. Participants self-reported significant improvement in confidence with the procedures from before to after the educational intervention (P < .001). Students also found the curriculum to be beneficial to their understanding of the subject matter (P < .001), would recommend this curriculum to other medical students (P < .001), and thought it better prepared them to meet expected ACGME (Accreditation Council for Graduate Medical Education) milestones (P < .001). CONCLUSIONS: Findings from our advanced "boot camp" simulation curriculum demonstrated successful gains in knowledge and confidence following learning modules and hands-on simulation, indicating that this type of educational intervention could be beneficial in improving exposure to skills and developing confidence prior to urology internship and junior residency.

Urology Boot Camp: A Pilot Medical Student Curriculum for Common Bedside Urologic Procedures.

OBJECTIVES: To develop a novel "bootcamp" simulation-based curriculum to introduce common urologic procedures and to improve readiness for performing them at bedside. METHODS: Three hundred twenty-five third-year medical students at our single institution participated in a hands-on simulation "boot camp" over a 2-year accrual period. This curriculum was designed to teach basic urologic bedside procedures (ie, Foley catheter placement, Bladder irrigation) to third year medical students prior to the start of their surgical clerkships in a live instructional setting with direct feedback from instructors. The objective aspects of the study consisted of a survey administered to study participants following participation in the simulation boot camp, as well as pre- and post-module assessments. RESULTS: Medical students self-reported knowledge gains following the simulation session (P < .001), with 45.8% increase in procedural confidence. Additionally, students reported that the educational intervention was beneficial to their understanding of the subject matter (P < .001), were "very likely" to recommend the session to another medical student (P < .001), and felt that educational intervention better prepared them for an upcoming national exam (P < .001). Finally, the greatest gains were seen for those students who self-reported lower precurriculum knowledge (P < .001). CONCLUSIONS: Findings from our M3 "boot camp" led to self-reported gains in subject matter knowledge following the hands-on simulation curriculum, indicating that this type of educational intervention can be beneficial in preparing medical students for common bedside procedures.

Implementation and Assessment of a Urology Education Curriculum for Nursing Residents.

BACKGROUND: Urethral catheter placement is a common hospital procedure, and the urology service is often consulted for difficult catheterizations. Simulation-based education is used to improve procedural proficiency and could be used to increase confidence and comfort with difficult catheter placement. This study provides simulation-based education to help new nursing residents learn to perform independent Foley catheter placement and maintenance. METHOD: All incoming nursing residents at our institution prospectively participated in this curriculum beginning in January 2020 (n = 291). Participants watched an instructional video and participated in a hands-on simulation. RESULTS: Nursing trainees rated pre- to post-curriculum gains in content knowledge (p < .001) and confidence (p < .001). Participants reported that the curriculum increased their understanding of the procedure (p < .001) and that they would recommend it to peers (p < .001). CONCLUSION: This educational initiative is a partnership between the Department of Urology and Department of Nursing to introduce and reinforce best practices for the care of patients who need Foley catheter placement and maintenance. [J Contin Educ Nurs. 2021;52(11):511-516.].

Knowledge is Key: Viewpoints of New Recurrent Urinary Tract Infections Guidelines.

OBJECTIVE: To evaluate management patterns, measure familiarity with the new guidelines, and gauge the level of education and confidence in treating rUTIs according to recent guidelines, specifically in the context of trainee education. Recurrent urinary tract infections (rUTI) are a common urologic complaint and a heavy burden on the healthcare system. Until recently, the AUA did not have a guideline on the management of rUTIs. METHODS: Participants were medical students (PGY3-4, n = 41), residents (n = 48), and fellows (n = 11) from a single institution (N = 100) from both urology and non-urology backgrounds. This prospective survey study measured demographic information, personal history of rUTI management, knowledge of the new guideline, personal practice patterns, and guideline education. RESULTS: Trainees reported that they felt "slightly unknowledgeable" (M = 2.6/4, P < .001) about rUTI treatment, although level of knowledge increased with increased training level. Participants were asked about the new rUTI guidelines that were published in 2019, with urology trainees (M = 83.3%) more aware (P < .001) of their recent release compared to non-urology residents and fellows (M = 12.2%) and medical students (M = 7.5%). When looking specifically at peri- and postmenopausal women, antibiotic treatment was the highest recommendation for rUTI in both peri- (70.6%), and post-menopausal women (68.2%), followed by cranberry juice/extract (43.5% vs 42.4%). Providers were more likely to recommend vaginal estrogens for post-menopausal (45.9%) compared to perimenopausal (28.2%, P < .05) women. CONCLUSION: Better trainee education about the current rUTI guidelines is warranted, including management of peri- and postmenopausal women which have specific guideline recommendations.

Risk factors, demographic profiles, and management of uncomplicated recurrent urinary tract infections: a single institution study.

OBJECTIVE: Recurrent urinary tract infections (rUTI) are a common urologic chief complaint. Although rUTIs are a significant burden on the healthcare system, until recently there were no published guidelines to delineate optimal management of this condition. The objective of this study was to describe the demographic profile of rUTI patients and summarize practice patterns at a single tertiary health center, as well as to assess whether our real-life practice patterns parallel the recently published guidelines. METHODS: We conducted a retrospective record review of female patients presenting for diagnosis of uncomplicated rUTI/cystitis between October 2010 and September 2018. Analyses were conducted to investigate (a) whether pre- versus postmenopausal women differed in their risk factors for rUTI, (b) whether providers adjust their practice patterns when treating pre- versus postmenopausal women with rUTIs, and (c) whether certain treatment regimens led to lower rates of rUTI than others. RESULTS: Of the 125 cases included in the final analysis, pre- versus postmenopausal women did differ in their risk factors for rUTI, specifically age, Charlson Comorbidity Index score, and comorbidities. Although common treatments were found across menopausal status, providers did adjust their practice patterns when treating pre- versus postmenopausal women, including the use of postcoital suppression, conservative measures, cranberry juice/extract, and probiotics for premenopausal women and daily suppression and vaginal estrogens for postmenopausal women. rUTI after treatment (<40%) was highest after the use of conservative measures for all women and rates of rUTI after treatment generally did not differ as a function of menopausal status, but rather by treatment option. CONCLUSIONS: This single institution report sheds light on practice patterns at a major academic center, specifically as it compares to the new American Urological Association guidelines and the use of estrogen cream for postmenopausal women.

Promoting patient followup treatment with intra-detrusor onabotulinumtoxinA for overactive bladder.

INTRODUCTION: We aimed to characterize patient-related factors that promote followup of repeat onabotulinumtoxinA treatments for overactive bladder via a mixed-methods approach. METHODS: A retrospective chart review was conducted for patients who received intra-detrusor injection of onabotulinumtoxinA at our institution from 2011-2018, who were then surveyed to evaluate their experience, knowledge, and perceptions regarding onabotulinumtoxinA treatment and followup. Patients who received one onabotulinumtoxinA treatment and patients who underwent multiple treatments were compared to assess followup rates following initial treatment, group characteristics, patient comfort, and patient knowledge of needed retreatment. RESULTS: A total of 29.3% of patients received a single treatment and 70.7% of patients received multiple treatments. There was no difference in clinical, demographic, or intake variables between groups. Patients receiving multiple treatments reported having their first procedure in the operating room and reported greater improvement in symptoms and procedure comfort. This group was also more likely to understand that repeat treatments are necessary than those undergoing one treatment. CONCLUSIONS: No research to date has systematically explored patient-reported factors that promote retreatment of onabotulinumtoxinA for overactive bladder. This novel, mixed-methods approach indicates that patient comfort and patient knowledge were the strongest predictors of previous retreatment and anticipated retreatment, suggesting concrete avenues for improved periprocedural patient counselling and education.

Assessment of a Novel Urology Resident Simulation-Based Curriculum.

INTRODUCTION: Interactive simulation training during residency is a rapidly growing initiative due to work-hour restrictions, improved simulation model fidelity and an evolving technological field. We designed and implemented a simulation curriculum for urology residents. The objective of this study was to assess its impact on trainee confidence and knowledge. METHODS: This was a prospective nonblinded case series analyzing the use of simulation education with entrance and exit surveys. We developed and implemented monthly workshops featuring fundamental urological procedures and skills. Residents from a single academic urology residency program received didactic instruction as well as supervised simulation training from an expert faculty member. RESULTS: The majority of residents highly rated all topics and affirmed that they would repeat the simulation topic in the future. Overall, junior residents averaged a 27% gain in base knowledge (p <0.001), and senior residents reported a 15.5% gain in base knowledge (p <0.001). Didactic and mentored simulation portions of the sessions were considered equally valuable (p >0.5). Of the residents 84% felt the sessions better prepared them to be in the operating room and 94% reported that they would recommend the simulation sessions to a peer (p <0.001). CONCLUSIONS: Simulation is a valuable tool that prepares residents for operating room experiences. We have developed a robust simulation curriculum that serves as a feasible and valuable model for other training programs, and has led to increased resident confidence and knowledge in urological procedures and skills.