MatricS-A novel tool for monitoring professional role development in surgical disciplines.

Introduction: Mentoring is an effective method for human resource development. Monitoring the process is important for individual mentee/mentor pairs as well as for program directors. Due to individual personality differences of both mentees and mentors and their respective interactions, it is challenging to monitor the individual development process of mentees in a structured manner. This study investigates to what extent a novel instrument, the mentee-based assessment tool for role development of interpersonal competencies in surgical professions (MatricS) can adequately monitor the professional role development process of residents during an established mentoring program. Material and methods: In a prospective longitudinal study, the competence development of 31 mentees in two subsequent cohorts was assessed by a modified role matrix based on Canadian Medical Education Directives for Specialists. The evaluation focused on three defined roles (D, developer; N, networker; M, multiplicator) at three levels (private, employer-related, national/international) with four stages of development. For validation of mentee self-assessments, the assessments of the respective mentors were recorded alongside. For correlation analyses, Pearson coefficients were calculated, pre-post-comparisons were done by paired t-tests; significance was assumed at p < 0.05, respectively. Results: Mentee self-assessments overall correlated well with the objective mentor assessments (Pearson's r 0.8, p < 0.001). Significant correlations of this magnitude were found for both individual cohorts as well as for all individual roles. The mentees acquired competencies in all roles indicated by significant increases of corresponding MatricS scores. The largest competency gains (mean ± SD) were found in the role D (start: 1.30 ± 0.77, end: 2.13 ± 0.83, p < 0.001). The majority of mentees achieved the prespecified target competency level in >75% of all roles and levels. Conclusion: The role development process during mentoring can be reliably monitored by using MatricS. MatricS scores highly correlate between mentees and mentors, indicating that mentee self-assessments are suitable and sufficient for monitoring. These findings help to lessen the work burden on senior surgeons and thus can help to increase the acceptance of mentoring programs in surgical disciplines.

[The association of job satisfaction with self-reported burnout among urologists with migration background working at German hospitals : Results of the EUTAKD study]. / Die Assoziation von beruflicher Zufriedenheit mit selbstberichtetem Burnout bei Urologen und Urologinnen mit Migrationshintergrund tätig an deutschen Kliniken : Ergebnisse der EUTAKD-Studie.

INTRODUCTION: Urologists with a migration background currently provide patient care in German hospitals. Study results on job satisfaction and burnout of this important professional group have not been available so far. MATERIALS AND METHODS: Between August and October 2020, a questionnaire (SurveyMonkey® with 101 items) was conducted among urologists with migration background working in German hospitals regarding professional satisfaction and a validated survey of burnout (Maslach Burnout Inventory), among others. The subject of this work was the association of job satisfaction with the critical thresholds of burnout in the domains of emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). RESULTS: For this work, 68 questionnaires could be completely analyzed. Study participants were dominantly male (90%), between 30 and 39 years of age (69%), married (72%), and working full-time (94%). Above critical thresholds of high burnout in the EE, DP, and PA domains were 27.9% (n = 19), 35.3% (n = 24), and 73.5% (n = 50) of study participants. A sum score was formed from five of a total of 39 satisfaction items, which independently predicted the EE and DP endpoints and a combined EE and DP endpoint in well-adjusted regression models. For each individual score of the sum score (range 5-25 points), the probability of a critical burnout is reduced by a relative 57% (EE), 25% (DP), and 34% (combined endpoint). In contrast, permanent employment contract, the clinic position as senior physician or chief physician, working full-time, and a married marital status significantly reduced the critical PA domain. CONCLUSION: Several dimensions of professional satisfaction were identified, the improvement of which could contribute to a decrease in burnout among urologists with a migrant background. Future intervention studies aimed at improving job satisfaction must follow.

[Working pregnant in urology! : Assessments by chief physicians and presentation of liability risks]. / Schwanger in der Urologie! : Einschätzungen von Chefärzt*innen und Darlegung haftungsrechtlicher Risiken.

BACKGROUND AND OBJECTIVES: In Germany, approximately 1500 female physicians become pregnant each year. This also applies to urologys. The announcement of a pregnancy is often met with ignorance and unanswered questions by chief physicians and colleagues. The aim of this study is to clarify how urological chief physicians assess the current situation and to present liability risks versus health risks. MATERIALS AND METHODS: From July to October 2019, an anonymous online questionnaire was sent to 340 chief physicians by the Working Group Young Urologists of the German Society of Urology (DGU). The questionnaire asked about the risk assessment of the workplace, the timing of a pregnancy announcement, and the employment possibilities of pregnant employees in urology. In addition, a law firm was commissioned to prepare a brief legal opinion on the topic of medical work and surgery during pregnancy with specific reference to the field of urology, including any liability risks. RESULTS: In all, 62 chief physicians participated in the survey (18.2%): 93.5% of the respondents considered an anticipatory risk assessment of the workplace for pregnant women to be useful; 82.3% would appreciate an overlapping recruitment by the employer. Respondents (62.9%) were skeptical of pregnant employees operating. Taking into account the regulations of the Maternity Protection Act, the liability risk does not exceed that which the employer generally has to bear. CONCLUSION: The amendment of the Maternity Protection Act has not fundamentally changed the reality for female urologists. However, the individual risk assessment provides an opportunity to develop concrete protective measures-also for the operating room-with the employer. The aim must be to provide pregnant women with greater support in asserting their rights in the future.

[Practical skills training : How suitable is Peyton's four-step approach for residents in urology?] / Vermittlung praktischer Fertigkeiten : Wie geeignet ist Peytons Vier-Schritte-Ansatz für urologische WeiterbildungsassistentInnen?

INTRODUCTION: The aim of residency is to acquire medical skills and abilities. One didactic model is "Peyton's four-step approach". The aim of the present study was to develop and evaluate a modified Peytonian approach for group interactions. The aim was to develop a course for the acquisition of practical skills and training assistants in suture techniques for urology. METHODS: A prospective study was conducted with a total of 38 participants and 6 tutors. In a modified four-step Peytonian approach, various suturing and knotting techniques were taught in a structured manner. Tutors evaluated the procedural activity using observation sheets. In addition, the learning method was evaluated by the participants and the tutors at the end of the course. In order to check the long-term learning success, a renewed survey of the participants was conducted after 6 months. RESULTS: 80% of the participants rated the modified teaching method as useful and 83% of the tutors rated the procedural implementation as good. Fluid movement sequences were difficult independent of the technique taught. After 6 months, the participants significantly improved their procedural skills in all techniques that were taught. CONCLUSION: This paper defines a four-step Peyton-based approach to teaching practical skills such as suturing and knotting used in urological training. The modified teaching method improved practical skills used in urology. This method should be considered in continuing education to promote self-confidence and increase the competence in surgical skills.

[Mentoring in urological postgraduate training : Use of a competence matrix for the evaluation of results]. / Mentoring in der urologischen Weiterbildung : Einsatz einer Kompetenzmatrix zur Ergebnisevaluation.

OBJECTIVES: For the professional development of junior employees, sufficient competence is decisive for their career. The mentoring programme Urology Roadmap provides residents career planning in various roles (junior staff member, developer, networker, multiplier). To date, no data are available on the extent to which the role matrix instrument is suitable as a competence matrix for evaluating results. MATERIALS AND METHODS: In a prospective longitudinal study, the competence development of 21 mentees was recorded by their mentors in a validated questionnaire (The Munich Evaluation of Mentoring Questionnaire, MEMeQ). A modified role matrix based on CanMEDs (Canadian Medical Education Directives for Specialists) was used as an assessment tool. The focus of the evaluation was on four defined roles at three levels (private, employer-related, (inter)national) with four development stages. RESULTS: The highest level of satisfaction was found for the aspect "successful design of the career path" (93%) and the lowest was found for the aspect "facilitation of everyday working life" (67%). In all, 93% recommend participation. The mentees achieved significant increases in competence in all four roles. The highest level of competence was found in the role of junior employee (mstart 1.3 ± 0.7, mend 2.4 ± 0.7, p < 0.001), followed by developer (mstart 1.2 ± 0.8, mend 2.2 ± 0.7, p < 0.001) and networker (mstart 1.3 ± 0.7, mend 2.1 ± 0.6, p < 0.001). Of the mentees, 54% were able to achieve the target competence level 2 in more than 90% of all roles and levels. CONCLUSIONS: The instrument role matrix is suitable to objectively evaluate the results of the mentoring programme and reflects the state of personnel development.

[Taskforce work-life balance-concepts instead of slogans]. / Die Taskforce Beruf, Familie und Freizeit ­ Konzepte statt Schlagworte.

After the Young Urologists' Working Group was founded in April 2018, the taskforce "Work-Life-Balance" was set up. The Working Group deals with the following topics.Most recently, a discussion guideline was developed for requests for part-time or parental leave. The guideline recommends to conduct the interview as soon as possible and in a structured manner. The maximum and minimum goal of working hours should be clearly and transparently defined.The inconsistent regulations on the crediting of absences during continuing medical education in the various federal states are also discussed as a further problem.Currently, the task force "Work-Life-Balance" is conducting and evaluating a survey on the topic of surgery during pregnancy and risk assessment of the workplace for pregnant women.The survey's results are expected to yield recommendations for the clinical practice.

[Attending physicians in urology working at university centers or non-university centers-what are the differences? : Results of a web-based cross-sectional study at German hospitals]. / Urologische Oberärztinnen und Oberärzte an universitären oder nicht-universitären Kliniken ­ welche Unterschiede gibt es? : Ergebnisse einer webbasierten Querschnittstudie an deutschen Kliniken.

BACKGROUND: Attending physicians (AP) in urology represent a very heterogeneous group covering various clinical priorities and career objectives. To date, there are no reliable data on professional, personal and position-linked aspects of AP in urology working in university centers (univ-AP) opposed to those working in non-university centers (n-univ-AP). MATERIALS AND METHODS: The objective of this study was to analyze individual professional perspectives, professional and personal settings, specific job-related activities and individual professional goals of univ-AP opposed to n­univ-AP. Thus, a web-based survey containing 55 items was designed to perform a cross-sectional study that was then forwarded using a link which was sent via a mailing list of the German Society of Urology. The survey was available for completion by AP at German urological centers from February to April 2019. Group-specific differences were evaluated using bootstrap-adjusted multivariate logistic regression models. RESULTS: Of the 192 evaluable surveys, 61 (31.8%) and 131 (68.2%) were part of the univ-AP and n­univ-AP study group, respectively. Participating n­univ-AP compared to univ-AP held the position of AP (p = 0.022) significantly longer and were on call significantly more frequently (p < 0.001). AP in urology (self)-assessed themselves as autonomously confident in performing robotic, laparoscopic, open, endo-urologic, and plastic-reconstructive surgery in 12.4%, 25%, 59.6%, 92.1%, and 25.7%, respectively, with no significant differences between the two groups among all above mentioned surgical subdomains based on multivariate analysis. AP in urology were (very) content in 92% concerning the choice of their discipline, in 73.9% concerning their actual working circumstances, and in 60.2% concerning their level of surgical expertise. Only 27.1% and 19.9% were (very) content with the amount of available time for their personal professional development and for private affairs, respectively. As opposed to n­univ-AP, univ-AP would choose a career in clinical centers once again significantly more frequently (OR 2.87; p(BS) = 0.041), but assess the position of AP as their definitive career goal significantly less frequently (OR 0.42; p(BS) = 0.40). Univ-AP state significantly more frequently that they were running for the position of head of department or full professor (OR 5.64; p(BS) = 0.001). CONCLUSION: In this first survey study world-wide on AP in urology divided according to their academic background, similarities and variances were analyzed, baring the potential to further improve identification of AP for a career in clinical centers.

[How do urological training residents experience the physician-patient conversation? : Promotion of communication competence in the context of medical residency training]. / Wie erleben urologische Weiterbildungsassistenten das Arzt-Patienten-Gespräch? : Förderung der Kommunikationskompetenz im Rahmen der ärztlichen urologischen Weiterbildung.

BACKGROUND: In urological continuing education, communication as a training content has not yet been offered in a structured way. Communication skills are already expected in the first year of training. OBJECTIVES AND METHODS: In the period from November 2017 to June 2018, a descriptive, multicentre cross-sectional study was conducted to identify the factors that promote and inhibit patient-oriented communication from the point of view of continuing training assistants in subject-specific situations (as-is analysis). For this purpose, modified focus groups were carried out in six urological departments with a total of 37 participants. The results were checked in a questionnaire analysis in 62 urological training assistants. RESULTS: The participants feel competent if they have sufficient specialist knowledge and experience, if it is a routine discussion situation and if they have sufficient time. They experience emotions, bad news and taboo topics as challenging. Facilitating factors are structural support at the workplace and support in the team. Aggravating factors are a lack of communication training, missing structures as well as a compression of the fields of work. They would personally benefit from mentoring, communication training and structured, interprofessional and interdisciplinary cooperation. CONCLUSIONS: This needs analysis provides a basis for the conception and elaboration of a communication curriculum. In this way, the overriding goal of promoting communication competence in urological continuing education can be achieved.

[Urology onLINE-webinar for assistants : Implementation and evaluation of a voluntary, web-based e­learning training series for urology assistants in continuing education (Urology onLINE)]. / Urologie onLINE ­ Webinar für Assistenten : Implementierung und Evaluation einer freiwilligen, webbasierten E­Learning Fortbildungsreihe für urologische Assistenten in Weiterbildung (Urologie onLINE).

BACKGROUND AND OBJECTIVES: The rapid development of new knowledge resources is essential for continuous training and continuing education. Since the training period often coincides with the starting of a family, time resources are often scarce. For this reason, a new, voluntary, web-based e­learning training series was designed for urological assistants (urology onLINE). We investigated to what extent the offer of a web-based training series is used by urological training assistants and how it is evaluated by participants and speakers. MATERIALS AND METHODS: The training series includes a one-month training on a topic from the urological continuing education, which is presented online and whose contents are checked by means of interspersed CME questions. During the investigation period November 2016 to October 2017, participants in the Urology onLINE training series were evaluated. In addition, an evaluation of individual events and an evaluation of the work load of the speakers took place. RESULTS: On average, 60 participants participated in the individual events. These were rated very well with an average grade of 1.43 ± 0.21. Two thirds of the participants experienced an active and inquisitive experience during the event. The workload for the speakers was less than that of a comparable classroom event. CONCLUSIONS: Overall, the new Urology onLINE training series aims to contribute to the increase in spatial and temporal flexibility, and complements existing training formats, especially in times of scarce time resources.

[Pilot study on drinking and voiding management in child day-care facilities in the district of Garmisch-Partenkirchen]. / Pilotstudie zum Trink- und Entleerungsmanagement in Kindertagesbetreuungseinrichtungen im Landkreis Garmisch-Partenkirchen.

BACKGROUND AND OBJECTIVES: The development of child day care is currently the focus of a public discussion. More and more very young children are cared for in a day-care facility rather than by the family. Therefore, key aspects of education are shifted into these institutions. The aim of this survey was to inquire about the current situation of drinking and voiding management in day-care facilities in the district of Garmisch-Partenkirchen. MATERIALS AND METHODS: In all, 322 questionnaires were sent to employees of 40 child day-care facilities. Organization of drinking and voiding behavior advices and personal assessments of continence education were queried. The evaluation was carried out anonymously. RESULTS: A total of 29 facilities (73%) replied. The average fluid intake was 260 ml (50-750 ml) at 12 o'clock in all day-care facilities included. The possibility to decide when to have breakfast and when to drink according to the individual thirst is practised in 43% (62/143) of the facilities. A fixed amount of fluid intake was offered by 11% (16/150) of the institutions. Of those responding, 92% (139/151) specifically send the children to the toilet, while 85% of the participants consider a continence education concept would be useful. CONCLUSION: According to a general trend, children attend day-care facilities earlier and spend more time there. This means that educational staff are taking care of children who are not yet continent. A verifiable continence educational concept does not exist in any of the institutions surveyed; however, most participants would favor such a concept. It would be desirable to establish an interprofessional health education program in which drinking and voiding training is integrated according to national recommendations.

[How do residents in urology evaluate their daily routine at work-a survey analysis]. / Wie wird der Berufsalltag von Weiterbildungsassistenten in der Urologie in Deutschland bewertet ­ eine Fragebogenanalyse.

BACKGROUND: The changing conditions in German hospitals is causing a shortage of young people. In order to identify starting point for improvements, the Bavarian association of urologists in collaboration with the German Society of Residents in Urology (GeSRU) conducted an online survey among residents in urology in summer of 2017. MATERIALS AND METHODS: A standardised survey composed of 38 questions was distributed to participants through a mailing list of the GeSRU. Most questions were closed-ended; however, some did allow participants to respond by means of an open-ended answer. RESULTS: A total of 218 participants provided a total of 11,764 responses: 58% were female and 42% were male. Over 70% were aged between 31 and 35 years. In all, 29% of participants responded negatively to the question asking whether they feel like their medical studies at university prepared them well for the daily routine in their workplace. Participants particularly demanded a higher degree of practical experience during their studies, as well as more teaching of soft skills. In relation to choosing their specialisation, participants considered the intern year and their clinical traineeships as crucial factors. Participants did express appreciation of their field of specialization in relation to the broad range of available treatments, the opportunity of further specialising, the clientele of patients, the opportunity of working in a small team, innovations, and the high possibilities of opening their own medical practice. On a personal level, participants specifically wished for a more structured plan relating to their further internship, involving regular meetings. They also expressed the wish for more personalised career plans, more flexible work hours, and improved advanced training, both internally and externally. CONCLUSIONS: With the aim of making urology even more attractive, participants' wishes and suggestions should be taken into consideration. These, in general, involve a more structured training plan, better working conditions with part-time programmes, and improved surrounding conditions at the workplace, in particular for families.

[Enuresis]. / Enuresis.

Enuresis in childhood and adolescence is a common symptom that significantly affects the quality of life of the patients and their social environment. Advanced diagnostic and therapeutic measures have significantly improved the treatment of affected children in the last 10 years in Germany. With the help of an often sufficient non-invasive diagnostic assessment it is possible to assign the symptom to a diagnostic category. This category forms the basis for a successful therapy. A high level of motivation and willingness to cooperate of the children and their families are therapeutic premises. In present-day treatment of functional urinary incontinence urotherapy has the highest priority.

[Transurethral prostatectomy: management of complications]. / Transurethrale Resektion der Prostata: komplikationsmanagement.

BACKGROUND: Transurethral resection of the prostate (TURP) is still the most common surgical method for the treatment of benign prostatic syndrome. Despite a significant reduction of mortality rate, the morbidity of TURP is still about 15%. OBJECTIVES: Based on current data, the goal of this article is to analyze which complications are expected today from the standpoint of improved high-frequency surgery and loop technology and what preventive or therapeutic measures should be undertaken. RESULTS: The use of the bipolar resection technique reduces the risk of TUR syndrome. However, cardiac risk due to possible irrigation fluid uptake remains unchanged. The blood transfusion rate has been reduced to 1% by a decreased risk of bleeding due to ongoing technical development in high-frequency surgery and a stricter indication for transfusion. Postoperative urethral strictures, which are generally caused by mechanical and electrical mucosal lesions, should be avoided by using an atraumatic surgical technique. To prevent bladder neck sclerosis, the additional routine incision of the internal sphincter is recommended for all smaller prostates. CONCLUSIONS: Due to a modern high-frequency technology, subsequently avoiding TUR syndrome and enabling a blood-sparing cut, a further reduction of complication rates can be expected.