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Perceptions of Competence In Pediatric Urology After Residency Training

Saturday, October 20, 2012: 12:16 PM
Grand Ballroom A/B (Hilton Riverside)
Michaella M. Prasad, M.D.1, Jessica T. Casey, M.S., M.D.1, Jennie Mickelson, MD, FRCSC2 and Elizabeth B. Yerkes, M.D., FAAP1, (1)Division of Urology, Children's Memorial Hospital, Chicago, IL, (2)Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada

Purpose: The American Board of Urology approved a subspecialty Certificate of Added Qualification (CAQ) for Pediatric Urology (PU) in 2008 to recognize additional training and completion of a certifying examination.  There have been concerns that this would adversely impact the practice of the general urologist.  We issued a survey to assess the perceptions among urologists at different stages in their careers regarding how likely they would be to perform certain pediatric procedures now that the CAQ is in place.  We would like to determine which procedures graduates feel competent to perform without further fellowship training and compare that with the practice patterns of established urologists. 

Methods: A survey was emailed to 8,889 American members of the American Urological Association (AUA).  Demographic data was collected including age, gender, amount/quality of PU training, practice setting and AUA section.  The respondents were directed to specific surveys based on his/her reported level of expertise (resident/fellow (RF), practicing urologist (UR), practicing pediatric urologist (PED), program director (PD)) and asked to comment on the CAQ and its effect on their current or intended patient population.  Respondents were then asked to rate their expected/current technical competence for 24 pediatric procedures and whether they do or expect to perform those procedures in practice on patients <16 years of age.

Results: A total of 876 respondents completed the survey (9.85%) with the following levels of expertise represented: 42 PD (33.33%), 107 PED (14.70%), 124 RF (8.08%), 603 UR (9.28%).   Respondents were overwhelmingly male (87.2%) and 83.4% were between 31-60 years of age.  Across all groups, the average time spent on a PU service was 3.43 and 4 months as a junior and senior resident, respectively.  Interestingly, a majority of PD and PED thought today’s graduating residents will perform more pediatric procedures without additional training (8 and 7, respectively) then a majority RF expect to do (6) and more than UR (4) currently perform.  These procedures are all in the Minor index category of residents’ case logs.  Furthermore, a majority of PD felt that today’s residents were technically competent to perform more procedures (18) of higher complexity without additional training, in contrast to PED (11), RF (14) and UR (15).  The majority of PD (64.3%) advise their residents to operate on patients <16 years of age without a fellowship, if they are referred to them. 

Conclusion: PD continue to support graduating residents’ ability to operate on pediatric patients and a majority of PED view today’s residents as technically competent to perform minor PU procedures without further fellowship training.  However, a majority of UR only perform 4 minor PU operations routinely.  Exposure to PU remains an important component of residency instruction which may be utilized in practice, despite the CAQ.