Education
Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey

https://doi.org/10.1016/j.euf.2016.12.001Get rights and content

Abstract

Background

Excellent uniform training of urology residents is crucial to secure both high-quality patient care and the future of our specialty. Residency training has come under scrutiny following the demands of subspecialized care, economical aspects, and working hour regulations.

Objective

To comprehensively assess the surgical training, research opportunities, and working conditions among urology residents in Germany.

Design, setting, and participants

We sent a 29-item online survey via email to 721 members of the German Society of Residents in Urology.

Outcome measurements and statistical analysis

Descriptive analyses were conducted to describe the surveys’ four domains: (1) baseline characteristics, (2) surgical training (cumulative completed case volume for all minor-, medium-, and major-complexity surgeries), (3) research opportunities, and (4) working conditions.

Results and limitations

Four hundred and seventy-two residents completed the online survey (response rate 65%). Surgical training: the median number of cumulative completed cases for postgraduate yr (PGY)-5 residents was 113 (interquartile range: 76–178). Minor surgeries comprised 57% of all surgeries and were performed by residents in all PGYs. Medium-complexity surgeries comprised 39% of all surgeries and were mostly performed by residents in PGYs 2–5. Major surgeries comprised 4% of all surgeries and were occasionally performed by residents in PGYs 3–5. Research opportunities: some 44% have attained a medical thesis (Dr. med.), and 39% are currently pursuing research. Working conditions: psychosocial work-related stress was high and for 82% of residents their effort exceeded their rewards. Some 44% were satisfied, 32% were undecided, and 24% were dissatisfied with their current working situation. Limitations include self-reported survey answers and a lack of validated assessment tools.

Conclusions

Surgical exposure among German urology residents is low and comprises minor and medium-complex surgeries. Psychosocial work-related stress is high for the vast majority of residents indicating the need for structural improvements in German urology residency training.

Patient summary

In this study, we evaluated the surgical training, research opportunities, and working conditions among urology residents in Germany. We found low surgical exposure and high rates for psychosocial work-related stress, indicating the need for structural improvements in German urology residency training.

Introduction

Excellent training of urology residents is crucial to secure both high-quality patient care and the future of our specialty. Accordingly, the European Association of Urology, as the largest urology organisation in the world, is strategically expanding on educational activities for residents, including their flagship European Urology Residents Education Programme [1]. Studies in the research field of resident training have emerged mainly in the USA and UK, focusing on the efficacy of training models and simulation [2]. In subspecialty fields such as robotic surgery, multinational collaboration approaches have been undertaken to design an international core curriculum [3], [4].

Despite these efforts, a comprehensive assessment of the current state of urology residents in various aspects of training is often lacking. According to the principles of quality management, the assessment of the actual state of residency trainings belongs to the first step (observe) before the consecutive steps plan, do, check, and act [5]. The results of a quality assessment of residency training then build the foundation for a quality improvement curriculum, both nationally as well as internationally [6]. Recently, survey results on the scientific activity, surgical exposure, and overall satisfaction of 324 urology residents in Italy were reported [7]. Consequently, more international studies are needed to assess urology residency training in order to tailor specific actions to improve it.

To address these unmet needs, we aimed to comprehensively assess the surgical training, research opportunities, and working conditions among urology residents in Germany.

Section snippets

Patients and methods

We created a 29-item online survey in German on the surgical training, research opportunities, and working conditions of urology residents in Germany. Methodologically, we followed the Checklist for Reporting Results of Internet E-Surveys [8]. We used the online platform at www.surveymonkey.com (Surveymonkey, Portland, OR, USA) to design the survey.

The survey consisted of the four domains–baseline characteristics, surgical training, research opportunities, and working conditions–and is provided

Baseline characteristics

A total of 472 out of 721 residents completed the online survey (response rate 65%). Table 1 lists the baseline characteristics of the study population. Among the responders there were slightly more female (55%) than male (45%) urology residents. Responders across the five years of postgraduate training followed a normal distribution.

Surgical training

Figure 1A illustrates that the cumulative completed case volume for all surgeries increased as residents progressed in their training. The median number of

Discussion

We conducted a 29-item online survey to assess the surgical training, research opportunities, and working conditions among urology residents in Germany. Our survey yielded 472 survey responses (response rate 65%) and has several principal findings.

The first principal finding is that the surgical case volume among urology residents in Germany is low. The median number of cumulative completed cases for PGY-5 residents was only 113 across surgeries from low to high complexity and major surgeries

Conclusions

Surgical exposure is low among German urology residents and comprises an adequate surgical caseload for minor surgery, a low caseload for medium-complexity surgery, and virtually no caseload for major surgery. Psychosocial work-related stress is high for the vast majority of residents indicating the need for structural improvements in German urology residency training.


Author contributions: Hendrik Borgmann had full access to all the data in the study and takes responsibility for the integrity

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