Pediatric urology fellowship training: Are we teaching what they need to learn? "Beyond the Abstract," by Kristina D. Suson, MD

BERKELEY, CA ( - While updating their pediatric urology fellowship curriculum, Wang, et al. decided who best to characterize what works than recent graduates? As such, the potential for implementation of their findings is at least as important as the results themselves. Do pediatric urology fellowships need to be improved? How can this data be used to formulate tangible improvements to pediatric urology education?

The authors stress that the fellow is an adult learner who should take ownership of his or her education. They found that most recent fellowship graduates identified faculty supervision/feedback, independent reading, and multidisciplinary conferences as particularly useful learning methods. The fellow should meet with faculty early to outline goals and a learning plan that incorporates and maximizes those methods. At the first meeting, the learning plan could focus on the areas in which, historically, most fellows felt they had the least knowledge, such as voiding dysfunction and urinary tract infection. At later interval meetings, the mentor and fellow can identify individual areas of weakness requiring more attention. A similar approach to surgical skills would actively encourage the fellow to monitor his or her case numbers and choose cases accordingly, while keeping in mind the national deficiencies perceived in robotic/laparoscopic training, hypospadias surgery, and augmentation/Mitrofanoff procedures.

If this were a talk, I would feel obligated to disclose that I am one of the first author's trainees. As my program director, how did she fare at modifying the curriculum? Early on, we met to discuss goals for the fellowship. At the start of my clinical year, a weekly pediatric urology-nephrology-radiology case conference was created to address a deficiency in pediatric-specific, organized, problem-based learning. This interactive conference gave me the chance to discuss cases I found perplexing and pinpoint with my mentors, in a formal fashion, surgical decision-making. Undoubtedly, faculty supervision/feedback will always top any surgical training list because that is how we learn to operate, but our multidisciplinary meeting gave me a clinical context. Not surprisingly, fellows spend more time in the operating room than in clinic. To ensure adequate clinical experience, I was responsible for two half-day clinics with the support not only of attending pediatric urologists, but also of the Voiding Improvement Program staff who provided tremendous knowledge as to the management of complex bladder and bowel dysfunction patients.

My biggest concern with this study is looking to the future. The authors conclude that the vast majority of pediatric urologists feel well prepared "for the procedures that they actually perform." I would like to know more about how they address new clinical situations, both in and out of the operating room. As a newly minted attending physician, I also feel well qualified for the procedures I actually perform, but the diversity of those procedures is still lacking while I build a practice. With time, the complexity of the young surgeon's cases expand. It is crucial that we remain motivated in our desire to do the best for our patients, through continued relationships with our valued mentors, sustained learning from our senior partners, and lifelong independent reading.

Written by:
Kristina D. Suson, MD as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA

Pediatric urology fellowship training: Are we teaching what they need to learn? - Abstract

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