CUA 2018: Resident-Run Urology Clinics: A Potential Tool for Use in Competency-Based Medical Education for Teaching and Assessing Transition-to-Practice Skills

Halifax, Nova Scotia (UroToday.com) In a competency-based approach to resident education, a component of training should focus on skills needed for the transition from residency to independent practice.

resident training diagram

Particularly with adaptations to resident work hours in surgical subspecialties, clinical and surgical resident autonomy is of concern. Specialties outside of urology have successfully implemented resident run minor surgery and anesthetic clinics1-3. Furthermore, resident-run clinics have been implemented in several programs to allow residents to practice skills, and have enhanced learning while providing excellent patient satisfaction1-3.  For the urology trainee, the ability to run an outpatient clinic represents one such vital skill, and to date there has been little experience with resident-run clinics in urology residency programs. At the CUA 2018 annual meeting, Shreya Jalali, MD, and colleagues from the University of Ottawa reported results of their study assessing a urology resident-run clinic and report assessments of both resident performance and patient satisfaction. 

This study defined a resident-run clinic as being attended and run independently by a senior-level urology resident. All cases were reviewed with faculty at the end of the day, and an evaluation form assessing resident performance was completed. Furthermore, all residents completed a brief self-assessment, and all patients completed an anonymous survey to assess aspects of patient satisfaction. 

Among 41 cases analyzed, resident performance was excellent, with changes to the management plan in only 7% of cases after faculty review. All clinics finished within 30 minutes of planned end time, and residents generally reported confidence in their ability to manage the clinic autonomously. There were 34 patient surveys completed with the following patient results on a five-point Likert scale:

  • Wait time: 384
  • Clinic environment: 4.29 
  • Appointment duration: 4.13
  • Resident communication: 4.29
  • Resident sensitivity: 4.29 
  • Resident treatment options explained: 4.32 
  • Resident answering questions: 4.45
Overall confidence in residents was 8.8/10 (SD 1.7), and 100% of patients would recommend the resident-run clinic.

The strength of this study is a urology specific evaluation of resident-run clinics, which has previously been deemed quite successful for other surgical specialties. A limitation of the study is the small sample size of encounters evaluated (n=41) and the need for external validation in other programs across the country. Dr. Jalali concluded that based on their ongoing experience, resident-run clinics provide well-received, safe patient care and serve as a learning tool for residents as they prepare for independent practice. Furthermore, they suggest that based on their results, residency programs should consider inclusion of a resident-run clinic as a component of the transition-to-practice training within a competency-based curriculum.


Presented by: Shreya Jalali, University of Ottawa, Ottawa, Ontario, Canada
Co-Authors: Luke Witherspoon1, Matthew Roberts1.
1Urology, The Ottawa Hospital, Ottawa, ON, Canada

References:
1. Wojcik BM, Fong ZV, Patel MS, et al. The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy. J Surg Educ 2016;73(6):e142-e149.
2. Day KM, Zoog ES, Kluemper CT, et al. Progressive surgical autonomy observed in a hand surgery resident clinic model. J Surg Educ 2018;75:450-457. 
3. Weissler JM, Carney MJ, Yan C, et al. The value of a resident aesthetic clinic: A 7-year institutional review and survey of the chief resident experience. Aesthet Surg J 2017;37:1188-1198. 


Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia
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