Mapping a competency-based surgical curriculum in urology: Agreement (and discrepancies) in the Canadian national opinion
Introduction: Urology residency training in Canada is quickly evolving from a time-based to a competency-based model. We aim to better define core surgical competencies that would comprise a surgical curriculum and assess any discrepancies in opinion nationally.
Methods: A web-based survey was validated and sent to the 536 practicing members of the Canadian Urological Association (CUA) in August and October 2014. The survey consisted of questions regarding practice demographics, fellowship training, and evaluated the 76 most common urological procedures (using a five-point Likert scale) in the context of the question, “After completion of residency training in Canada a urologist should be proficient in…” A core procedure was defined as one for which there was ≥75% agreement. Descriptive statistics and non-parametric testing were used to summarize the findings.
Results: A total of 138 urologists completed the survey (25.7% response rate) with representation from all geographic regions. Respondents included 40.6% community and 59.4% academic urologists. The survey identified 16 procedures with 90‒100% agreement and a total of 30 core procedures with ≥75% agreement. When comparing community and academic urologists, there was statistically significant disagreement on 27 procedures, including 11 core procedures, most notably cystectomy (88.5% agreement vs. 67.1%; p=0.002), open pyeloplasty (84.6% vs. 65.8%; p=0.04), simple prostatectomy (78.9% vs. 69.7%; p=0.03), perineal urethrostomy (80.8% vs. 67.1%; p=0.02), open radical prostatectomy (96.1% vs. 80.3%; p=0.007), and Boari flap (90.4% vs. 76.3%; p=0.004). Regional discrepancies were also found, demonstrating eight procedures deemed uniquely core and three core procedures deemed less important regionally.
Conclusions: This national survey has provided some consensus on 30 procedures that should comprise a core surgical curriculum in urology. However, there are some key differences of opinion (most notably between community and academic urologists) that must be considered.
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