What Every Graduating Medical Student Should Know About Urology: The Stakeholder Viewpoint

doi:10.1016/j.urology.2007.12.010

Urology

Volume 71, Issue 4, April 2008, Pages 549-553

https://doi.org/10.1016/j.urology.2007.12.010 Get rights and content

Objectives

What should every medical student know about urology upon graduating from medical school? To answer this question, we conducted a survey of key stakeholders in an effective medical student education in urology.

Methods

Directors of the generalist residencies in the United States (emergency medicine, family medicine, internal medicine, and pediatrics), directors of urology residencies, medical student educators in urology, and applicants to the 2006 urology residency match were invited to complete an online survey. Participants were asked to select the 5 most important topics to be included in a core urology curriculum for all medical students.

Results

Among 1859 stakeholders surveyed, response rates by stakeholder cohort ranged from 67% to 26% (overall 44%). There was marked homogeneity among participant groups as to what respondents considered to be the most important topics for a core urology curriculum for medical students. Based on aggregate data, the 8 most commonly cited topics included urinary stone disease (75% of respondents), hematuria (65%), urinary tract infections in adults (53%), benign prostatic hyperplasia (52%), urinary incontinence (45%), prostate cancer (45%), screening with prostate-specific antigen (33%), and testis torsion (24%).

Conclusions

This survey has identified the most important urology topics about which medical students should learn before graduation. Work is currently under way under the aegis of the American Urological Association to develop materials to standardize student education in these core topics across the United States.

Section snippets

Study Participants

Educational leaders who were invited to participate represented the primary beneficiaries of an effective medical student education in urology: urology residency directors, medical student educators in urology, urology residency applicants, and directors of generalist residencies (emergency medicine, pediatrics, family medicine, and internal medicine). The names and e-mail addresses of the directors of the generalist residencies in the United States (emergency medicine, family medicine,

Results

The survey response rates were 67% (80 of 119), 65% (55 of 85), and 61% (288 of 468) for urology residency directors, medical student educators in urology, and urology applicants, respectively. For the directors of generalist residency programs, response rates were 40% (54 of 135), 39% (78 of 201), 35% (163 of 464), and 26% (101 of 387) for emergency medicine, pediatrics, family medicine, and internal medicine, respectively. The overall response rate to the survey was 44% (819 of 1859).

Comment

This survey study of over 1800 urology education stakeholders provides a broad view of the urology learning needs of medical students across the United States. The survey results have elucidated the most important topics to be included in a core curriculum for all medical students and demonstrate an unexpected homogeneity among stakeholders as to what these core topics should be. These results are consistent with those from a 1998 survey of family practice residency directors that asked

Conclusions

This survey of key stakeholders has identified core topics to be included in a urology curriculum for all medical students. Based on these findings, work is currently under way under the aegis of the American Urological Association to develop standardized educational materials to improve medical student education in these core urology topics across the United States.

Acknowledgments

The authors thank Jessica E. Hyde for administrative support and the American Urological Association for providing the e-mail addresses of the applicants to the 2006 urology match. In addition, they thank Drs. E. Ann Gormley (Dartmouth Medical School), William C. Hulbert, Jr. (University of Rochester Medical Center), Thomas L. Jackson (University of Vermont), Jonathan P. Jarow (Johns Hopkins Hospital), Jay I. Sandlow (Medical College of Wisconsin), Joel M. H. Teichman (University of British

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To assess the quality and extent of the urology education provided to medical students both by third-party resources (TPRs) and by the curriculum provided by medical schools
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The TPRs for Step 1 together covered 73.3% of the AUA-MSC topics, and for Step 2 covered 81.9%. First Aid covered 49.5% of Step 1 topics and 58.4% of Step 2 topics, Uworld covered 58.6% and 67.9%, respectively, and Anking covered 61.8% and 58.8%, respectively. Pathoma covered 28.1% of Step 1 topics. Survey results showed that 33/39 (84.6%) of schools have required urology coursework in preclinical years, but only 3/39 (7.7%) have required urology rotations in the third or fourth years. Of those without required rotations, 35/36 (97.2%) indicated that they offer an elective rotation in urology.
There is little emphasis placed on urology after the preclinical years of medical school, pointing to a need for greater exposure to these topics regardless of the student’s selected specialty. This need stems from incomplete knowledge provided by TPRs compared to the AUA-MSC. Drawing attention to this gap can provide insight for those creating future iterations of medical curricula and shed light on areas in need of improvement, which would ultimately benefit both patients and providers.
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Regardless of career intentions, junior doctors will meet patients with urological problems. There are no studies on the status of undergraduate education for urology in Europe. We designed an 18-item online survey using the platform www.surveymonkey.com to assess the current status of undergraduate education in urology. A total of 347 medical students, trainees, and urologists responded to the survey. Medical students’ exposure to urology during their undergraduate career was heterogeneous. Although the quality of urology education was valued from moderate to high, urology as a speciality did not influence their future training decision making. Decision making in relation to residency training correlated with the number of hours spent on practical training, duration of urology rotation, and year of medical school in which urological exposure was introduced. The current European exposure to urology at undergraduate level is heterogeneous, with various factors influencing future decisions regarding training and specialisation. A uniform undergraduate curriculum would eliminate such heterogeneous exposure and facilitate a workforce fit for the future urological needs.
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Citation Excerpt :
In response the AUA medical student curriculum and the related website were announced.16 The content is developed from a consensus among urologists, general practitioners and urology residency applicants regarding the 8 most important areas to the core urology curriculum, including urinary stone disease, hematuria, adult urinary tract infection, benign prostatic hyperplasia, urinary incontinence, prostate cancer, prostate specific antigen screening and testis torsion.17 Interactive case based clinical modules, uroradiology cases, an operative video library, a step-by-step procedure guide and video interviews of leading urologists are available on the internet without registration.18
Providing medical students with a basic urological education is important as the geriatric population expands and the need for urological care increases. In the last decades there have been considerable changes to medical school curricula and graduation requirements that may impact medical student exposure to urology. We reviewed the literature pertaining to urological education for medical students in the United States.
We searched the PubMed® and Medline® databases to identify articles pertaining to medical student education in urology. We summarized these articles according to 4 themes, including 1) medical student electives in urology, 2) medical student career interest in urology, 3) new interventions in urology education and 4) the urology match.
We identified 25 articles, which showed that 1) medical student exposure to urology has markedly declined, 2) medical students remain highly interested in pursuing a career in urology, 3) the AUA (American Urological Association) medical student curriculum has provided a key resource for medical school urological education and 4) applying for urology residency may be expensive and challenging.
Medical school urological education has changed in the last decades. Although it appears that fewer medical students are required to rotate through urology, new materials are available to educate medical students in urology and many students are highly interested in pursing a career in the field.
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The AUA Education Council announced that it was going to work with the assistance of others to create a medical student Web site and a urology curriculum for medical students.5 The AUA looked to the expertise of urologists who had surveyed major stakeholders to learn the urologic skills and topics graduating medical student should know.15 With support from the AUA and volunteer effort contributed by urology experts and medical-student education advocates, an open access Web site was developed with a core curriculum that focuses on those skills and topics.
To provide an updated report on the status of urology education in the United States.
Forty-one randomly selected accredited medical schools in the United States were surveyed concerning their urology curriculum. All schools were included in the randomization, even those that had not produced any successful urology applicants during the past 5 years.
In 48% of the schools, there were no urology lectures or coursework required before third-year clinical rotations. Two schools (5%) had a mandatory urology clinical clerkship. All schools offered an elective urology clerkship during either the third or fourth year of medical school. Fifty-five percent of medical schools used a core curriculum, and 31% based their curriculum on the American Urological Association's medical student core curriculum. Twenty-nine percent used Web-based resources during their clerkship, and 21% had a urology interest group.
This survey further reveals that there is a decline in exposure of medical students in the United States to formal urology teaching. In an attempt to minimize any possible adverse impact and to ensure that students are being exposed to the most important urologic topics and skills needed, some medical schools have instituted the use of a core curriculum in their clerkships. Despite the persistent decline in required medical student exposure to urology, urology residency programs remain extremely competitive.
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This study was supported by the Pellegrino Foundations, the Research Career Development Award Program of the Veterans Affairs Health Services Research & Development Service, the American Urological Association Foundation and Astellas Pharma US, Inc.

The views expressed in this article are those of the authors and do not necessarily reflect the position and policy of the United States Federal Government or the Department of Veterans Affairs. No official endorsement should be inferred.

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Special ArticleWhat Every Graduating Medical Student Should Know About Urology: The Stakeholder Viewpoint

Objectives

Methods

Results

Conclusions

Section snippets

Study Participants

Results

Comment

Conclusions

Acknowledgments

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

Urology

J Urol

Special Article
What Every Graduating Medical Student Should Know About Urology: The Stakeholder Viewpoint