Page 6 - CUA2018 Abstracts - Miscellaneous/Other

Poster session 2: Education/Practice Management

Methods: The RRC is attended and run independently by a senior resi- that PRO should be included as quality indicators at a hospital–level and,
dent. All cases were reviewed with faculty at the end of the day, and an importantly, 55 (69.6%) agreed that quality indicators should be associ-
evaluation form assessing resident performance was completed. Residents ated with patient outcomes. Finally, 67 (84.8%) respondents reported
completed a brief self–assessment. All patients completed an anonymous concern that measurement of quality indicator data would be used to
survey to assess aspects of patient satisfaction. inform policy without adequate supporting evidence.
Results: Overall, resident performance was excellent, with changes to Conclusions: Urologists remain skeptical about the measurement and
the management plan in 6% (2/32) of cases after faculty review. All clin- reporting of quality indicators. Growing public demand for increased
ics finished within 30 minutes of planned end time. Residents reported transparency in surgery may be in opposition of urologists’ current
confidence in their ability to manage the clinic (8.25/10). Eighteen patient views, foreshadowing possible future conflict between quality stakehold-
surveys were completed. On a five–point scale, patient ratings of wait ers and surgeons.
time, clinic environment, and appointment duration were 3.94, 4.41, References:
and 4.24 respectively. Patient ratings of residents’ skills (communica- 1. Dimick JB, Greenberg CC. Understanding gaps in surgi-
tion, sensitivity, treatment options, and answering questions) were 4.28, cal quality. Ann Surg 2013;257:6–7. https://doi.org/10.1097
4.18, 4.24, and 4.41, respectively. Overall confidence in residents was SLA.0b013e31827ba13d
8.83/10 (standard deviation 1.69) and 100% of patients would recom- 2. Lindenauer PK, Lagu T, Ross JS, et al. Attitudes of hospital leaders
mend the RRC. toward publicly reported measures of health care quality. JAMA
Conclusions: Based on our ongoing experience, RRCs provide well– Intern Med 2014;174:1904–11. https://doi.org/10.1001/jamain-
received, safe patient care and serve as a learning tool for residents as ternmed.2014.5161
they prepare for independent practice. Given these results, residency 3. Goldenberg MG, Grantcharov TP. Video–analysis for the assessment
programs could consider inclusion of a RRC as a component of the transi- of practical skill. Tijdschrift voor Urologie 2016.
tion–to–practice training within a competency–based curriculum. 4. Smith AB, Schwarze ML. Translating patient–reported outcomes
References: from surgical research to clinical care. JAMA Surg 2017;152:811–2.
1. Serwint JR, Thoma KA, Dabrow SM, et al. Comparing patients seen https://doi.org/10.1001/jamasurg.2017.1583
in pediatric resident continuity clinics and national ambulatory
medical care survey practices: A study from the continuity research MP–2.9
network. Pediatrics 2006;118:e849–58. https://doi.org/10.1542/
peds.2006–0422 Attitudes of graduating Canadian urology residents on the job
2. Smith SD, Marrone L, Gomez A, et al. Clinical outcomes of diabetic market: Is it getting better or are we just spinning our wheels?
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patients at a student–run free clinic project. Fam Med 2014;46:198– Gregory Hosier , Naji Touma
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203. Urology, Queen’s University, Kingston, ON, Canada
3. Yancy WS, Macpherson DS, Hanusa BH, et al. Patient satisfac- Introduction: There has been increasing awareness of employment dif-
tion in resident and attending ambulatory care clinics. J Gen ficulties for physicians, especially surgeons, in Canada over the past few
Intern Med 2001;16:755–62. https://doi.org/10.1111/j.1525– years. Our objective was to elucidate the attitudes and experiences of
1497.2001.91005.x graduating Canadian urology residents in obtaining employment.
4. Day KM, Zoog ES, Kluemper CT, et al. Progressive surgical auton- Methods: We surveyed four separate cohorts of graduating urology resi-
omy observed in a hand surgery resident clinic model. J Surg Educ dents in 2010, 2011, 2016, and 2017. Responses from the 2010 and
2018;75:450–7. https://doi.org/10.1016/j.jsurg.2017.07.022 2011 cohorts were combined and compared to the combined results of
5. Weissler JM, Carney MJ, Yan C, et al. The value of a resident aes- the 2016 and 2017 cohorts. Mean Likert responses were compared using
thetic clinic: A 7–year institutional review and survey of the chief unpaired t–tests. An agreement score was created for those responding
resident experience. Aesthet Surg J 2017;37:1188–98. https://doi. with “strongly agree” and “agree” on the Likert scale.
org/10.1093/asj/sjx103 Results: A total of 126 surveys were administered with a 100% response
rate. The job market was rated as poor or very poor by 64.9% and 58.4%
of graduates in 2010/2011 and 2016/2017, respectively (p=0.67). Lack of
MP–2.8 resources was identified as the biggest barrier to improved employment in
Urologists’ attitude toward performance measurement: both cohorts. Networking at meetings and staff urologists at their institution
A Canadian perspective were the most important factors aiding employment identified by both
Mitchell Goldenberg , Keith Lawson , Kunal Jain , Antonio Finelli 1 cohorts. The ideal practice was academic or academically associated com-
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1 Division of Urology, University of Toronto, Toronto, ON, Canada munity practices in a large urban area with 5–10 partners for both cohorts.
Study Groups: Princess Margaret Cancer Centre Foundation. Conclusions: The majority of graduating urology residents viewed the
Introduction: Recent efforts toward surgical quality improvement have job market as poor or very poor and this did not change over a six–year
been focused on increasing transparency in processes of performance period. It is unclear how much personal preference for location and prac-
measurement. Publically reported surgeon and hospital outcomes has tice type drove the somewhat negative outlook of employment opportuni-
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become a controversial topic. Novel measurements of quality have ties, as the majority of residents were seeking large urban, academic, or
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been proposed, including intraoperative assessment of surgeon techni- academically associated community practices in competitive locations.
cal skill and patient–reported outcomes (PRO). 4
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Methods: A survey questionnaire was created with input from urologists MP–2.10
and experts in quality improvement. Consensus was first reached on
questions assessing the topics of surgical skill as a quality indicator, best Canadian interprovincial urological economic disparity 2,8
1,2
2,7
2,3
use of operative video for quality improvement, and public reporting of Omar Nazif , Keith Rourke , Hassan Razvi , Curtis Nickel , Paul
2,9
5
6
2,10
hospital outcomes and audit feedback in surgery. The survey was distrib- Weckworth , Darrel Drachenberg , John Kell , Lorne Aaron , Christopher
2,11
4
uted via email to the Urology Section of the Ontario Medical Association. French , Gregory Bailly
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Results: Seventy–nine urologists completed the questionnaire (response Department of Urologic Sciences, University of British Columbia,
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rate 30.8%), of which 49 (62.0%) were community–based and 48 (60.7%) Surrey, BC, Canada; Health Policy Committee, Canadian Urological
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had more than 10 years in practice. Forty (50.6%) respondents agreed Association, Montreal, QC, Canada; Urology, University of Western
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that surgical skill should be included as a quality indicator, but only 23 Ontario, London, ON, Canada; Urology, Dalhousie University, Halifax,
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(29%) felt that operative video analysis should be included in quality NS, Canada; Urology, University of Manitoba, Winnipeg, MB, Canada;
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improvement databases. Only five (6.3%) respondents agreed that opera- Urology, University of Saskatchewan, Saskatoon, SK, Canada; Urology,
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tive video should be made publically available, however, 36 (45%) felt University of Alberta, Edmonton, AB, Canada; Urology, Queen’s
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that hospital performance measures should be. Forty–three (54.4%) felt University, Kingston, ON, Canada; Urology, University of Toronto, East
CUAJ • June 2018 • Volume 12(6Suppl2) S75