Educational program in onco-urology for young urologists: What are their needs?

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U. Pinar, L. Freton, B. Gondran-Tellier, M. Vallée, I. Dominique, M. Felber, Z.-E. Khene, E. Fortier, F. Lannes, C. Michiels, et al.

To cite this version:

U. Pinar, L. Freton, B. Gondran-Tellier, M. Vallée, I. Dominique, et al.. Educational program in

onco-urology for young urologists: What are their needs?. Progrès en Urologie, Elsevier Masson,

2021, �10.1016/j.purol.2021.04.006�. �hal-03268868�

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ORIGINAL ARTICLE

Educational program in onco-urology for young urologists: What are their needs?

Formation des jeunes urologues en onco-urologie: quels sont leurs besoins?

U. Pinar

^a

, L. Freton

^b

, B. Gondran-Tellier

^c

, M. Vallée

^d

, I. Dominique

^e

, M. Felber

^a

, Z.-E. Khene

^b

, E. Fortier

^f

, F. Lannes

^c

, C. Michiels

^g

, T. Grevez

^h

, N. Szabla

ⁱ

,

F. Bardet

^j

, K. Kaulanjan

^k

, E. Seizilles de Mazancourt

^l

, X. Matillon

^l

, B. Pradere

^m^,∗

aGRCn^o5,Predictiveonco-urology,AP—HP,HôpitalPitié-Salpêtrière,Urology,Sorbonne université,75013Paris,France

bDepartmentofUrology,UniversityHospitalofRennes,Rennes,France

cDepartmentofurology,LaConceptionUniversityHospital,Assistance—PubliqueMarseille, Marseille,France

dDepartmentofUrology,PoitiersUniversityHospital,Poitiers,France

eDepartmentofUrology,groupehospitalierDiaconessesCroixSaint-Simon,Paris,France

fDepartmentofUrology,MontpellierUniversityHospital,Montpellier,France

gDepartmentofUrology,BordeauxUniversityHospital,Bordeaux,France

hDepartmentofUrology,CHRUdeTours,Francois-RabelaisUniversity,France

iDepartmentofUrologyandTransplantation,CaenUniversityHospital,Caen,France

jDepartmentofUrology,DijonUniversityHospital,Dijon,France

kDepartmentofUrology,CHUdePointe-à-Pitre,Guadeloupe,France

lDepartmentofUrologyandTransplantation,Edouard-HerriotHospital,Hospicescivilsde Lyon,Lyon,France

mDepartmentofUrology,ComprehensiveCancerCenter,MedicalUniversityofVienna, Vienna,Austria

Rec¸ule11janvier2021 ;acceptéle19avril2021

KEYWORDS Medicaleducation; Urology;

Summary

Purpose.—Theemergenceofnewcommunicationmediasuchasdigitalcontentsareprogres- sivelyreplacingmoretraditionalmediasintheﬁeldofeducationalprograms.Ourpurposewas toassessurologistintrainingaspirationsregardingurologicaleducation.

∗Correspondingauthor.

Adressee-mail:[email protected](B.Pradere).

https://doi.org/10.1016/j.purol.2021.04.006

Pourciter cet article : U.Pinar, L.Freton, B.Gondran-Tellieret al.,Educationalprogram in onco-urologyfor young

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Residents;

E-learning ^Methods.^—^Membersôfâ^national ûrologist ⁱⁿ^trainingassociationwere sentananonymous onlinequestionnaireregardingtheirmedicalformationinthefieldofurology.Respondersinter- estforurologicalsub-specialtyoreducationsupport(newtoolsandtraditionalsupport)were evaluatedthrougha5-pointLikertscale.

Results.—Overall,109youngurologists(26%)respondedtothesurvey.Mostoftherespondents workedduring theirtraining inanacademichospital (n=89, 82%).The threefavorite tools for training chosenby theresponderswere: videos,workshopor masterclass,andpodcasts (respondersveryinterestedwererespectivelyn=64(58.7%),n=50(45.9%),andn=49(45%)).

E-mailnewsletters werereportedasthelessuseful educationaltoolby participants(n=38, 34.9%).Participantswereveryinterestedinimprovingtheirsurgicalskillsandtheirradiological knowledge.ResponderswhowerethemostattractedbyPCaweremuchmorelookingtoimprove theirsystemictreatmentandradiologicalknowledges.

Conclusions.—Urologic-oncologywasapriorityregardingeducationforurologistsintraining.

Amajorityofparticipantsexpressedalackintheirsurgicaleducation,revealingareducedOR accessandunderliningutilizationofnewtoolssuchassimulation.Newdigitalcontentssuchas socialmediaorpodcastachievedhighinterestfortheparticipants,insteadofmoretraditional media.Thereisaneedthateducationalcontentevolveandusesnewdigitalmedia.

Levelofevidence.—3.

MOTSCLÉS

Formationmédicale; Onco-urologie; Internes; E-learning; Podcast

Résumé

But.—Danslaformationmédicale,lesnouveauxmédiasdecommunicationtelsquelesconte- nus numériques se développent très rapidement et tendent à remplacer les médias plus traditionnels.Notreobjectifétaitd’évaluerlesaspirationsdesurologuesenmatièredeforma- tionenonco-urologie.

Matériel.—Lesmembresdel’Associationsfranc¸aisedesurologuesenformationontréponduà unquestionnaireenligneanonymeconcernantleurformationenonco-urologie.L’intérêtdes participantspourlesdifférentsmoyensdeformationainsiquepourlesspécialitésd’organes ontétéévaluésavecuneéchelledeLikertà5-points.

Résultats.—Autotal,109urologuesenformationontréponduàl’enquête(26%).Laplupart ont effectué leurformation exclusivement dans unhôpital universitaire(n=89, 82 %). Les troisoutilsdeformationpréférésdesparticipantsétaient:lessupportsvidéo,lesateliersou masterclass,etlespodcast(étaienttrèsintéressésrespectivementn=64(59%),n=50(46%) etn=49 (45%)).Les newslettersontétéconsidéréescommel’outiléducatif lemoinsutile (n=39,35%).Lesparticipantsétaienttrèsintéressésparl’améliorationdeleurscompétences chirurgicales etde leursconnaissancesradiologiques. Les participants quis’intéressaientle plusaucancerdelaprostatecherchaientàconsoliderleursconnaissancessurlestraitements systémiquesainsiqu’enradiologie.

Conclusion.—L’onco-urologieestuneprioritépourlesurologuesenformation.Lesnouveaux contenusnumériquestelsquelesréseauxsociauxoulespodcastsontsuscitéungrandintérêt chezlesparticipants,supplantantlesmédiasplustraditionnels.Ilestnécessairequelecontenu éducatifévolueetsereposesurlesnouveauxmédiasnumériques.

Niveaudepreuve.— 3.

Introduction

Educational programs in onco-urology for residents give manyinterdisciplinaryknowledgessuchassystemiccancer therapy,surgery, brachytherapy, immunologyor radiology.

Nowadays, educationalprograms aremainly composed of lectures, practical training and recommendations. Howe- ver,neweducationalcontentsthroughdifferentmediaare

nowusedin ordertostay updatedin thisrapidlyevolving ﬁeld.Thus,traditionalfacetofacelecturesareprogressi- velyreplacedbynewdigitalcontentssupportedbyvirtual congress, e-learning sessions, social mediaor smartphone applications. Although e-learning efﬁciency has already beendemonstratedinsurgeryandinurology,morerecent communication tools have not been properly studied yet neithertheiracceptanceamongurologistsintraining[1,2].

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Education in surgery relies historically on a senior-to- junior relationship, but residents and program directors may have different perceptions regarding education and resourcesassociatedmajorlyduetoaninter-generationgap [3].Forexampleperceptionsofresidents’needsdifferfrom facultiesregardingoperativemanagement[4].Additionally, withwork-hour restrictions for residents,surgery training hasbeenreducedandsurgicalskillscouldbeoverestimated [5—7].

Becauseofahighworkloadassociatedwithimbalanced betweeneffortandreward,stressfulsituationsandimpor- tantfatigue,surgeonsintrainingareathighriskofburn-out [8].Inthiscontext,educationandimprovementoftheresi- dency learning environment have been demonstrated to contributetosurgeonsintrainingwellness[9—11].Ina2019 nationalFrenchsurvey,25%oftheurologistsintrainingsuf- fered fromglobal burn-out and the feelingof being well trainedwastheonlyprotectivefactoragainstburn-out[10].

Asaconsequence,educationalprogramsshouldbeadapted totheresident’sexpectationsandneed.

In order topromote resident’swellness while ensuring thebesteducationalprograms,we aimedtoassess urolo- gistsintrainingwishesregardingonco-urologicaleducation thoughanonlinesurvey.

Methods

Studydesign

Duringthe1sttrimesterof2020,eachmemberoftheFrench association of young urologists(AFUF) including residents andclinicalfellowswereinvitedtoansweranonlinesurvey regardingtheirmedicalformationintheﬁeldofUrology.The surveywasdesignedbytheAFUFmembers(BP,XM,LF,UP), andthenwasanonymouslyaccessibleonlinethroughGoogle Form©andsoughttoassessyoungurologists’education.The surveywasapprovedbytheAFUFboardandeachparticipant havegiventheirconsentfordataanalysis.

Thesurveywascomposedof19itemsamongwhichthree were demographic questions (living location, working in generaloracademic hospital,wishedfuturepractice)and 16wereabout medicaleducation.Respondersinterestfor urologicalsub-specialtyor educationsupportwereevalua- tedthrougha5-pointLikertscale(1=notinterestedatall to5=veryinterested).

Statisticalanalysis

Quantitativevariableswereexpressedasmedianandinter- quartilerange [IQR] andqualitative variables asabsolute numbersandpercentage.

Analyses were performed using R version 3.6.2.

(2009—2019RStudio,Inc.)andtheﬁguresweremadewith ExcelStat.

Results

Amongthe420membersoftheassociation,atotalof109 young urologists(26%) responded to the survey.Of them, 56 (51.4%)were willingto validatean oncological degree especiallyfor themanagementanduseofsystemicdrugs.

Mostoftherespondentsworkedduringtheirtraininginan academic hospital(n=89,82%) (Fig.1 and2). Aftertheir training,42responderswouldliketoworkinprivatepractice (38.5%),41inanacademichospital(37.6%),20inageneral hospital(18.3%),4(3.7%)werenotdecidedyetand2(1.8%) inahospitalspecializedintheﬁeldofoncologyonly.

Among the ﬁeld of oncology, responders were more attractedbytheoncologicalmanagementofrenalcellcar- cinoma(RCC)comparedtobladdercancer(BCa),prostate cancer(PCa)andtesticularcancer(TCa)(respondersranked

>4/5respectivelyn=61(56%),n=42(38.5%),n=40(36.7%), andn=38(34.9%))(Fig.3).

Overall,consideringthedomainsofinteresttoimprove, 85% werevery interestedto improvetheir surgical knowledge, almost two third (61%) wanted to improve their

Figure1. Geographicrepartitionamongresponders.ThismapofFrance,evidencethatmostoftherespondentslivedinthenorthof France(n=50,46%).Moreover,therewasahomogenousrepartitionofresponsesinFrance.

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Figure2. Workingactivityrepartitionamongresponders.Inthis study,themajorityoftheparticipantsworkedinanacademichospi- tal(n=89,82%)whilelittleworkedasprivatepractice.Thesetrends areexplainedbecauseofamajorityofresident’sparticipation.

radiologicalskills,22%werespeciallyfocusedondeveloping theirknowledgeintermsofsystemictreatmentbutonly10%

inbrachytherapy.

Thethreefavoritetoolsfortrainingchosenbytherespon- derswere:videos,workshopor masterclass,and podcasts (respectivelyn=64(58.7%),n=50(45.9%),andn=49(45%)) (Fig. 4). E-mail newsletters were reported as the least useful educational tool by participants: 38 (34.9%) deﬁ- ned it as ‘‘notinterested at all’’ to ‘‘medium interest’’.

Moreover, the three preferred information sources were

scientific literature, scientific congress and recommendations fromscientific societies (respectively n=93(85.3%), n=77 (70.6%) and n=69 (63.3%)). Only four young urologists(3.7%)inquiredwiththepharmaceuticalindustryand 20(18.3%)withthehealthauthority.

Overall, 92 participants (85%) were very interested in improvingtheirsurgicalskillsand66(61%)theirradiological knowledge.ResponderswhowerethemostattractedbyPCa weremuchmore lookingto improvetheir systemictreat- mentandradiologicalknowledges(respectivelymean(SD) Likertscale4.1(0.9)and4.6(0.7))(Table1).

Discussion

We reportedurologists in training habits and expectation regardingmedicaleducationintheﬁeldofonco-urology.A majorityofparticipantswereinterestedinoncologyespe- cially in RCC, they mostly expressed a need of digital contenttoimproveeducationalprograms.Moreover,despite atheoreticaldailysurgicaltrainingwithseniorsurgeonsin academichospitals,theywerestillveryinterestedinper- fectingtheirsurgicalskills.

Interestingly,inadditiontothewidelyusedclassicalfor- mats(lectures,books), socialmedia, e-learning,podcasts orotherinteractiveformatsarenowincludingeducational content. This is conﬁrmed in ourstudy where videosand Podcastswereconsideredasthefavoritemediafortraining.

Evolution and advances in the personal-use technological devicesandsocialnetworkswerethetriggerthatenhanced digitaleducationsupports[12].Socialmediaimprovemedi- calknowledgethroughopenaccesseducationalsupportand throughafacilitatedcollaborationforprofessionaldevelop- ment[13].Socialmediaalsoallowa‘‘live’’publicexchange ofideasbetweenpractitionersworldwidecontrastingwith thetraditionalandconﬁdentialpeer-reviewedpublications.

Social networksare a showcasefor scientiﬁc publications orfor congresslivebroadcastingwithan inﬁnitepotential

Figure3. Repartitionoforganinterestamongresponders.Respondersweremoreattractedtooncologicalrenaldiseasecomparedto bladder,prostateandtestisdisease(respondersranked>4/5respectivelyn=61(56%),n=42(38.5%),n=40(36.7%),andn=38(34.9%)).

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Figure4. Preferredinformativemediaamongresponders.Amongtheresponders,the3besttoolsforeducationwerevideos,workshop ormasterclass,andpodcasts(respondersveryinterestedwererespectivelyn=64(58.7%),n=50(45.9%),andn=49(45%)).

Table1 Mediaandskillenhancementevaluationregardingspeciﬁcorgandisease.

Prostate Kidney Bladder Testis

(n=40) (n=61) (n=42) (n=38)

Preferredmedia(mean,(SD))

Video 4.3(1) 4.4(0.9) 4.5(0.9) 4.6(0.9)

E-learning 4.2(1.1) 4.1(1.1) 4.2(1.1) 4.2(1.2)

Podcasts 4.2(1.1) 4.2(1.1) 4.2(1.3) 4.1(1.4)

Masterclass 4.1(1.1) 4.3(1) 4.1(1.1) 4.1(1.1)

Newsletter 2.9(1.3) 3(1.3) 3(1.3) 2.8(1.3)

Skillsenhancement(mean,(SD))

Radiology 4.6(0.7) 4.5(0.7) 4.5(0.9) 4.5(0.7)

Surgery 4.9(0.5) 4.8(0.6) 4.8(0.6) 4.9(0.5)

Brachytherapy 3.2(1.2) 2.9(1.3) 2.8(1.5) 2.5(1.4)

Systemictreatment 4.1(0.9) 3.8(1) 3.8(1.1) 3.3(1.3)

worldwidewithspread[14].Finally,accesstoarapid,global andpublicinformationexchangethroughsocialmediacould alsoleadtoethicalmisconductthatusersshouldavoidwith thehelpofguidelines[15].

We highlighted thata veryfewparticipants usedphar- maceutical industryas an educational information source (3.7%).Previousstudiesevidencedahighleveloffrequent interactionbetweenindustryandpractitionerduringtheir residency [16,17]. This resultcould show a lack of confi- dencetowardspharmaceuticalindustry.Indeed,Schneider et al. demonstrated that residents perception regarding industrygiftsandinteractionschangedduringtheirtraining andwasconsideredinappropriate[18].Moreover,educatio- nalworkshopaloneprovidedbyindustrywasnotsufficient to improve resident’s perception proving a need for a consistentinstitutionalpolicy.Thisresultcouldalsoreflect the anti-industry mindset implemented over the last ten yearsandenhancedbylawprohibitinganyadvantagesfor residents[19].

Inourstudy,amajorityofparticipantsexpressedthewill toenhancesurgicalskills.Previoussurveysamongresidents areconsistent withourﬁndings byevidencing thelack of practicaleducationin urology [20].These resultsseem in contradictionwiththesurgicalformationitselfandbringsto lightagapintheeducation.Indeed,inamultidisciplinary specialtysuchasurology,theoreticaleducationtendstobe timeconsuming and reducesOR access. Moreover,recent policiesinmanycountriesregulateresidentsworkinghours and results toa decreasing surgical hour. New treatment modalitieswhichincludemoreoftenneoadjuvanttherapies or multimodal therapies with brachytherapy or emerging therapiessuchasimmunotherapyalsoledtoreducesurgical indicationsinonco-urology.

Simulationplatformsforrobotics, endoscopicandlapa- roscopictrainingareemergingandprovidecontent[21,22].

However, validation level differs between simulators and proper evaluation will be needed for each device [23,24].

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Wealsoevidencedthatmorethan50%oftheresponders expressedthewilltoimprovetheirradiologicalskills,espe- ciallyforthosewhoweremoreinterestedinPCa.Thistrend could reﬂect that young urologists are willing to deepen theirradiologicalknowledgeandtoreadtheseexamsmore accurately.At thetimeof targetedprostate biopsies that requireadvancedradiologicalexpertise,ourﬁndingmaybe evidenceacollective needtogaingreater autonomywith prostateMRI.

This study has several limitations. First, the response rate waslow limitingthe interpretation andgeneralisabi- lityof ourresults regardingourdescriptiveaims. Second, surveyshaveinherentlimitationsrelatedtothebiasesthat mayaffectself-report.Conﬁdentialityandtheuseofvalida- tedscalesshouldminimisethispossiblebias.Thissurveyhas beenproposedjustbeforetheCOVID-19crisiswhichforced everyonetoquicklyadopttheuseofdigitalmediacontent topursuethemedicaleducationofyoungcolleagues.The- refore, itwillbe veryinterestingin anear future, tosee howthiscrisishaschangedthepointofviewoftraineesand thenewtrendsintermsofeducationalprogramcontent.In ordertoanswertothisquestionanewdedicatedsurveywill besentoncethecoronacrisisended.

Conclusion

Amongurologistsintraining,urologic-oncologyisapriority regardingeducation.Mostofthemexpressedthenecessity todeepentheirsurgicalcompetences,revealingareduced ORaccessandunderliningutilization ofnewtoolssuchas simulation.Finally,digitalcontentssuchassocialmediaor podcasts achieved high interests for urologists in training establishingtheimperativeneedtodevelop thesetoolsto improvemedicaleducation.

Disclosure of interest

Theauthorsdeclarethattheyhavenocompetinginterest.

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