ORIGINAL RESEARCH Attitudes and experiences of residents in pursuit of postgraduate fellowships: A national survey of Canadian trainees N a ji J. Tourna, MD, FRCSC; D. Robert Siemens, MD, FRCSC Department of Urology, Queen's University, Kingston, ON
Cite os: Can Urol Assoc J 2014;8(1 1-12):437-41. http://dx.doi.org/10.5489/cuoj.2136 Published online December 15,2014.
Abstract Introduction: There have been significant pressures on urology training in North America over the last decade due to both the constantly evolving skill set required and the external demands around delivery o f urological care, particularly in Canada. We explore the attitudes and experience of Canadian urology residents toward their postgraduate decisions on fellowship opportunities. Methods: The study consisted of a self-report questionnaire of 4 separate cohorts of graduating urology residents from 2008 to 2011. The first cohort graduating in 2008 and 2009 were sent surveys through SurveyMonkey.com after graduation from residency; those graduating in 2010 and 2011 were prospectively invited as a con venience sample attending a Queen's Urology Examination Skills Training Program review course just prior to graduation. The survey included both open- and closed-ended questions, em ploying a 5-point Likert scale, and explored the attitudes and experience of fellowship choices. Likert scores for each question were reported as means ± standard deviation (SD). Descriptive and correlative statistics were used to analyze the responses. In addition, an agree ment score was created for those responding w ith "strongly agree" and "agree" on the Likert scale. Results: A total of 104 surveys were administered, w ith 84 respon dents (80.8% response rate). As a whole, 84.9% o f respondents agreed that they pursued fellowships; oncology and m inim ally invasive urology were the most popular choices throughout the 4 years. Respondents stated that reasons for pursuing a fellowship included: interest in pursuing an academic career (mean 3.73± 1.1 (SD): agreement score 61.1%) as well as acquiring marketable skills to obtain an urology position (3.59 ± 1.3: 64.4%). Most agreed or strongly agreed (84.9%) that a reason for pursing a fellowship was an interest in focusing their practice to this sub-specialty area. In comparison, most graduates disagreed that a reason for pursuing a fellowship was that residency did not equip them w ith the nec essary skills to practice urology (2.49 ± 1.2: 19%). Most (81.2%) of graduates agreed they knew enough about academic urology to know if it w ould be a suitable career choice for them versus 54.7% regarding com m unity urology (p < 0.0001). Surprisingly,
only 61.7% o f residents agreed that they completed a comm unity elective during training, and most felt they w ould have benefited from additional elective time in the community. Conclusions: U rology residents graduating from Canadian pro grams pursue postgraduate training to enhance their surgical skill set and to achieve marketability, but also to facilitate a potential academic career. Responses from the trainees suggest that exposure to comm unity practice appears suboptimal and may be an area of focus for programs to aid in career counselling and professional development.
Introduction The practice of urology is ever evolving and this is particu larly evident by the relatively recent shift in the surgical management of many urological disorders towards more minimally-invasive techniques. As well as navigating these significant changes in terms of knowledge and skills in sub specialty areas, training programs need to further balance time and effort towards the formal education in broader physician roles in practice and in the community, beyond the role of medical expert. 1,2 With the adoption of these roles and competencies by accrediting bodies, their incorporation into postgraduate curricula objectives has added to the com plexity of the training and evaluation of urology trainees . 3' 6 Postgraduate education in surgical disciplines, including residency and subsequent fellowship, is further confounded by the changing societal requirements of practitioners and the availability of healthcare resources. Most graduating urology residents in North America will practice in non-academic settings where practice patterns and availability of technol ogy may vary considerably. In Canada, the discrepancy in the number of trained surgeons and the available hospital resources has recently stimulated dialogue around significant unemployed or under-employed specialists. As well, there are concerns about the documented decline in the number of physician-scientists in surgical practice. 7,8 This has stimu-
CUAJ • November-December 2014 • Volume 8, Issues 11-12 © 2014 Canadian Urological Associofion
437
Tourna and Siemens
lated an increasing focus on scie n tific in q u iry and research in
an a g re e m e n t score c o m b in in g th e responses o f 4 (agree)
m edical school and residency tra in in g . The e ffica cy o f these
and 5 (stro n g ly agree) w as created and rep o rte d a longsid e
in itia tiv e s in s tim u la tin g y o u n g e r c lin ic ia n s to a c q u ire the
th e m ean 5 -p o in t L ike rt score fo r each q u e s tio n .10S im ila rly ,
research skills to access an academ ic career alone is lim ite d
a d isagreem e nt score was re ported by c o m b in in g responses
and post-residency fe llo w sh ip s are generally a requirem ent.
o f 1 (strongly disagree) and 2 (disagree). The a n c h o rin g score
These re a litie s have e n c o u ra g e d C a n a d ia n residents to pu rsu e fu rth e r tra in in g th ro u g h c lin ic a l and research fe l
o f 3 on th e L ik e rt score w as d e sc rib e d as " n e u tra l" on th e survey. The c h i-s q u a re and Fisher e xa ct tests w e re used to
lo w s h ip s .9 The u n d e rly in g reasons fo r th is o b s e rv a tio n are
c a lc u la te s ig n ific a n c e b e tw een 2 separate fre q u e ncie s. The
p o o rly u n d e rsto o d and lik e ly affe cte d b y m u ltip le factors,
W ilc o x o n S igned-R a nks test w as used to c o m p a re L ik e rt
in c lu d in g in d iv id u a l trends in career c h o ic e , external d riv
scale scores o f respondents b e tw een th e years o f th e study
ers such as m a rke t forces, as w e ll p o te n tia lly self-assessed
and b e tw een s p e c ific a lly lin k e d question s. Vassar Statistics
d e fic ie n c ie s in surgical s k ill a tta in m e n t. The p urpose o f this
w as used fo r a ll statistical analysis.
study is to e lu c id a te the attitudes and experience s in fo rm in g th e p u rs u it o f fu rth e r p o s t-re s id e n c y tra in in g o f C a n a d ia n
R e s u lts
u ro lo g y residents. A to ta l o f 104 surveys w e re a d m in is te re d w ith 84 re spon dents, fo r an o v e ra ll response rate o f 8 0 .8 % . The response
M e th o d s W e in c lu d e d r e c e n tly g ra d u a te d o r s o o n to g ra d u a te C anadian u ro lo g y residents fo r 4 co n se cu tive years betw een 2 0 0 8 and 2 0 1 1 . These tra in e e s w e re surve ye d as 2 sepa rate co h o rts. The firs t sam ple consisted o f 2 0 0 8 and 2 0 0 9 graduates w h o w e re a d m in is te re d a survey o n lin e th ro u g h s u rv e y m o n k e y .c o m in th e fa ll o f 2 0 1 0 . A u to m a tic e -m a ils w e re sent, w ith 1 re m in d e r e -m a il sent 2 w e e ks a fte r th e in itia l e m a il w ith a lin k to th e survey. T he second c o h o rt w as a c o n v e n ie n c e sam ple o f PGY-5 residents in b o th 2 0 1 0 and 2011 years at the tim e o f the ann u a l Q u e e n 's U ro lo g y E xam ination S kills T ra in in g Program (QUEST) in Kingston, O n ta rio . The q u e stio n n a ire was a d m in iste re d to w illin g p a r tic ip a n ts in an a u d ito riu m at th e b e g in n in g o f th e program b efore th e start o f th e p ro g ra m in 2 0 1 0 and 2 0 1 1 . A ll sur vey responses w e re ano n ym o u s. The 2 cohorts, a ro u n d the end o f th e ir re sid e n cy o r d u rin g th e ir fe llo w s h ip tra in in g , w e re targeted fo r th e survey. W e chose these p a rtic ip a n ts as th e y w o u ld m ost lik e ly be a rra n g in g o r c o m p le tin g th e ir fe llo w s h ip a ctivitie s. Ethics a p p ro v a l w as o b ta in e d fro m the Q u e e n 's U n iv e rs ity in s titu tio n a l re v ie w b o a rd w ith assur ance o f c o n fid e n tia lity p ro v id e d to all p a rticip a n ts. The q u e stio n n a ire consisted o f 20 o p e n - and close-ended questions e x p lo rin g residents' plans after c o m p le tio n o f resi dency tra in in g (h ttp ://jo u rn a ls .s fu .c a /c u a j/in d e x .p h p /jo u rn a l/ a rtic le /v ie w /2 1 3 6 /1 9 5 0 ). The q u e stio n n a ire was d e ve lo p e d s p e c ific a lly fo r this survey on fe llo w s h ip pursuits and re su lt ed fro m p re vio u s experience s w ith survey c o n s tru c tio n fo r s im ila r attitudes fo r sp e c ia lty residents.5-6 A lim ite d n u m b e r o f residents and e d u c a to rs in v o lv e d in p o s tg ra d u a te p ro grams w e re asked to assess and m o d ify the survey fo r c la rity . D e scrip tive statistics w e re used to describe dem ograp hics and b a ckg ro u n d in fo rm a tio n o f respondents. Responses to th e questions using th e 5 -p o in t Like rt scale are describ e d as means ± standard d e v ia tio n (SD). For ease o f re p o rtin g and to d istin g u ish trends in the in te n s ity o f the survey responses,
438
rate w as lo w e r (55.6% ) w h e n th e survey w as a d m in iste re d th ro u g h s u rv e y m o n k e y .c o m fo r th e 2 0 0 8 and 2 0 0 9 g ra d u a tin g years c o m p a re d w ith 1 0 0 % fo r th e 2 0 1 0 and 2011 g ra d u a tin g years w h e n the survey w as a d m in is te re d p rio r to Q U EST (p < 0.0001 ). The responses to the survey betw een the 2 cohorts, w h ic h had the survey adm inistered at diffe re n t points in th e ir u ro lo g ic a l tra in in g and by d iffe re n t m ethods, w ere e xplored to determ ine any sig n ifica n t differences in th e ir attitudes and experiences in pursuing further tra in in g after resi dency. Interestingly, no substantive o r statistically sig n ifica n t trends w ere observed betw een the cohorts and over the years o f graduatin g residents (data not show n). The o n ly difference w as th e response rate. G iv e n the co n siste n cy in the survey responses, it was d ecided post-hoc to c o m b in e the data from the 2 cohorts rather than describe the results separately. The o v e rw h e lm in g m a jo rity o f g ra d u a tin g residents fro m 2 0 0 8 to 2011 p ursued a fe llo w s h ip , w ith 5 3 .5 % p u rsu in g a c lin ic a l fe llo w s h ip w ith a research c o m p o n e n t, 2 9 .1 % a c lin ic a l fe llo w s h ip , and 2 .3 % a p u re ly rese a rch-orien ted fe llo w s h ip . O f th e re m a in in g g raduate s, 1 2 .8 % started a u ro lo g ic a l p ra c tic e in C anada, and 2 .3 % p u rs u in g a lo cu m rig h t after residency. O f those p ursuing a fe llo w s h ip betw een 2 0 0 8 and 2 0 1 1 , o n c o lo g y (35.2% ) and m in im a lly invasive surgery o r e n d o u ro lo g y (33.8% ) w e re the m ost fre q u e n t sub sp e cia ltie s chosen. The b re a k d o w n fo r th e re m a in in g sub specialties was 1 4 .1 % fo r re c o n s tru c tio n o r fe m a le uro lo g y, 8 .5 % fo r p e d ia tric u ro lo g y , 5 .6 % fo r a n d ro lo g y /in fe rtility , and 2 .8 % fo r tra nsplanta tion. The m ean and m edian num ber o f papers o r abstracts c o -a u th o re d d u rin g residency o f this g ro u p was 9 .9 and 7, re sp e ctive ly. The reasons fo r p u rs u in g a fe llo w s h ip w e re p robed w ith pla u sib le , closed-end ed questions and candidates rated th e ir answ ers w ith a 5 p o in t L ik e rt scale (Fig. 1). A n interest in having a focused p ra c tic e in u ro lo g y was the m ost c o m m o n ly cite d ju s tific a tio n , w ith 8 4 .9 % agreeing w ith this statem ent and a m ean score o f 4 .2 6 (± 0 .8 SD) on th e 5 -p o in t Likert
CUAJ • November-December 2014 • Volume 8, Issues 11-12
Resident experiences in pursuing postgraduate fellowships
0.00
Interest in Pursuing an Academic Career
Unable to Find a Obtaining Interest in Feel that Interest in Suitable Position Focusing your Marketable Residency did Learning about Skills for an Research not Equip you Practice to this in Urology Area of Urology with the Skills in Canada Acceptable Methodology Position in the Needed to Community Practice Urology
Fig. 1. Reasons for pursuing a fellowship. Responses from 2 cohorts of urology trainees representing graduating residents from 2008 to 2011 on stated reasons for pursuing postgraduate training. Responses to questions were combined from all respondents. Bar graph represents mean Likert Score ± standard deviation. Likert scores are grounded by 3 or "neutral" attitude. A response of 5 represents "strongly agree” and 1 represents "strongly disagree."
scale. Other reasons with over 50% agreement included an interest in pursuing an academic career (61.6%, 3.73 ± 1.1), and obtaining marketable skills to secure employment in urology (64.4%, 3.59 ± 1.3). Conversely, only 19% of respondents agreed or strongly agreed (mean 2.49 ± 1.2) that residency did not equip them with adequate skills to practice urology without further training, with 52.1% dis agreeing or strongly disagreeing with this statement. For all respondents between 2008 and 2011, 61.7% of subjects had completed an elective in community urology during residency. Many respondents agreed (54.2%) that a
3rogram Director
Urology Faculty
Networking at Meetings
community elective was essential to improve their surgical skills, with a mean score of 3.48 (± 1.1 ). In addition, there appeared to be strong consensus (74.0% strongly agreed or agreed) that these residents would have benefited from additional time in a community setting (mean 4.00 ± 1.0). Most residents (81.2%: 4.04 ± 1.0) agreed that by the end of residency, they knew enough about academic practice to know if it would be a suitable career choice. This is in contrast to a similar question concerning the understanding of a non-academic, community practice, with only 54.7% agreement (mean 3.43 + 1.2, p < 0.0001 ).
Own Initiative
SubSpecialty Associations
Elective at an Outside Institution
Research Productivity During Residency
Fig. 2. Helpful resources for finding a fellowship. Responses from 2 cohorts of urology trainees representing graduating residents from 2008 to 2011 on the resources used to aid in finding fellowship positions. Responses to questions were combined from all respondents. Bar graph represents mean Likert Score ± standard deviation. Likert scores are grounded by 3 or "neutral" attitude. A response of 5 represents "strongly agree" and 1 represents "strongly disagree."
CUAJ • November-December 2 0 1 4 » Volume 8, Issues 11-12
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Tourna and Siemens
W ith respect to th e process o f p u rs u in g a fe llo w s h ip , the vast m a jo rity m a d e th e ir d e c is io n in P G Y -4 (4 1 .3 % ) and PG Y-3 (3 7 .3 % ), w ith o n ly 1 0 .7 % fin a liz in g th e ir d e c is io n
to a sp e c ific area o f u ro lo g y . F urtherm ore, there was agree
in PG Y-5. In te re stin g ly , 1 0 .6 % o f responde nts m ade th e ir d e cisio n o f typ e o f fe llo w s h ip ve ry ea rly in tra in in g (
Cite os: Can Urol Assoc J 2014;8(1 1-12):437-41. http://dx.doi.org/10.5489/cuoj.2136 Published online December 15,2014.
Abstract Introduction: There have been significant pressures on urology training in North America over the last decade due to both the constantly evolving skill set required and the external demands around delivery o f urological care, particularly in Canada. We explore the attitudes and experience of Canadian urology residents toward their postgraduate decisions on fellowship opportunities. Methods: The study consisted of a self-report questionnaire of 4 separate cohorts of graduating urology residents from 2008 to 2011. The first cohort graduating in 2008 and 2009 were sent surveys through SurveyMonkey.com after graduation from residency; those graduating in 2010 and 2011 were prospectively invited as a con venience sample attending a Queen's Urology Examination Skills Training Program review course just prior to graduation. The survey included both open- and closed-ended questions, em ploying a 5-point Likert scale, and explored the attitudes and experience of fellowship choices. Likert scores for each question were reported as means ± standard deviation (SD). Descriptive and correlative statistics were used to analyze the responses. In addition, an agree ment score was created for those responding w ith "strongly agree" and "agree" on the Likert scale. Results: A total of 104 surveys were administered, w ith 84 respon dents (80.8% response rate). As a whole, 84.9% o f respondents agreed that they pursued fellowships; oncology and m inim ally invasive urology were the most popular choices throughout the 4 years. Respondents stated that reasons for pursuing a fellowship included: interest in pursuing an academic career (mean 3.73± 1.1 (SD): agreement score 61.1%) as well as acquiring marketable skills to obtain an urology position (3.59 ± 1.3: 64.4%). Most agreed or strongly agreed (84.9%) that a reason for pursing a fellowship was an interest in focusing their practice to this sub-specialty area. In comparison, most graduates disagreed that a reason for pursuing a fellowship was that residency did not equip them w ith the nec essary skills to practice urology (2.49 ± 1.2: 19%). Most (81.2%) of graduates agreed they knew enough about academic urology to know if it w ould be a suitable career choice for them versus 54.7% regarding com m unity urology (p < 0.0001). Surprisingly,
only 61.7% o f residents agreed that they completed a comm unity elective during training, and most felt they w ould have benefited from additional elective time in the community. Conclusions: U rology residents graduating from Canadian pro grams pursue postgraduate training to enhance their surgical skill set and to achieve marketability, but also to facilitate a potential academic career. Responses from the trainees suggest that exposure to comm unity practice appears suboptimal and may be an area of focus for programs to aid in career counselling and professional development.
Introduction The practice of urology is ever evolving and this is particu larly evident by the relatively recent shift in the surgical management of many urological disorders towards more minimally-invasive techniques. As well as navigating these significant changes in terms of knowledge and skills in sub specialty areas, training programs need to further balance time and effort towards the formal education in broader physician roles in practice and in the community, beyond the role of medical expert. 1,2 With the adoption of these roles and competencies by accrediting bodies, their incorporation into postgraduate curricula objectives has added to the com plexity of the training and evaluation of urology trainees . 3' 6 Postgraduate education in surgical disciplines, including residency and subsequent fellowship, is further confounded by the changing societal requirements of practitioners and the availability of healthcare resources. Most graduating urology residents in North America will practice in non-academic settings where practice patterns and availability of technol ogy may vary considerably. In Canada, the discrepancy in the number of trained surgeons and the available hospital resources has recently stimulated dialogue around significant unemployed or under-employed specialists. As well, there are concerns about the documented decline in the number of physician-scientists in surgical practice. 7,8 This has stimu-
CUAJ • November-December 2014 • Volume 8, Issues 11-12 © 2014 Canadian Urological Associofion
437
Tourna and Siemens
lated an increasing focus on scie n tific in q u iry and research in
an a g re e m e n t score c o m b in in g th e responses o f 4 (agree)
m edical school and residency tra in in g . The e ffica cy o f these
and 5 (stro n g ly agree) w as created and rep o rte d a longsid e
in itia tiv e s in s tim u la tin g y o u n g e r c lin ic ia n s to a c q u ire the
th e m ean 5 -p o in t L ike rt score fo r each q u e s tio n .10S im ila rly ,
research skills to access an academ ic career alone is lim ite d
a d isagreem e nt score was re ported by c o m b in in g responses
and post-residency fe llo w sh ip s are generally a requirem ent.
o f 1 (strongly disagree) and 2 (disagree). The a n c h o rin g score
These re a litie s have e n c o u ra g e d C a n a d ia n residents to pu rsu e fu rth e r tra in in g th ro u g h c lin ic a l and research fe l
o f 3 on th e L ik e rt score w as d e sc rib e d as " n e u tra l" on th e survey. The c h i-s q u a re and Fisher e xa ct tests w e re used to
lo w s h ip s .9 The u n d e rly in g reasons fo r th is o b s e rv a tio n are
c a lc u la te s ig n ific a n c e b e tw een 2 separate fre q u e ncie s. The
p o o rly u n d e rsto o d and lik e ly affe cte d b y m u ltip le factors,
W ilc o x o n S igned-R a nks test w as used to c o m p a re L ik e rt
in c lu d in g in d iv id u a l trends in career c h o ic e , external d riv
scale scores o f respondents b e tw een th e years o f th e study
ers such as m a rke t forces, as w e ll p o te n tia lly self-assessed
and b e tw een s p e c ific a lly lin k e d question s. Vassar Statistics
d e fic ie n c ie s in surgical s k ill a tta in m e n t. The p urpose o f this
w as used fo r a ll statistical analysis.
study is to e lu c id a te the attitudes and experience s in fo rm in g th e p u rs u it o f fu rth e r p o s t-re s id e n c y tra in in g o f C a n a d ia n
R e s u lts
u ro lo g y residents. A to ta l o f 104 surveys w e re a d m in is te re d w ith 84 re spon dents, fo r an o v e ra ll response rate o f 8 0 .8 % . The response
M e th o d s W e in c lu d e d r e c e n tly g ra d u a te d o r s o o n to g ra d u a te C anadian u ro lo g y residents fo r 4 co n se cu tive years betw een 2 0 0 8 and 2 0 1 1 . These tra in e e s w e re surve ye d as 2 sepa rate co h o rts. The firs t sam ple consisted o f 2 0 0 8 and 2 0 0 9 graduates w h o w e re a d m in is te re d a survey o n lin e th ro u g h s u rv e y m o n k e y .c o m in th e fa ll o f 2 0 1 0 . A u to m a tic e -m a ils w e re sent, w ith 1 re m in d e r e -m a il sent 2 w e e ks a fte r th e in itia l e m a il w ith a lin k to th e survey. T he second c o h o rt w as a c o n v e n ie n c e sam ple o f PGY-5 residents in b o th 2 0 1 0 and 2011 years at the tim e o f the ann u a l Q u e e n 's U ro lo g y E xam ination S kills T ra in in g Program (QUEST) in Kingston, O n ta rio . The q u e stio n n a ire was a d m in iste re d to w illin g p a r tic ip a n ts in an a u d ito riu m at th e b e g in n in g o f th e program b efore th e start o f th e p ro g ra m in 2 0 1 0 and 2 0 1 1 . A ll sur vey responses w e re ano n ym o u s. The 2 cohorts, a ro u n d the end o f th e ir re sid e n cy o r d u rin g th e ir fe llo w s h ip tra in in g , w e re targeted fo r th e survey. W e chose these p a rtic ip a n ts as th e y w o u ld m ost lik e ly be a rra n g in g o r c o m p le tin g th e ir fe llo w s h ip a ctivitie s. Ethics a p p ro v a l w as o b ta in e d fro m the Q u e e n 's U n iv e rs ity in s titu tio n a l re v ie w b o a rd w ith assur ance o f c o n fid e n tia lity p ro v id e d to all p a rticip a n ts. The q u e stio n n a ire consisted o f 20 o p e n - and close-ended questions e x p lo rin g residents' plans after c o m p le tio n o f resi dency tra in in g (h ttp ://jo u rn a ls .s fu .c a /c u a j/in d e x .p h p /jo u rn a l/ a rtic le /v ie w /2 1 3 6 /1 9 5 0 ). The q u e stio n n a ire was d e ve lo p e d s p e c ific a lly fo r this survey on fe llo w s h ip pursuits and re su lt ed fro m p re vio u s experience s w ith survey c o n s tru c tio n fo r s im ila r attitudes fo r sp e c ia lty residents.5-6 A lim ite d n u m b e r o f residents and e d u c a to rs in v o lv e d in p o s tg ra d u a te p ro grams w e re asked to assess and m o d ify the survey fo r c la rity . D e scrip tive statistics w e re used to describe dem ograp hics and b a ckg ro u n d in fo rm a tio n o f respondents. Responses to th e questions using th e 5 -p o in t Like rt scale are describ e d as means ± standard d e v ia tio n (SD). For ease o f re p o rtin g and to d istin g u ish trends in the in te n s ity o f the survey responses,
438
rate w as lo w e r (55.6% ) w h e n th e survey w as a d m in iste re d th ro u g h s u rv e y m o n k e y .c o m fo r th e 2 0 0 8 and 2 0 0 9 g ra d u a tin g years c o m p a re d w ith 1 0 0 % fo r th e 2 0 1 0 and 2011 g ra d u a tin g years w h e n the survey w as a d m in is te re d p rio r to Q U EST (p < 0.0001 ). The responses to the survey betw een the 2 cohorts, w h ic h had the survey adm inistered at diffe re n t points in th e ir u ro lo g ic a l tra in in g and by d iffe re n t m ethods, w ere e xplored to determ ine any sig n ifica n t differences in th e ir attitudes and experiences in pursuing further tra in in g after resi dency. Interestingly, no substantive o r statistically sig n ifica n t trends w ere observed betw een the cohorts and over the years o f graduatin g residents (data not show n). The o n ly difference w as th e response rate. G iv e n the co n siste n cy in the survey responses, it was d ecided post-hoc to c o m b in e the data from the 2 cohorts rather than describe the results separately. The o v e rw h e lm in g m a jo rity o f g ra d u a tin g residents fro m 2 0 0 8 to 2011 p ursued a fe llo w s h ip , w ith 5 3 .5 % p u rsu in g a c lin ic a l fe llo w s h ip w ith a research c o m p o n e n t, 2 9 .1 % a c lin ic a l fe llo w s h ip , and 2 .3 % a p u re ly rese a rch-orien ted fe llo w s h ip . O f th e re m a in in g g raduate s, 1 2 .8 % started a u ro lo g ic a l p ra c tic e in C anada, and 2 .3 % p u rs u in g a lo cu m rig h t after residency. O f those p ursuing a fe llo w s h ip betw een 2 0 0 8 and 2 0 1 1 , o n c o lo g y (35.2% ) and m in im a lly invasive surgery o r e n d o u ro lo g y (33.8% ) w e re the m ost fre q u e n t sub sp e cia ltie s chosen. The b re a k d o w n fo r th e re m a in in g sub specialties was 1 4 .1 % fo r re c o n s tru c tio n o r fe m a le uro lo g y, 8 .5 % fo r p e d ia tric u ro lo g y , 5 .6 % fo r a n d ro lo g y /in fe rtility , and 2 .8 % fo r tra nsplanta tion. The m ean and m edian num ber o f papers o r abstracts c o -a u th o re d d u rin g residency o f this g ro u p was 9 .9 and 7, re sp e ctive ly. The reasons fo r p u rs u in g a fe llo w s h ip w e re p robed w ith pla u sib le , closed-end ed questions and candidates rated th e ir answ ers w ith a 5 p o in t L ik e rt scale (Fig. 1). A n interest in having a focused p ra c tic e in u ro lo g y was the m ost c o m m o n ly cite d ju s tific a tio n , w ith 8 4 .9 % agreeing w ith this statem ent and a m ean score o f 4 .2 6 (± 0 .8 SD) on th e 5 -p o in t Likert
CUAJ • November-December 2014 • Volume 8, Issues 11-12
Resident experiences in pursuing postgraduate fellowships
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Interest in Pursuing an Academic Career
Unable to Find a Obtaining Interest in Feel that Interest in Suitable Position Focusing your Marketable Residency did Learning about Skills for an Research not Equip you Practice to this in Urology Area of Urology with the Skills in Canada Acceptable Methodology Position in the Needed to Community Practice Urology
Fig. 1. Reasons for pursuing a fellowship. Responses from 2 cohorts of urology trainees representing graduating residents from 2008 to 2011 on stated reasons for pursuing postgraduate training. Responses to questions were combined from all respondents. Bar graph represents mean Likert Score ± standard deviation. Likert scores are grounded by 3 or "neutral" attitude. A response of 5 represents "strongly agree” and 1 represents "strongly disagree."
scale. Other reasons with over 50% agreement included an interest in pursuing an academic career (61.6%, 3.73 ± 1.1), and obtaining marketable skills to secure employment in urology (64.4%, 3.59 ± 1.3). Conversely, only 19% of respondents agreed or strongly agreed (mean 2.49 ± 1.2) that residency did not equip them with adequate skills to practice urology without further training, with 52.1% dis agreeing or strongly disagreeing with this statement. For all respondents between 2008 and 2011, 61.7% of subjects had completed an elective in community urology during residency. Many respondents agreed (54.2%) that a
3rogram Director
Urology Faculty
Networking at Meetings
community elective was essential to improve their surgical skills, with a mean score of 3.48 (± 1.1 ). In addition, there appeared to be strong consensus (74.0% strongly agreed or agreed) that these residents would have benefited from additional time in a community setting (mean 4.00 ± 1.0). Most residents (81.2%: 4.04 ± 1.0) agreed that by the end of residency, they knew enough about academic practice to know if it would be a suitable career choice. This is in contrast to a similar question concerning the understanding of a non-academic, community practice, with only 54.7% agreement (mean 3.43 + 1.2, p < 0.0001 ).
Own Initiative
SubSpecialty Associations
Elective at an Outside Institution
Research Productivity During Residency
Fig. 2. Helpful resources for finding a fellowship. Responses from 2 cohorts of urology trainees representing graduating residents from 2008 to 2011 on the resources used to aid in finding fellowship positions. Responses to questions were combined from all respondents. Bar graph represents mean Likert Score ± standard deviation. Likert scores are grounded by 3 or "neutral" attitude. A response of 5 represents "strongly agree" and 1 represents "strongly disagree."
CUAJ • November-December 2 0 1 4 » Volume 8, Issues 11-12
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Tourna and Siemens
W ith respect to th e process o f p u rs u in g a fe llo w s h ip , the vast m a jo rity m a d e th e ir d e c is io n in P G Y -4 (4 1 .3 % ) and PG Y-3 (3 7 .3 % ), w ith o n ly 1 0 .7 % fin a liz in g th e ir d e c is io n
to a sp e c ific area o f u ro lo g y . F urtherm ore, there was agree
in PG Y-5. In te re stin g ly , 1 0 .6 % o f responde nts m ade th e ir d e cisio n o f typ e o f fe llo w s h ip ve ry ea rly in tra in in g (
