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Journal of Clinical Urology
http://uro.sagepub.com/content/early/2014/02/19/2051415813519627
The online version of this article can be found at:
DOI: 10.1177/2051415813519627
published online 19 February 2014Journal of Clinical Urology
Hamid Abboudi, Andrew Chetwood, Rajesh Nair, Marco Bolgeri, Charles Coker, Tim Larner and James Green
students
An introductory course in urology: results of a novel course for foundation doctors and medical
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Journal of Clinical Urology
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© British Association of
Urological Surgeons 2014
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DOI: 10.1177/2051415813519627
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Introduction
In recent years urology has been regarded as one of the
most undersubscribed surgical specialties, with a ratio of
approximately five applicants to one place.1 To make an
informed decision, future trainees and undergraduates
require exposure to the specialty and advice from those
practicing within the specialty. It is felt there is a lack of
urology exposure for medical students within the under-
graduate and junior doctor curricula both in the United
Kingdom (UK) and the United States (US).2 Students in
only 17% of US medical schools currently receive
didactic training in urology, while in the UK 58% of
medical students do not have compulsory urology clini-
cal attachments.3,4
An introductory course in urology: results
of a novel course for foundation doctors
and medical students
Hamid Abboudi1, Andrew Chetwood1, Rajesh Nair1, Marco
Bolgeri1, Charles Coker1, Tim Larner1 and James Green2
Abstract
Objective: The objective of this article is to critically assess the value of a medical student and junior doctor weekend
introduction to urology course.
Materials and methods: All UK medical students and foundation doctors were invited to attend an introductory
course held at The Royal Society of Medicine, London, organised by the Section of Urology. The course included
consultant-delivered lectures, practical skills sessions and an academic competition.
Pre- and post-course feedback questionnaires were used to assess (a) perceptions of urology as a specialty, (b) career
aspirations and (c) confidence performing basic urological surgical skills.
Results: Sixty delegates attended from a variety of UK medical schools and hospitals. Seventy-three per cent of
respondents were more likely to pursue a career in urology post-course. The most common negative perceptions
included being a competitive career with long training and lacking glamour. Confidence in suturing, knot tying, suprapubic
catheterisation, basic laparoscopy and cystoscopy were significantly improved following this course (p < 0.005).
Conclusion: A short urology course should be offered to medical students by urology departments and surgical
societies; it will benefit students as well as the specialty. It is important that medical students are exposed early to
urology given both positive and negative perceptions. Such initiatives may help strengthen the positive perceptions and
dispel negative perceptions while increasing delegates’ desire to pursue a urology career.
Keywords
Career, education, junior doctor, training, undergraduate
Date received: 29 September 2013; revised: 16 October 2013; accepted: 7 December 2013
1Department of Urology, Royal Sussex County Hospital, UK
2Whipps Cross General Hospital, UK
Corresponding author:
Hamid Abboudi, Department of Urology, Royal Sussex County
Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Email: hamid.abboudi@doctors.org.uk
519627URO0010.1177/2051415813519627Journal of Clinical UrologyAbboudi et al.
research-article2014
Original Article
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2 Journal of Clinical Urology
A survey in 2002 revealed that urology was part of the
undergraduate curriculum at 37% of responding medical
schools.5 A UK-based online questionnaire to all newly
qualified foundation doctors in 2010 revealed that 60% and
72% of respondents had not inserted a female catheter and a
three-way catheter, respectively.6 Limited exposure of med-
ical students has resulted in the perception that the majority
of the urology workload is male dominated and repetitive.7
It is encouraging to see the support of organizations such
as the British Association of Urological Surgeons (BAUS)
and the Royal College of Surgeons of England (RCS Eng).
The BAUS ‘introduction to urology course’ and the RCS
Eng urology modules 1–4 have been heavily oversub-
scribed. However, these are primarily aimed at existing core
surgical trainees (three to four years’ post-graduation).
The Urology Section of the Royal Society of Medicine
hosted the first documented one-and-a-half-day urology
careers course aimed at medical students and junior doc-
tors in the first two years of post-graduate training. Our
aim was to introduce delegates to the varied field of urol-
ogy. Over the duration of the course, we assessed change
in perceptions of urology as a specialty and confidence
performing basic urological surgical skills.
Method
All UK medical students from any year of study and foun-
dation year 1 and 2 doctors were invited to attend the course
held at The Royal Society of Medicine, London. The course
took the format of consultant-led talks about the different
subspecialties within urology (Table 1) followed by five
rotating workshops with a tutor-to-delegate ratio of 1:8.
The workshops covered the following topics (Figure 1):
Suturing and surgical knot tying: The main tutor gave a brief
talk regarding the principles of sutures and wound healing
followed by a demonstration. Tutors then supervised their
delegates performing various suturing techniques and knot
tying on specialised suturing pads.
Laparoscopy: Tutors took their delegates through basic
principles of laparoscopy, handling of instruments and
exercises including sugar cube stacking, object placement,
and intracorporal suturing.
Catheterisation: Each delegate was instructed on and
performed, using sterile technique, the male and female
urethral and suprapubic catheter placement on a silicone
model under supervision by a surgical trainee.
Rigid cystoscopy: Delegates listened to an introductory talk
covering the basics of urethral and bladder anatomy. Each
delegate had the opportunity to use the cystoscope to examine
a bladder model and perform ureteric guidewire placement.
Core surgical application process: Students had a question-
and-answer session with current core surgical trainees who
shared their experience of applications, interviews and
portfolio development with the delegates.
Table 1. Lecture topics, each between 15 and 25 minutes.
What is urology?
History of urology.
Plan for urological training, career prospects, and academic
pathways.
Writing a paper, how to get research published.
Imaging in urology.
Laparoscopy.
The future and robotics.
The use of lasers in urology.
Endourology.
Urological emergencies.
Paediatric urology.
Andrology.
Benign prostatic hyperplasia.
Urological malignancy.
Female/reconstructive urology.
Figure 1. Urology workshops: (a) suturing, (b) laparoscopy and (c) cystoscopy.
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Abboudi et al. 3
Delegates were asked to complete a pre- and post-
course questionnaire (Appendix A). This was designed to
assess three key areas:
Career plans: Delegates were asked to rank all surgical
specialties from 1 to 11 depending on their interest in pursuing
that specific surgical field.
Perceptions of urology: Delegates were given both positive
and negative perceptions about urology and asked to identify
which descriptions apply to urological surgeons.
Surgical skills: Delegates were asked to record on a Likert
scale (1= strongly disagree, 5= strongly agree) their
confidence in performing basic urological skills.
The course also adopted an academic element, with a
‘call for abstracts’ to compete for a research poster prize.
Results were presented as mean scores. Results were
analysed using the paired t-test, with p < 0.05 deemed sta-
tistically significant.
Results
Sixty delegates attended from a variety of UK medical
schools and hospitals. Of these, 30 completed pre- and
post-course questionnaires giving a response rate of 50%.
Approximately 50% of delegates were undergraduates
while the remainder were within the first two years of
post-graduate training.
Delegates were asked to rank urology against the other
main surgical specialties (a total of 11) depending on their
‘interest in pursuing that surgical field’. The mean rank for
urology was 1.9 and 1.6 pre- and post-course, respectively,
with 1 being the most popular and 11 the least.
Prior to the course the most common positive precon-
ceptions of urology as a speciality were improving patient
quality of life (22/30), being challenging (18/30), cutting
edge (18/30) and rewarding (18/30). The most common
negative perceptions included being a competitive career
(10/30) with long training (10/30) and lacking glamour
(10/30). Post-course delegates felt that diversity (29/30)
was the most positive feature of urology, with improving
patient quality of life (27/30) and the challenging nature of
the speciality (23/30) being the next most commonly
selected. They commented that the competitive aspects
(19/30), long hours (10/30) and long training (9/30) were
the most negative aspects of a career in urology, with no
delegates commenting on the lack of glamour post-course.
Seventy-three per cent (n = 22) of delegates said that
the course would make them more likely to pursue a career
in urology. Thirty-two research posters were presented,
including case reports, audits, clinical data as well as basic
science research.
Discussion
We have presented the results of a novel introduction to
urology course held over one and a half days. The impor-
tance of undergraduate and junior doctor exposure to urol-
ogy cannot be overstated; with 5%–10% of general practise
consultations pertaining to a urological problem, an in-
depth understanding of the specialty is paramount.8
Delegates ranked urology, before and after the course,
as the surgical specialty they aspire to embark on. This is
expected as delegates attending an undergraduate urology
course are more inclined to the speciality.
However, urological surgery is the only field that expe-
rienced an increase in its mean score upon completion of
the course. This can be explained by delegates re-affirming
their aspirations by listening to inspirational and realistic
talks and by the surgical skills learnt. Furthermore, dele-
gates who did not consider urology as a career option, hav-
ing clarified some of the preconceived misconceptions,
developed an interest in pursuing it as a career.
In terms of positive perceptions, there was an 80%
increase in delegates’ awareness of the various subspecial-
ties within urology and a 17% increase in delegates’ aware-
ness of quality of life improvement and challenging nature.
There was a 30% increase in their awareness of the com-
petitive nature of the specialty. The high competition ratio
Table 2. Mean rank from 1 to 5 (1 = strongly agree, 5 = strongly disagree) for the pre- and post-course views from the delegates
as to how confident they were in some core skills relevant to urology.
Mean pre-
course score
Mean post-
course score
p value
Suturing 2.7 1.9 <0.05
Knot tying 2.8 2 <0.05
Urethral catheterisation 2.4 1.9 <0.05
Supra-pubic catheterisation 4.2 2.4 <0.05
Basic laparoscopy 4 2.3 <0.05
Cystoscopy 4.1 2.2 <0.05
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4 Journal of Clinical Urology
for training posts was discussed during the career section
in the morning session. Regarding negative perceptions,
there was a –100% change in delegates who perceived
urology as ‘lacking glamour’. Delegates were more aware
of the long hours and long training pathway in urology
with a change of 27% and 43%, respectively.
The stark change in delegates’ perceptions of urology
lacking glamour may be a reflection of the lack of expo-
sure of medical students to urology during their surgical
rotations and undergraduate curriculum.
The third part of the questionnaire assessed the dele-
gates’ confidence in performing specific basic urology
skills that was based on a self-reported Likert scale.
There was a statistically significant increase in self-
reported confidence scores in all six main categories with
the largest increase in performing rigid cystoscopy, with a
mean score of 4.1 and 2.2 (p < 0.0001) before and after the
course, respectively (Table 2). The results indicate the
importance of teaching those basic skills and clarifying
basic concepts that undergraduates are not exposed to.
This will develop a solid foundation for undergraduates to
build on as they progress in their careers. Furthermore, the
increase in confidence performing different forms of sutur-
ing will enable undergraduates to be more proactive when
assisting in theatre during their surgical rotations.
Upon completion of the course, 73% felt that such a
course is more likely to influence their career decision and
pursue urology.
There is an ever-increasing pressure for medical stu-
dents to decide on their future career paths early in training
and thus tailor their curriculum vitae (CVs) accordingly.
Therefore courses in urological surgery are potential cata-
lysts to instil interest. Career choice is based on precon-
ceived ideas and ‘positive exposure’ to a specialty, both of
which can be driven during influential courses.9 Kaplan
et al. were the first to describe how a two-day genitourinary
skills course significantly increases urology knowledge and
skills interest in medical students.10
We believe a short urology course should be offered to
medical students and junior doctors by urology departments
and surgical societies because it may benefit students and
the specialty. It has been estimated that 41% of benign pros-
tate hyperplasia (BPH) referrals to urologists could be man-
aged in primary care and 35% of urologists’ time with BPH
patients is spent seeing inappropriate general practitioner
(GP) referrals.6 Additionally, primary care physicians are
less likely to prescribe appropriate medical therapy for
lower urinary tract symptoms compared to urologists, while
non-urologists are more likely to inappropriately request
prostate-specific antigen (PSA) tests.11,12 Benefits to urolo-
gists of increased exposure to the specialty include improved
quality of patient referrals and improved basic urological
knowledge in non-urological surgery trainees.
Urology is a challenging career and junior doctors wish-
ing to secure a urology-training programme must have a
strong academic record. This was the emphasis behind
including an academic component to the course. Such occa-
sions provide students with an opportunity to expand their
CVs as well as encourage the development of an evidence-
based approach to their practise from an early stage. Medical
students and junior doctors are under increasing pressure to
choose their future specialty at an earlier stage. With the
often limited teaching of urology at medical schools, stu-
dents are less informed about the specialty.13 It has been
shown that the positive influence from a consultant plays a
large role in a particular career choice.2 Consequently, it is
important that medical students are exposed early to the
field of urology to engender positive perceptions and dispel
negative preconceived ideas, as seen by this study.
Conclusion
A short urology course should be offered to medical stu-
dents; it will benefit students as well as the specialty. It is
important that medical students are exposed early to urol-
ogy, given both positive and negative perceptions. Such
initiatives may help strengthen the positive perceptions and
dispel negative perceptions while increasing delegates’
desire to pursue a urology career. It can teach students basic
urological surgical skills, which are useful to any surgical
specialty and to allied specialties such as emergency medi-
cine. It may also alert students at an early stage that urology
is a difficult specialty to get into and may encourage moti-
vated students to work harder to achieve their goals to suc-
ceed in the specialty. We encourage urology departments
and surgical societies to offer similar courses.
Conflict of interest
None declared.
Funding
This research received no specific grant from any funding agency
in the public, commercial, or not-for-profit sectors.
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