The impact of formal education and training on urodynamic practice in the United Kingdom: A survey

Statistical process control for the analysis of quality control in urodynamics: A potential new approach for quality review of urodynamics

PURPOSE

To analyze quality control in urodynamic studies, using a proportion control chart (p-chart) for statistical process control.

MATERIALS AND METHODS

This single-center study was conducted at the Urodynamic Center of West China Hospital, Sichuan University. We randomly selected 15 samples from each month in 2020, and 180 urodynamic traces were finally enrolled. We used the p-chart of statistical process control for analysis. We calculated the proportion of the incidence of a selected set of artefacts in the monthly urodynamic study process, including non-standard zero setting, no cough test, incomplete records of all measurements by urodynamicists, catheter displacement, and baseline drift. Through the specific calculation formula of statistical process control, we obtained the values of the center line, lower control limit, and upper control limit.

RESULTS

All data points of each artefact were within zone A. However, one outlier was found in the p-chart of all artefacts in October, which might have been caused by inexperienced operators.

CONCLUSIONS

Statistical process control may play an important role in the process control of urodynamic studies and guide us in identifying the cause of poor quality in process management.

Impact of a 1-day urodynamic course on knowledge, perceptions, and attitudes of urology residents

AIMS

No evidence-informed educational curriculum is available for designing urodynamics (UDS) courses. We evaluated the learning outcomes of a short-lasting urodynamic course for urology residents.

METHODS

Urology residents of postgraduate years 4 and 5 (n = 13 and n = 1316, respectively) attended a 1-day urodynamic course. Learning objectives included patient preparation, indication and technique, terminology, trace interpretation, and impact on patient management. Instructional methods consisted of short lectures (3 h) and case-based discussions (7.5 h). Learners' reactions, modifications of perceptions and attitudes, and acquisition of knowledge and skills were assessed by three written tests with a single group, pretest, posttest 1, and posttest 2 design. Tests were conducted precourse, 1 week after, and 4 months after the course.

RESULTS

All participants felt more confident in several urodynamic competencies after the course, including patient preparation, urodynamic indication and technique, terminology, trace interpretation, and impact for patient management. These perceptions remained unchanged after 4 months. Most became stricter in the indication of UDS, including 20 (87.0%) at posttest 1 and 8 (66.7%) at posttest 2. The mean number of correct answers in the knowledge evaluation was 52.2% versus 61.4% versus 56.7%, respectively at pretest, posttest 1, and posttest 2; p = 0.535). All participants rated the course as very useful or useful in both posttest evaluations.

CONCLUSIONS

Our study demonstrates that a 1-day urodynamic course can promote lasting improvements in self-reported perceptions, attitudes, and urodynamic-related competencies of urology residents. Further studies using evidence-informed educational principles are needed to determine the effect of specific educational interventions on urodynamic competencies in different contexts.

Is the value of urodynamics undermined by poor technique?: ICI-RS 2018

INTRODUCTION

The quality of urodynamic measurements in clinical practice has been debated as a matter of concern. It is considered plausible that this has a direct bearing on patient care and the perceived value of urodynamic testing.

METHODS

This is a report of the proceedings of the Think Tank: "Is the value of urodynamics undermined by poor technique?" from the Annual International Consultation on Incontinence-Research Society, which took place in June 2018 in Bristol, UK. The Think Tank discussed the evidence for deficiencies in urodynamic test quality and considered the implications of improvements for clinical diagnosis and practice.

RESULTS

There is evidence that technique affects urodynamic quality, and that urodynamic practice is variable. Factors such as team skill set, technologies used, and training received will also affect the quality of urodynamic service. Questions exist regarding the influence of technique on the utility and perceived value of urodynamics.

CONCLUSIONS

We suggest research questions that will provide the necessary evidence on the link between technique, reporting, and outcome, and clarify the role of good practice in the utility of urodynamic testing.

Teaching and evaluation of basic urodynamic skills in urology residency programs: Randomized controlled study

AIMS

Considering the growing role of urodynamic studies (UDS) in urology, we aimed to determine the most effective teaching method with objective evaluation for urodynamic skills, to improve training and patient care.

METHODS

Urology residents (n = 20) post-graduate years 3-5 were randomized to receive either a UDS video training module or a standard UDS teaching document one week prior to an objective structured clinical examination (OSCE). The OSCE was a validated visual recognition exam with interpretation of 12 UDS tracing scenarios. Participants rated their proficiency to interpret UDS tracings before doing the OSCE. Total interpretation score was determined by the accuracy of their response to each question ranging from 0 to 2.

RESULTS

The mean total interpretation score was 13.3 of 24 (55%). The video group achieved significantly higher interpretation scores (15.1 ± 2.08 vs 11.4 ± 2.41, P = 0.0017), and cumulative certainty scores (P = 0.0341). Overall interpretation scores significantly correlated with self-reported proficiency scores prior to the exam (r = 0.502, P < 0.05), and total certainty scores (r = 0.531, P < 0.05).

CONCLUSIONS

Reviewing a UDS video training module resulted in significantly better scores on objective assessment of urology residents' UDS interpretation skills when compared with a standard teaching document. These findings must be interpreted with caution in light of sample size and short knowledge retention required for the assessment within a week. Therefore, using a UDS video training module could be more effective review tool for urology residents. These findings highlight the need to incorporate multimedia teaching into urology training curriculum.

The evidence for urodynamic investigation of patients with symptoms of urinary incontinence

Urodynamic studies are the gold standard to objectively diagnose dysfunction of the lower urinary tract. The widely available evidence for the clinical relevance is, however, fragmented. This article summarizes the published knowledge supporting the use of urodynamic studies in urinary incontinence in female, male and frail patients, as well as patients with relevant neurological disease. Five technological innovations are discussed briefly. Standard urodynamic cystometry can, on the basis of a solid body of evidence, objectively unveil the entire function of the lower urinary tract in all patients with urinary incontinence, regardless of the patients' perception of (ab-)normality of signs and or symptoms.

Bladder contractility and urethral resistance relation: what does a pressure flow study tell us?

Hydrodynamic analysis of a pressure flow study is the only reliable method to determine the presence or absence of a bladder outlet obstruction, especially benign prostatic obstruction. To interpret the results of pressure flow study in benign prostatic obstruction, understanding the outlines of the basic theory about evaluation of the relationship between bladder contractility and urethral resistance relation is of paramount importance. In contrast, hydrodynamic analysis of pressure flow study in conditions other than benign prostatic obstruction is complicated by the limits of theories about the hydrodynamics of the lower urinary tract. In this review, the proposed hydrodynamic theories about the relationship between bladder contractility and urethral resistance relation are outlined. Then, problems encountered in the application of hydrodynamic analysis of pressure flow study to diseases other than benign prostatic obstruction are discussed.

Executive summary: The International Consultation on Incontinence 2008--Committee on: "Dynamic Testing"; for urinary incontinence and for fecal incontinence. Part 1: Innovations in urodynamic techniques and urodynamic testing for signs and symptoms of urinary incontinence in female patients

AIMS

The members of The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of faecal incontinence is also discussed.

METHODS

Evidence based and consensus committee report.

RESULTS

The chapter 'Dynamic Testing' is a continuation of previous Consultation-reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency.

CONCLUSION

This first part of a series of three articles summarizes the committees recommendations about the innovations in urodynamic study techniques 'in general', about the test characteristics and normal values of urodynamic studies as well as the assessment of female with signs and or symptoms of incontinence and includes only the most recent and relevant literature references.