Crowd-Sourced Assessment of Surgical Skills of Urology Resident Applicants: Four-Year Experience

Innate Versus Acquired: A Review of Predictive Technical Aptitude Assessments in Surgical Trainee Selection

PURPOSE OF REVIEW

The evaluation and selection process of similarly qualified applicants for surgical residency positions in the United States (US) is challenging. Technical aptitude assessments may provide an opportunity to improve the selection process by offering insight into a candidate's technical skills. The use of these assessments prompts consideration of the degree to which technical aptitude in surgery is innate versus acquired. In this narrative review, we review the state of these assessments and the limitations of developing and validating these instruments.

RECENT FINDINGS

Recent evidence suggests that technical aptitude can be quantified in medical students prior to selection for surgical training; however, both technical aptitude and dedicated practice of technical skills influence operative performance. In the US, technical aptitude assessments are inconsistently used in selecting candidates for surgical residency. Internationally, few countries have implemented standardized technical aptitude assessments in their surgical trainee selection processes. The development of technical aptitude assessments is ongoing worldwide. Technical aptitude assessments may help identify individuals particularly well-suited for a surgical career or those who might benefit from additional practice or remediation. The potential role of technical aptitude assessments in the selection process for surgical trainees remains uncertain. Consideration of these instruments requires an understanding of meaningful outcomes associated with particular technical assessments as well as the assessments' limitations.

Increasing Diversity, Equity, and Inclusion in Urology Residency Recruitment: Recommendations From the Society of Women in Urology

OBJECTIVE

To provide a framework for diversifying the urologic workforce through residency recruitment by integrating principles of diversity, equity, and inclusion (DEI) into program mission and values, application review, and interview process.

MATERIALS AND METHODS

For this narrative review, the Society of Women in Urology Advancing DEI in Urology Residency Recruitment Task Force identified 4 areas for incorporating DEI into residency recruitment: defining a residency program's mission and values, holistic application review, an objective interview process, and implementing DEI principles into a program. Using PubMed and Google Scholar, we performed a non-systematic literature search of articles from January 2014 to January 2024. Search terms included combinations of "diversity", "equity", "inclusion", "residency", "holistic review", "applications", "interviews", and "initiatives". Additional resources were identified through citations of selected articles. Based on findings from these articles, Task Force members made recommendations for best practices.

RESULTS

The diversity of practicing urologists is disproportionate to that of the United States population. Emerging evidence demonstrates that DEI efforts in healthcare are associated with better outcomes and reduction in healthcare inequities. We offer strategies for residency programs to integrate DEI initiatives into their recruitment, application review, and interview process. Furthermore, we address extending DEI principles into a program's mission and culture to create an inclusive environment conducive to training and supporting individuals from unique backgrounds.

CONCLUSION

It is critical to recruit and retain diverse talent in urology to improve patient care. We urge residency programs and their supporting institutions to adopt DEI principles into their recruitment efforts.

Medical Students Cannot Assess Robotic Surgeons Performing Radical Prostatectomy

INTRODUCTION

Medical students have previously been shown to be just as effective for video rating as experts. We want to compare medical students to experienced surgeons as video assessors of simulated robot-assisted radical prostatectomy (RARP) performance.

MATERIALS AND METHODS

Video recordings of three RARP modules on the RobotiX (formerly Simbionix) simulator from a previous study were used. Five novice surgeons, five experienced robotic surgeons, and five experienced robotic surgeons in RARP performed a total of 45 video-recorded procedures. The videos were assessed with the modified Global Evaluative Assessment of Robotic Skills tool as both full-length and an edited edition that only included the first 5 minutes of the procedure.

RESULTS

Fifty medical students and two experienced RARP surgeons (ES) performed a total of 680 video ratings of full-length videos and 5-minute videos (2-9 ratings per video). Medical students and ES showed poor agreement for both full-length videos and 5-minute videos (0.29 and -0.13, respectively). Medical students could not discriminate between the skill level of the surgeons in either full-length videos or 5-minute videos ( P = 0.053-0.36 and P = 0.21-0.82), whereas ES could discriminate between novice surgeons and experienced surgeons (full-length, P < 0.001, and 5 minutes, P = 0.007) and intermediate and experienced surgeons (full-length, P = 0.001, and 5 minutes, P = 0.01) in both full-length videos and 5-minute videos.

CONCLUSION

We found that medical students cannot be used to assess RARP because they showed poor agreement with the ES rating for both full-length videos and 5-minute videos. Medical students could not discriminate between surgical skill levels.