Evaluation of the Urology residency program in Saudi Arabia

Introduction
The education environment is an essential parameter for satisfaction, achievement, and accomplishment of medical

eer. Improved learner performance is directly related to the positive learning environment.

A five years based hospital constructed urology residency program is available in Saudia Arabia. The Saudi

mmission supervises this program for the Health Specialities. The first year is for general surgery and surgical

ensive care rotation. After the completion of the residency training, the residents received the certification as a

cialist. In the 5th year of the clinical studies, students have10 weeks rotation in surgery including the urology. The

quency of the urological problems increases with the increases in the patient population in the primary care settings.

e significance of effective didactic and clinical urological education cannot be ignored. The decline in neurological

cation has been reported. The effort to improve urological studies in medical schools are lacking. Previously United

te Graduate Exit Questionaire is being used to evaluate the routine educational process. The data obtained through

survey analyzed for quality assurance, curriculum revision and the track of changes made over a long period

inselah et al. 2014).

In Saudi Arabia, there are about 70 general hospitals with urology units and approximately 250 licensed

logists operating in those centers. For a patient in the out-patient unit to get an appointment with a qualified

logist they have to wait close to three months as the ration of the urologists to the general population is 1 to 66,000.

bohemaet al. 2016 ) Urologist and training, residency programs urologists, should be increased for the development

adequate training programme.

Urology cancer cases are challenging in daily practice in the hospitals of Saudi Arabia. The current status

uires for the improvement of the urology cases Gender disparities were also observed in the residency programs.

e evaluation of the urology program with the perception of the theatre educational environment by the STEEM

vides that it is less than an ideal training program.STEEM survey is applicable and reliable to study the urology

dency program in Saudi Arabia. At different stages of the program, the perception of the theatre learning
ironment remains the same. This assures the uniformity of the urology training in whole Saudi Arabia at different

lth stages of the health sector system or different training region of Saudi Arabia. (Binsaleh et al. 2014).

Despite the incorporation of the laparoscopic training in the residency programs, this area still needs training. The

ume of cases of laparoscopy is usually less as reported by the residents. Because of less encounter, inadequate

ning of laparoscopy is present among residents. Only those physicians who received training were able to perform

aroscopy. ( Shay et al. 2004).

Literature Review

Laparoscopic training is one of the specialized training received by the urologists. The demands for laparoscopic

ning has increased in the past few years. The demand for the laparoscopy increased with shorter hospital stay and

reased recovery time. Patient preference can also increase the demand for laparoscopic techniques near the futur.

ny training courses are required by the urologists to acquire the laparoscopic technique. The initial assessment

wed that urologists had incorporated the practice of laparoscopy in their residency program. The current status has

wn that the use of laparoscopy is decreasing in the postresidency postgraduates programs. The study by Shay et al.

02) suggests that the laparoscopic techniques are only performed by the physicians who have received the urology

ning during their residency programs. Almost 69% of the urologist got the laparoscopic training during their

dency program. The shift towards the laparoscopic training in the urology needs to increase. The laparoscopic skills

ally performed by the residents in Saudi Arabia are pelvic lymph node dissection and simple nephrectomy. (Shay et

2002).

Urology is an evolving profession which brings multidimensional skills with it including laparoscopy and

atre learning skills. Urology theatre is a complicated place. The residents perceived the theatre learning environment

s than ideal. The supportive hospital environment with planned teaching of procedure/skills with the best supervision
proper coverage are the areas which need to work in urology. Management of workloads is also necessary for the

logists. (Binsaleh 2014). Residency training programs should train residents with surgical and nonsurgical skills.

e later is associated with communication and administrative skills. According to the Royal College of the of

ysicians and Surgeons of Canada (RCPSC), the seven necessary competencies required by the residents are a

dical expert/clinical decisionmaker, communicator, collaborator, manager, health advocate, scholar,

professional. (Morrison et al. 2006).

The assessment of the urology training program by the PHEEM survey concluded that the residents perceived the

ning programmes as the less satisfactory. The area which needs improvement is clinical protocols, workload,

rking hours, quality of teaching supervision, and supportive hospital environment. This study shows that the urology

dency programme needs improvement. The percentage of the female resident was less than male in the urology

dency program. (Binsaleh 2015).

The Perception of urology students was insignificant. The knowledge of the graduates is insufficient in many

jects. The Learning objectives of urology rotation are unclear, and feedback on performance is inadequate. The time

urology rotation is not productive with lack of variability of urology medical conditions and the need for more

logy exposure. Social reasons and lack of knowledge about urology hinder the choice of urology specialty as a

ure career. The findings of this study should assist urology specialty in developing a robust curriculum for urology

ation ensuring a good knowledge of urology and satisfactory acquisition of necessary urological skills. The study

o supports more

earch in urologic education in the undergraduate medical education levels and the creation of a validated instrument

valuate medical student learning in clinical urology. (Binsaleh et al. 2015).

 The depressive symptoms, sleep deprivation and drowsiness were observed in the urology residents. The

ociation between, sleep deprivation, long duty hours, and female was significant. The regulations regarding sleep

rivation, long duty hours need to be revised. (Maddah et al. 2014).

A literature review has provided that not only Saudi Arabia, but the United States also face the issues in the urology

ning programs. Hospital funding and clinical revenue are the main ways of financial support for residency

grams. Adequate Funding is required for proficient training. Another factor which results in a decreasing number of

dents is strict rules related to the requirements of residency, and restriction of the resident duty hours ( Gonzaleza &

Kenna 2013).

The study by Mira et al., suggests that the curriculum also affects the effectiveness of a residency program.

e competitive curriculum results in the production of competent residents. This study shows that the ratio of men

urology is more as compared to women. Women are mostly concentrated in the obstetrics and gynecology and

iatrics. ( Mira et al. 2000)

Mohsen et al. test the knowledge, skills, and training of the physicians working in urology towards the erectile

functionality. Urologist scored highest in this study. The urologist with more than 10 years of experience scored

hest, and those with less experience and training scored less. (Mohsen et al. 2004)

The laparoscopic training in the residency program is insufficient as reported by the residents. The urologists

ieve that they were not appropriately trained during the residency program and lacks techniques associated with the

of laparoscopy. The majority were trained in North America and Europe. Only a few percentages of the residents

ieve that they were trained adequately locally in Saudi Arabia to perform laparoscopy. The Saudi Board of Urology

hioned training program for laparoscopy was different from those who have trained aboard. (Rabah 2010)

Objective

mary Objective.
 evaluate the urology residency programs in Saudi Arabia.

ondary Objective.

To assess the level of perceived satisfaction of resident with the current Saudi Urology curriculum.

To evaluate the adequacy of Saudi urology residency programs in an attempt to achieve the competencies outlined

the Saudi Commission for Health Specialist.

determine methods to improve the standards of training in the urology program

determine methods to improve surgery in urology training programs

evaluate the gender disparities faced by the urology residents in the choice of the Academic Career and Academic

ductivity.

Study Design

The cross-sectional survey is designed for the study. Data were collected from February 2019 till April 2019 after

B approval. Emails and links circulated the closed-ended questionnaire through a mobile application and hard copies

ing scientific committee visits to current residents in their programs in Saudi Arabia. This study will rely on survey

dings of primary data collected from urology residents located in Saudi Arabia. Around 300 urology residents in

ious hospitals in Saudi Arabia will be contacted in order to take part in the study. They will be identified using a

ord of urology residents from the Saudi Commission for Health Specialties. They will then do initial canvassing

ails to the respective urology residents stating the main objective of the research study, providing a link via which

participants can undertake an online survey. For three months, the researcher will send reminders to the physicians

minding them of the research study after which they will close the data collection session and move on to analysis. It

sists of 40 statements. The 5 points Likert Scale is used for the evaluation of the residency program. It consists of 5
nts ranging from strongly agree (5), agree (4), uncertain (3), disagree (2), to strongly disagree (1). The overall

sible maximum score of the questionnaire is 200, and the minimum score is 40. An overall score of 120 of 200

uld indicate a neutral perception, any value more than 120 would indicate a more satisfactory environment whereas

of less than 120 indicates a less satisfactory result.

Sample Size

The sample is divided into

Junior Residents. (R1+R2)

SeniorResidents. (R3+R4)

Recently graduated urologists (2014-2018).

Data Analysis

mographic variables categorized data. SPSS is used for analysis. the results will be published via tables, figures, and
rts

Expected Findings

Of the urology residents who will be expected to take part in this research study, the researcher expects that more

n 50% will accept the invitations and complete the survey study. This will provide adequate data for analysis and

vide reliability to the data collected. The survey designed to evaluate the urology residency programs will help to

d out the symptoms responsible for inadequacy of the residents in urology. This will provide the Saudi Board of

ology to revise the curriculum and redesign the urology residency program and fills the gap in the training process.
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