Urology training requirements focus on work hours, competency

The Urology Residency Review Committee (RRC), which is charged with accrediting programs for the training of urologists, is working on two important issues related to resident training: duty hour restrictions and measuring surgical competency. In this interview, Michael O. Koch, MD, current RRC chair and president of the American Board of Urology, discusses how the committee is addressing these changes and the challenges they present. Dr. Koch is professor and chairman of urology at the Indiana University School of Medicine, Indianapolis. He was interviewed by Urology Times Editorial Consultant Stephen Y. Nakada, MD, professor and chairman of urology, University of Wisconsin, Madison.

Q: What is the role of the Residency Review Committee?

A: It's not clear what the new duty hours will be. The Institute of Medicine released a report in January 2009 that proposed changes in resident duty hours that were actually much smaller than most people expected. Dr. Tom Nasca, a nephrologist who is CEO of the American Council of Graduate Medical Education (ACGME), is collecting information over an 18-month period from organizations across all the surgical and medical specialties. The goal is to analyze what are the best duty hour restrictions to implement and how to best implement them. The American Urological Association, the RRCs, the American College of Surgeons, and various other organizations are all in the process of providing input to the ACGME about which restrictions are appropriate and which ones place limitations on surgical training.

Q: Do most residency training programs in urology comply with the current duty hour rules?

A: The biggest change in recent years was the 80-hour work week restriction, and all urology programs meet that right now. In some specialties, programs can apply for exceptions to the 80-hour rule that are approved by the ACGME. No urology program has applied for an exception.

Q: What are some of the innovations and strategies that program directors are using to stay in compliance with the duty hour restrictions?

Q: There has been talk about the possibility of evaluating surgical and procedural technique, either as part of another competency or as a separate competency. Can you comment on that?

A: There's some restructuring taking place at the ACGME. The chairs of the various RRCs form the Council of Review Committee Chairs, and that group has been split into three different groups: surgery, medicine, and hospital-based practices. That's a recognition, for the first time, by the ACGME that surgeons should be evaluated differently than their non-surgical colleagues. The surgical group has decided that there needs to be another competency-technical skills. Dr. Nasca and others support the need for this additional competency. It's not clear whether this would be a seventh competency or included in the medical knowledge competency, but the ACGME seems to support this change. I think it will probably be included within medical knowledge.

Q: Do we know how surgical competency will be measured?

A: It's not clear yet. One possibility is that competency will be measured using various types of surgical simulators. They might be completely inanimate or make use of animal models. The AUA and American College of Surgeons are making use of models and we will probably work together in this area. A joint group of the American Board of Urology, the AUA, and the ACGME are beginning to examine how to best measure surgical competency.