The need for a course to complete urological education for consultant practice using a simulated ‘boot camp’ structure at the end of specialist training: A survey-based study

Abstract

Background and aims

To obtain opinions from urology trainees and consultants regarding the need for, and structure of, a post-specialty training Urology Simulation Boot Camp (USBC) for consultant practice.

Methods and results

A survey-based study was conducted, and ‘Google Forms’ were distributed electronically via social media. Urology specialist trainees (ST) in years 5–7 (ST5-ST7), post-certification of completion of training (CCT) fellows and ST3 boot camp faculty consultants in practice for ≤5 years and >5 years were included. One hundred and seven responses were received. 97.2% of responders thought a pre-consultant USBC was worthwhile; 55.1% selected the course duration to be 2 days. 47.7% felt that the USBC should be delivered post-exam in ST7. 91.6%, 43.9%, 73.8%, 87.9% and 74.8% considered that modules in emergency operative procedures, novel uro-technologies, delivering multidisciplinary team (MDT) meetings, non-clinical consultant roles and responsibilities, stress and burnout to be important, respectively. 62.6% and 31.8% felt that the course should be wholly or part-funded by Health Education England (HEE).

Conclusions

A post-specialty training, pre-consultant, USBC delivered post-exam in ST7, is worthwhile and should include modules on emergency operative procedures, leading MDTs, non-clinical roles and responsibilities and managing stress and burnout in consultant careers. Ideally, it should be fully/part-funded by HEE.

Keywords

Boot camp urology ISCP education simulation consultant practice trainees

Introduction

Transitioning from a specialist trainee (ST) to a consultant can be one of the most difficult moves a doctor can make.^1–3 Studies have regularly shown that new consultants have been better trained for the clinical components of their job than for the non-clinical aspects, such as job planning, personnel, time and financial management and complaint handling.^2–5 The international incidence of burnout amongst surgeons is high amongst new consultants and has been connected to a perceived lack of preparedness for many of the non-clinical competencies expected of a new consultant.^6,7

The Urology Curriculum of 2021 constitutes requirements in training to achieve a certificate of completion of training (CCT) in Urology,⁸ specifying the professional standards and clinical capabilities, expected of a fully trained day-one consultant urologist. The Intercollegiate Surgical Curriculum Programme (ISCP) was developed in response to the ‘Shape of Training’ review and considering updated GMC guidance on the role and purpose of postgraduate curricula.^9,10 A number of the vocational roles consultants are expected to fulfil during the course of their careers¹¹ are missing from the curriculum, meaning trainees are not fully prepared for the rigours of the non-clinical components of their consultant posts. Better preparedness for these non-clinical responsibilities is likely to reduce ambient stress for newly appointed consultants at a time when workplace burnout is most prevalent.¹¹

Simulation boot camps, as a means of providing concentrated training, have gained popularity in recent years.^12,13 There is limited data on the cost-effectiveness of the boot camp approach. However, Kabariti et al. reported £460 saving per core surgical trainee (Year 1) with the introduction of a 3-day induction boot camp.¹⁴ The Leeds Urology Simulation Boot Camp (USBC) for Year 3 specialty trainees (ST3) has shown to be welcoming, enjoyable and effective in providing basic clinical skills at the start of a urological career.^15–19 Consequently, it seemed appropriate to consider a pre-consultant USBC to help provide the vocational non-clinical skills required before a consultant appointment. The aim of this study was to explore the desire for such a course, define its potential components, and when and how it would best be delivered for UK urological trainees.

Materials and methods

Study design and participants

We performed a descriptive, cross-sectional, survey-based study. Our population consisted of urology ST in their last 3 years of higher specialist training (ST5-ST7), post-certification of CCT fellows and pre-consultant ‘specialist’ doctors. We also surveyed UK consultant urologists who were members of the ST3 Urology boot camp faculty who had been established in practice for ≤ or > 5 years.

Data collection method

The methods are reported in accordance with the Checklist for Reporting Results of Internet Surveys (CHERRIES).⁸ The instrument used in our study was a 15-item survey designed with ‘Google Forms’ (https://www.google.co.uk/forms/about/).

An online survey, developed in consultation with a working group that included 4 trainees and 6 educationalists, 2 of whom were senior retired urology consultants, was formulated in January 2022. This comprised 11 questions containing 15 items enquiring about the necessity of such a course, when to deliver the course, ideal duration of the course, importance of suggested modules and costs and potential sponsorship (Supplemental material 1 – survey). Five modules were identified by the working group which included:

A simulated open/emergency operative procedures module utilising porcine tissue. This would provide an enhancement of the ST3 boot camp¹⁵ including managing ureteric injury (primary anastomosis, re-implantation +/− Psoas hitch and Boari flap), pyeloplasty and renorraphy, ileal conduit formation (Bricker and Wallace techniques), fractured penis and initial management of urethral injury.

A module on uro-technology consisting of the basic principles and use of laser, harmonic scalpel, LigaSure^TM, diathermy and radiology as well as novel therapeutic technologies.

A module delivering best practice in the organisation of multidisciplinary team (MDT) meetings focussing on aspects of cancer, benign MDTs and managing human factors during the MDT.

A module exploring the roles and responsibilities in consultant practice.

A module exploring the initiators of stress in clinical practice, the role of informal mentoring and how to actively manage factors generating burnout.

Opinions from responders were obtained using a 5-point Likert scale²⁰ (1 – not important; 2 – slightly important; 3 – moderately important; 4 – important; 5 – very important). In addition, a free-text box was available to responders, who could make individual comments about the prospect of a USBC at the end of training.

The survey was disseminated through emails and social media (Twitter and WhatsApp), to the ST3 boot camp faculty (n = 110) and to the British Association of Urological Surgeons (BAUS) Section of Trainees (BSoT, https://www.baus.org.uk/professionals/bsot/) via email and WhatsApp. The survey was opened between 31 January 2022 and 14 February 2022. Responses were all obtained from the online Google Forms data repository for analysis.

The survey introduction detailed the nature, format, duration of the study and the rationale behind it. This was an anonymised study that did not identify participants other than by their status at a defined career point. Participation in the questionnaire was deemed to be consent to the study. Participants were made aware that data were intended for dissemination through presentation and publication.

Data analysis

Survey responses were entered into Microsoft Excel v16 for analysis. Statistical analyses were performed using SPSS (SPSS version 25.0, SPSS Inc., Chicago IL, USA). Categorical data were compared using a chi-square test with Yates correction. Responses from different grades were compared. A p-value of <0.05 was considered to be statistically significant.

Results

Overall, 107 responses were received (52 non-consultants; 55 consultants). Due to the methods employed to disseminate the survey, the total number of potential participants was unknown, therefore calculation of the response rate was not possible. Responders’ career grades are presented in Figure 1.

Figure 1.

The career demographic of the study population.

Utility and duration of a pre-consultant boot camp

In total, 104 (97.2%) responders thought that a pre-consultant boot camp was worthwhile; non-consultants, 96.2%; consultants, 98.2%, p = 0.5.

Overall, 59 (55.1%) selected the course duration to be 2 days rather than 3 days (44.9%). A total of 60% of consultants preferred a 2-day training compared to 50% of non-consultants, p = 0.3.

The majority, 51 (47.7%) of participants thought that the course should be delivered post-exam during ST7 rather than earlier in training. However, consultants (47.3%) chose post-exams in ST6 or post-CCT (16.4%) whilst non-consultants (59.6%) preferred post-exams in ST7, p < 0.001.

In total, 62 (57.9) considered that the final day should have a sub-specialty-specific component; non-consultants, 69.2%; consultants, 59.5%, p = 0.4 (Table 1).

Table 1.

The percentage of respondents who felt a post-specialist training Urology Simulation Boot Camp (USBC) would be worthwhile, their preferred length of the course and whether a specialty component should be included, by employment grade.

Questions	Total, n (%)		ST5, n (%)		ST6, n (%)		ST7, n (%)		Post-CCT or pre-consultant, n (%)		Cons ≤5 years, n (%)		Cons >5 years, n (%)		P-value*
Usefulness															0.03
Yes	104	97.2	2	66.7	24	100	16	94.1	8	100	13	100	41	97.6
No	3	2.8	1	33.3	0	0	1	5.9	0	0	0	0	1	2.4
Duration															0.63
2 days	59	55.1	1	33.3	11	45.8	9	52.9	5	62.5	6	46.2	27	64.3
3 days	48	44.9	2	66.7	13	54.2	8	47.1	3	37.5	7	53.8	15	35.7
When to deliver															0.005
Pre ST6	6	5.6	1	33.3	1	4.2	3	17.6	1	12.5	0	0	0	0
Post-exam ST6	39	36.4	0	0	7	29.2	3	17.6	3	37.5	3	23.1	23	54.8
Post-exam ST7	51	47.7	2	66.7	16	66.7	10	58.8	3	37.5	6	46.2	14	33.3
Post-CCT or pre-consultant	11	10.3	0	0	0	0	1	5.9	1	12.5	4	30.8	5	11.9
Sub-specialty specific on final day															0.87
Yes	62	57.9	1	33.3	14	58.3	9	52.9	4	50	9	69.2	25	59.5
No	45	42.1	2	66.7	10	41.7	8	47.1	4	50	4	30.8	17	40.5

*Trend across grades.

CCT: completion of training; ST: specialist trainee.

Module options

Emergency operative procedures

A total of 91.6% of respondents (n = 98) believed that this module was important or very important; 92.3% of non-consultants and 90.9% of consultants agreed, p = 0.8 (Table 2).

Table 2.

The percentage of respondents who considered each proposed module would be an important inclusion in a post-specialist training Urology Simulation Boot Camp (USBC), by employment grade.

Questions	Total, n (%)		ST5, n (%)		ST6, n (%)		ST7, n (%)		Post-CCT or pre-consultant, n (%)		Cons ≤5 years, n (%)		Cons >5 years, n (%)		P-value*
Module 1															0.03
Not Important	0	0.0	0	0	0	0	0	0	0	0	0	0	0	0
Slightly important	6	5.6	0	0	0	0	4	23.5	0	0	0	0	2	4.8
Moderately important	3	2.8	0	0	0	0	0	0	0	0	0	0	3	7.1
Important	19	17.8	1	33.3	4	16.7	0	0	0	0	5	38.5	9	21.4
Very important	79	73.8	2	66.7	20	83.3	13	76.5	8	100	8	61.5	28	66.7
Module 2															0.81
Not Important	9	8.4	0	0	2	8.3	1	5.9	0	0	2	15.4	4	9.5
Slightly important	24	22.4	1	33.3	4	16.7	5	29.4	0	0	4	30.8	10	23.8
Moderately important	27	25.2	2	66.7	7	29.2	2	11.8	2	25	2	15.4	12	28.6
Important	31	29.0	0	0	6	25	7	41.2	4	50	3	23.1	11	26.2
Very important	16	15.0	0	0	5	20.8	2	11.8	2	25	2	15.4	5	11.9
Module 3															0.16
Not Important	2	1.9	1	33.3	0	0	0	0	0	0	0	0	1	2.4
Slightly important	10	9.3	0	0	3	12.5	2	11.8	1	12.5	0	0	4	9.5
Moderately important	16	15.0	1	33.3	4	16.7	4	23.5	0	0	2	15.4	5	11.9
Important	40	37.4	0	0	11	45.8	6	35.3	3	37.5	6	46.2	14	33.3
Very important	39	36.4	1	33.3	6	25	5	29.4	4	50	5	38.5	18	42.9
Module 4															0.61
Not Important	0	0.0	0	0	0	0	0	0	0	0	0	0	0	0
Slightly important	5	4.7	1	33.3	2	8.3	1	5.9	0	0	0	0	1	2.4
Moderately important	8	7.5	0	0	2	8.3	1	5.9	1	12.5	0	0	4	9.5
Important	30	28.0	1	33.3	5	20.8	3	17.6	2	25	6	46.2	13	31
Very important	64	59.8	1	33.3	15	62.5	12	70.6	5	52.5	7	53.8	24	57.1
Module 5															0.57
Not Important	1	0.9	0	0	1	4.2	0	0	0	0	0	0	0	0
Slightly important	9	8.4	1	33.3	2	8.3	3	17.6	0	0	1	7.7	2	4.8
Moderately important	17	15.9	0	0	5	20.8	5	29.4	1	12.5	1	7.7	5	11.9
Important	36	33.6	2	66.7	8	33.3	3	17.6	2	25	5	38.5	16	38.1
Very important	44	41.1	0	0	8	33.3	6	35.3	5	62.5	6	46.2	19	45.2

*Trend across grades.

Module 1: Surgical management of emergency urological procedures; Module 2: Uro-technology: Module 3: Delivering a multidisciplinary team meeting: Module 4: Understanding the management of consultant non-clinical roles: Module 5: Understanding management of stress, the use of mentors and the prevention of workplace burnout.

CCT: completion of training; ST: specialist trainee.

Uro-technology

Overall, 47 (43.9%) responders thought that this module was important or very important. Half of the non-consultants (50.0%) believed that it was important or very important inclusion in a USBC, as opposed to only 38.2% of the consultants, p = 0.3 (Table 2).

Delivering MDT meetings

The majority of responders (n = 79, 73.8%) considered that this module was important or very important; non-consultants, 69.2%; consultants, 78.2%, p = 0.4 (Table 2).

Consultant roles and responsibilities

A total of 94 responders (87.9%) thought that this module was important or very important; non-consultants, 84.6%; consultants, 90.9%, p = 0.5 (Table 2).

Stress, mentoring and burnout

Overall, 80 (74.8%) responders considered that this module was important or very important; non-consultants, 65.4%; consultants, 83.6%, p = 0.05 (Table 2).

Costs of the course

With regards to costs, 43 (40.2%) respondents said they would not pay for the course and 67 (62.5%) said Health Education England (HEE) should pay for it (Table 3). The course should be paid for by HEE, according to most non-consultants (n = 41, 78.8%), whilst 47.3% and 43.6% of consultants thought that the course should be paid for by HEE or part-funded, respectively, p = 0.03. Most non-consultants (n = 20, 38.5%) thought the cost should be £200 per day, whilst the majority of the consultants (n = 23, 41.8%) voted for a daily rate of £150, p = 0.3. However, the majority of non-consultants (n = 27, 51.9%) who were asked how much they would pay for a USBC said they would pay up to £150 per day compared to 21 (38.2%) consultants, p = 0.08.

Table 3.

The number and percentage of respondents who felt who should pay for a post-specialist training Urology Simulation Boot Camp (USBC), what the cost should be and their willingness to contribute to its cost by employment grade.

Questions	Total, n (%)		ST5, n (%)		ST6, n (%)		ST7, n (%)		Post-CCT or pre-consultant, n (%)		Cons ≤5 years, n (%)		Cons >5 years, n (%)		P-value*
Who should pay															0.06
HEE	67	62.6	2	66.6	20	83.3	13	76.5	6	75	9	69.2	17	69.2
Part-funded	34	31.8	1	33.3	4	16.7	4	23.5	1	12.5	3	23.1	21	23.1
Self-funded	6	5.6	0	0	0	0	0	0	1	12.5	1	16.7	4	7.7
Cost per day															0.21
£0	14	13.1	1	33.3	0	0	3	17.6	1	12.5	3	23.1	6	14.3
£150	40	37.4	0	0	9	37.5	5	29.4	3	37.5	8	61.5	15	35.7
£200	33	30.8	0	0	11	45.8	6	35.3	3	37.5	1	7.7	12	28.6
£250	20	18.7	2	66.7	4	16.7	3	17.6	1	12.5	1	7.7	9	21.4
Personal contribution															0.18
£0	43	40.2	1	33.3	9	37.5	10	58.8	1	12.5	8	61.6	14	33.3
£150	48	44.9	2	66.7	13	54.2	6	35.3	6	75	5	38.5	16	38.1
£200	11	10.3	0	0	2	8.3	1	5.9	1	12.5	0	0	7	16.7
£250	5	4.7	0	0	0	0	0	0	0	0	0	0	5	11.9

*Trend across grades.

CCT: completion of training; HEE: Health Education England; ST: specialist trainee.

Free-text comments

Free-text comments were made by 36 respondents, 16 trainees (44.4%) and 20 consultants (55.6%). Thirty-eight comments were made that fell into one of the following four categories, concern about changes in role, anxieties about clinical practice, worries about health and well-being and other transitional matters (Table 4). The greatest number of anxieties was related to readiness for non-clinical roles in consultant practice and preparedness for having to deal with emergency urological procedures.

Table 4.

The number and percentage of 38 responses about specific issues in making/having made the transition into the consultant role.

Concern		n	Percentage	Concern		n	Percentage
Changes in role	Readiness for consultant role	14	36.8%	Health and well-being	Support	3	7.9%
	Complaint handling	3	7.9%		General support	2	5.4%
	Staff management	1	2.6%		Stress management/WLB	1	2.6%
	Management	1	2.6%
	Job planning	1	2.6%	Other transitionary concerns	Financial management	2	5.4%
	Appraisal	1	2.6%	Other transitionary concerns	Private practice	1	2.6%
Clinical concerns	Emergency surgery	7	18.4%
Clinical concerns	Clinical issues	1	2.6%

Discussion

Principle findings

We present objective data from an online survey about a potential pre-consultant simulation boot camp utilising data from a mixture of senior trainees and consultants. The UK ST3 urology boot camp has gained acceptance and popularity nationally and internationally as a paradigm for the development of the basic knowledge and skills required for a first-year ST.^15,19 Considering this experience, we believed that a similar model would help provide the key higher-level clinical and non-clinical knowledge and skills required for a first-year consultant prior to their exit from specialist training. The principal outcome of the survey was to design a pilot course. Similar to the UK ST3 boot camp, such an advanced pre-consultant USBC would be led by the Leeds Medical Education Urology Consultant Faculty along with the contribution of appropriately experienced consultants from across the UK. Its structure was intended to be hands-on with a minimally didactic educative component.

The key findings of this survey were that most respondents thought that a pre-consultant USBC would be useful, it should be delivered post-exams, either in the ST6 or ST7 years of training, be 2 or 3 days in duration, with or without including sub-specialty elements on the final day. It demonstrated that modules addressing emergency urological surgery, delivering an MDT meeting, having a better understanding of non-clinical roles in consultant practice and education about stress, mentoring and burnout in the workplace were important; the need for further education in the use of uro-technology was unclear although the trainee members of the working group expressed an appetite for additional training in the use of novel therapeutic technologies that were not included in the ISCP. A systematic review speculated that effective coping mechanisms may also help reduce psychological distress, particularly in situations where stressful working conditions prevail.²¹ Most considered such a USBC should either be free or cost around £150 per day. The majority of responders thought that it should be funded by HEE, the body responsible for the completion of post-graduate education.

Limitations

There are several limitations to this study, although it provides data relevant to developing a modular programme of clinical and non-clinical education late in urological training. Our sample size, and unknown response rate, may not represent the population for which the survey was intended, which may mean our results may be subject to the influence of chance factors. Although there was a mixture of different levels of seniority reached, the numbers in each group were heterogeneous, with only 3 ST5 participants. It is also important to recognise that the trainee responder may have understood that this course was for pre-consultant preparation and NOT for exam revision purposes. Making this point clear, could have changed the observed outcome, although the experiences or consultants who had already made the transition will have added significant value from their retrospective experience. Some of the fellows or consultants may not have received training in the UK which could have affected the validity of our results. Similarly, a proportion of respondents were consultants over 5 years in post, which could introduce an element of recall bias, and consultants who had retired did not receive the survey invitation and their views on this proposal are unknown. The questions were not competency-based and did not assess deficiencies of skills or knowledge in proposed modular areas. Therefore, it was not possible to determine whether there were any deficiencies in skills in those who thought that a particular module was important. In particular, the training of new consultants and senior trainees may have been affected by COVID-19 and possibly influenced their responses. Those encountering deficiencies in training, consequent upon training disruptions, may be more likely to enrol in the survey and induce a skew in response data.

Meaning and implications of the study

Taking our results into account, it is reasonable to suggest that there is both an appetite, and a perceived need by trainees, for further education in non-clinical skills, and specific technical education, at the end of urological training which are not covered by the current ISCP curriculum for urology. These training deficiencies pose an issue for the generation of workplace-based stress, the need for formal mentoring and, consequently, the development of burnout in the early years of consultant practice. Addressing these educative needs could either be achieved by a revision of the ISCP curriculum, or by the development of a USBC at the end of training to provide a preliminary induction for consultant careers. A short course ‘Boot camp’ has proven both a cost-effective model to provide this sort of vocational training and effective as a longer-term educational provision.^13–17 Any introductory knowledge provided by such an intensive primer, at the end of training, could then be enhanced by Continuing Professional Development within consultant practice. The development of, in particular, non-technical skills, utilising well-established educative vehicles such as scenario-based education^22,23 could provide a training continuum established from the platform started prior to CCT. We feel that some of the generic elements of such a methodology could also be transferrable across a range of other specialties within healthcare.

Supplemental Material

sj-docx-1-scm-10.1177_00369330231163376 - Supplemental material for The need for a course to complete urological education for consultant practice using a simulated ‘boot camp’ structure at the end of specialist training: A survey-based study

Supplemental material, sj-docx-1-scm-10.1177_00369330231163376 for The need for a course to complete urological education for consultant practice using a simulated ‘boot camp’ structure at the end of specialist training: A survey-based study by Karl H Pang, Sunjay Jain, Chandra Shekhar Biyani and Stephen R Payne in Scottish Medical Journal

Footnotes

Acknowledgements

The authors would like to acknowledge the cooperation of all of the participants who completed this survey.

Author Note

Karl H. Pang certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Author’s Contribution

KHP, SJ, CSB and SRP had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: CSB, SJ and SRP.

Acquisition of data: CSB and SRP.

Analysis and interpretation: KHP, CSB, SJ and SRP.

Drafting of the manuscript: KHP.

Critical revision of the manuscript: KHP, CSB, SJ and SRP.

Statistical analysis: KHP.

Obtaining funding: None.

Administrative, technical or material support: KHP, CSB, SJ and SRP.

Supervision: CSB, SJ and SRP.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Karl H Pang

Supplemental Material

Supplemental material for this article is available online.

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