LEARN: uroLogical tEAching in bRitish medical schools Nationally
Overview
LEARN was a national, multicentre evaluation of Urology teaching in UK Medical Schools, assessed against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology, published in 2012.
7,063 responses from FY1 doctors and medical students from every year group across all 39 UK medical schools were included, and it identified 3 key findings:
Firstly, the overall reported rates of observed urological procedures was low across all year groups. By the end of medical school, the reported observation rates were highest for laparotomy (51.6%), flexible cystoscopy (50.8%) and transurethral resection of the prostate (35.8%), and amongst the lowest were for circumcision (18.6%) and scrotal surgery (17.7%).
Secondly, it was identified that by the end of medical school, not all students had observed and/or performed common examinations and skills, including male genital examination, digital rectal examination, and male and female catheterisation. In the UK, the General Medical Council mandates catheterisation as one of the skills that “newly qualified doctors will have performed on real patients during medical school” under direct supervision. We found that whilst performance rates of catheterisation in our cohort was higher than previously reported, only 92.1% and 73.0% had performed male and female catheterisation on patients, respectively. This suggests that a substantial proportion of newly qualified doctors have not met this clinical competency required by the GMC, and this lack of experience may contribute to catheter-associated iatrogenic injury, urethral stricture disease and poor patient experience.
Thirdly, we identified that there was a declining interest in Urology as a career with progression through medical school. Overall, 62.9% of second-year students reporting wanting a Urology rotation as newly qualified doctors, decreasing to 42.8% in final year; and 21.9% of second-year students reported having considered a career in Urology, decreasing to 16.9% amongst newly qualified doctors.
The results also identified the rule of 20s:
- 20% of FY1 doctors did not have a Urology rotation during medical school
- 20% of FY1 doctors have a Urology rotation
- 20% fewer FY1 doctors performed a female versus a male catheter, whilst in medical school
LEARN has now closed, and has successfully led to numerous publications, presentations and awards. We are now working towards LEARN 2, and developing an updated Undergraduate Syllabus for Urology.
