Chief urology resident management of the urinary tract in stable patients with high spinal cord injuries - survey results and applications in the era of Competence by Design.

INTRODUCTION: The urologist's role in the management of patients with spinal cord injury (SCI) is to prevent upper tract damage and renal failure while facilitating acceptable means for urine elimination. Residency provides the framework to manage SCI patients. The purpose of this study was to determine the surveillance practices of chief urology residents in high SCI patients (T4/5 and above) and their confidence in managing this patient population.
METHODS: A 14-question survey was administered at the Canadian chief resident preparation examination in 2017. Questionnaire domains included: visit frequency, imaging modality, laboratory testing, and procedures related to upper and lower tract surveillance.
RESULTS: All 33 candidates completed the questionnaire. Chief residents encountered high SCI patients in either diverse clinical settings (48%) or solely as hospital inpatients (33%). Candidates had similar surveillance algorithms for stable high SCI patients. Responses for surveillance cystoscopy in stable high SCI patients varied. When asked how comfortable residents were managing high SCI patients, 42% responded they were comfortable, while the rest responded neutral, uncomfortable, or very uncomfortable.
CONCLUSION: Most chief residents made similar surveillance decisions for high SCI patients. Residents did differ on the frequency of cystoscopy and how comfortable they were managing this patient population. In the era of competence by design, this information can be used to highlight training opportunities.