Predictors of catheter-free voiding after spinal cord injury.

CONTEXT: Despite a high prevalence of neurogenic bladder (NGB) in patients with spinal cord injury (SCI), clinicians are unable to predict long-term bladder outcomes due to variable phenotypes of bladder dysfunction. This study investigates if early bladder events, infections, and spinal cord injury characteristics during rehabilitation admission affect bladder outcomes one year after SCI. METHODS: This retrospective study included patients with SCI admitted to a tertiary rehabilitation center between 1 January 2016 and 1 January 2020. Data was collected on early bladder management, comorbidities, infections and injury characteristics; level of injury, American Spinal Injury Association Impairment Scale (AIS) classification, and International Standards for Neurological Classification of Spinal Cord Injury lower extremity motor score (LEMS). RESULTS: Seventy-two patients met inclusion criteria; 63% (45/72) patients had cervical SCI and 31% (22/72) were complete injuries. Twenty-two percent (16/72) did not use an internal catheter to empty the bladder, improving to 41% (29/72) at one year. On multivariate logistic regression accounting for age, sex, Charlson comorbidity index, LEMS, and infections during admission, higher LEMS (OR 1.104, 95%, CI 1.037-1.176, P = 0.002) associated with catheter-free voiding (CFV) at one year while male sex (OR 0.091, 95% CI 0.012-0.713, P = 0.0225), and non-urologic infections (OR 0.088, 95% CI 0.010-0.768, P = 0.0279) were negatively associated. CONCLUSIONS: Preserved LEMS early after SCI associates with CFV at one year while male sex and early non-urologic infections such as pneumonia are associated with persistent urinary retention. This can be used to counsel SCI patients on expected bladder recovery and outcomes.

Advanced Urology Boot Camp: A Simulation-based Curriculum to Enhance Fourth-year Medical Student Procedural Competency.

INTRODUCTION: Simulation-based medical education continues to gain popularity as the clinical environment requires exemplary patient safety while simultaneously maximizing the learner's educational experience. There is a current lack of urology-focused medical student education curricula in the literature. Here, we present the findings of a didactic and simulation-based medical student advanced "urology boot camp" curriculum, which was designed for learners interested in pursuing careers in urology. METHODS: Twenty-nine fourth-year urology-dedicated medical students completing their subinternship at our institution during the 2018-2019 academic year participated in an advanced hands-on simulation "boot camp," which taught both simple and advanced Foley catheter placement, manual and continuous bladder irrigation, and diagnostic cystoscopy. Knowledge acquisition was assessed through quizzes administered before and after completing electronic modules, and a post-simulation survey assessing learners' confidence in their knowledge and skill set, as well as their satisfaction with the curriculum. RESULTS: Medical students demonstrated significant gains in knowledge from pre-test (mean 73.7%) to post-test (mean 94.5%, P < .001), which was consistent across each simulation procedure. Participants self-reported significant improvement in confidence with the procedures from before to after the educational intervention (P < .001). Students also found the curriculum to be beneficial to their understanding of the subject matter (P < .001), would recommend this curriculum to other medical students (P < .001), and thought it better prepared them to meet expected ACGME (Accreditation Council for Graduate Medical Education) milestones (P < .001). CONCLUSIONS: Findings from our advanced "boot camp" simulation curriculum demonstrated successful gains in knowledge and confidence following learning modules and hands-on simulation, indicating that this type of educational intervention could be beneficial in improving exposure to skills and developing confidence prior to urology internship and junior residency.

Urology Boot Camp: A Pilot Medical Student Curriculum for Common Bedside Urologic Procedures.

OBJECTIVES: To develop a novel "bootcamp" simulation-based curriculum to introduce common urologic procedures and to improve readiness for performing them at bedside. METHODS: Three hundred twenty-five third-year medical students at our single institution participated in a hands-on simulation "boot camp" over a 2-year accrual period. This curriculum was designed to teach basic urologic bedside procedures (ie, Foley catheter placement, Bladder irrigation) to third year medical students prior to the start of their surgical clerkships in a live instructional setting with direct feedback from instructors. The objective aspects of the study consisted of a survey administered to study participants following participation in the simulation boot camp, as well as pre- and post-module assessments. RESULTS: Medical students self-reported knowledge gains following the simulation session (P < .001), with 45.8% increase in procedural confidence. Additionally, students reported that the educational intervention was beneficial to their understanding of the subject matter (P < .001), were "very likely" to recommend the session to another medical student (P < .001), and felt that educational intervention better prepared them for an upcoming national exam (P < .001). Finally, the greatest gains were seen for those students who self-reported lower precurriculum knowledge (P < .001). CONCLUSIONS: Findings from our M3 "boot camp" led to self-reported gains in subject matter knowledge following the hands-on simulation curriculum, indicating that this type of educational intervention can be beneficial in preparing medical students for common bedside procedures.