Introduction

It is important for internal medicine (IM) providers to understand the management of many urologic conditions, particularly in the inpatient environment. Specifically, topics pertaining to the evaluation of urinary retention, renal colic, and gross hematuria significantly overlap with the scope and practice of medicine colleagues. These domains often constitute the basis for urologic consultation. The AUA Core Curriculum for Medical Students describes many of these conditions and can serve as a helpful resource for these clinicians.¹

Despite the overlap in clinical practice, there is currently no formal urology education program consistently integrated into medicine residency didactics. To address this training gap, a Urology 101 Interactive Seminar was developed by one of the authors (A.G.) for the NewYork-Presbyterian/Columbia IM residency program. The program focused on the acute management of inpatients on medicine services presenting with general urologic complaints. Herein, we describe the components of this novel curriculum and share the feedback received from this teaching pilot.

Key Components of the New Urology Curriculum

At NewYork-Presbyterian/Columbia, the IM residency education curriculum includes a “learning lab,” which is a 3-hour block of protected educational time 1 afternoon weekly. There are 131 Columbia IM residents. The pilot program took place during 3 separate learning lab sessions in order to educate as many residents as possible (Figure 1). The urology curriculum consisted of small-group teaching and discussions as well as hands-on demonstrations to teach high-yield urology topics in an engaging and fun manner.

Figure 1. Dr Grant running 1 of 3 urology education sessions at the internal medicine “learning lab.”

First, the didactics portion focused on topics of acute urinary retention, Foley catheter management, gross hematuria, nephrolithiasis, and Fournier gangrene. The session was divided into interactive components and a structured lecture outlined in Figure 2. To create a comfortable learning environment that encouraged participation and collegiality, a brief game show titled “Name That Urology Thing” was introduced, followed by audience participation and definition review. The remainder of the lecture was organized by topic (Figure 2). In addition to basic content review, case didactics, and imaging review, emphasis was placed on teaching the residents about the criteria for a urology consultation and the critical information to provide urology colleagues when the consult is requested. Lastly, time was dedicated to reviewing the difference between routine, urgent, and emergent urologic issues, to ultimately answer the question, “When should I be worried?”

Figure 2. Urology curriculum for the internal medicine resident: high-yield topics and content of education session for learning lab, fall 2023.

Following the didactics, focus was turned to the hands-on demonstrations. Figure 3 outlines the 3 stations featured, which were centered around Foley catheter insertion, continuous bladder irrigation setup, and catheter interrogation and management. At station 1, catheter insertion kits were used to teach residents proper technique for placing catheters. At station 2, a continuous bladder irrigation setup allowed residents to understand the mechanics of gross hematuria management. Station 3 taught residents how to properly hand-irrigate a standard catheter using a catheter irrigation tray (Figure 3).

Figure 3. Hands-on demo stations.

Response From Resident Survey

At the end of each session, the residents were asked to complete a 10-question survey about their experience with the seminar. A total of 70 residents participated in the seminar, corresponding to 53% of the IM residency program. The response rate was 66% (46/70). The participation breakdown by postgraduate year (PGY) was: 37% PGY1, 33% PGY2, and 30% PGY3. Eighty percent of respondents reported that they did not have adequate preexisting exposure to urology education incorporated into their learning lab curriculum. One hundred percent of respondents reported that the urology seminar was worthwhile and should be permanently integrated into the curriculum. When asked about the most useful part of the lecture, residents rated the following topics the highest: (1) basic catheter review/troubleshooting, and (2) important protocols and data surrounding placing a urology consult.

Implementation and Next Steps

Unequivocally, the IM resident will encounter patients with urologic problems while on service in the hospital. For example, a 2009 retrospective cohort study of managed care organizations found that over 70% of men with benign prostatic hyperplasia were initially managed by primary care providers.² Furthermore, the Centers for Disease Control and Prevention reported that indwelling urinary catheters may be used in 15% to 25% of hospitalized patients.³ Given the potentially high volume of urologic issues encountered by internists, urology education for the IM resident is critical to optimize the delivery of excellent patient care. This pilot curriculum outlining inpatient urologic care for the IM resident was well received and will be incorporated into the IM learning lab schedule moving forward. More globally, this pilot curriculum could be implemented at other institutions, expanding efforts to include basic urology instruction into IM residency didactics.

Conclusion

Urology education for the IM resident is critical. Given the frequency of urologic problems encountered by IM residents, it is imperative our colleagues be trained to adequately manage these cases. In 1 institutional pilot, the vast majority of surveyed IM residents reported that urology education was lacking in their training, and 100% of them felt that this was a worthwhile seminar to be incorporated into their training. This program can serve as a model to be introduced to other institutions and IM training programs in the future.