How do pediatric urology fellows learn outside of direct patient care? A qualitative study



      A large proportion of time during pediatric urology fellowship training is focused on surgical skill development. While fellows begin their fellowship training with some knowledge of pediatric urology from residency, they rely on self-directed learning to expand their knowledge base.


      To assess how pediatric urology fellows learn about their field outside of direct patient care experiences. Additionally, we were interested in how the pandemic affected fellows self-directed learning.


      First and second year pediatric urology fellows at Accreditation Council of Graduate Medical Education (ACGME)-accredited programs were asked to participate in the study. Individual virtual interviews were conducted and transcribed. Each transcript was coded shortly after transcription. Constructivist grounded theory was used in the data collection and analysis. As interviews progressed, a constant comparative analysis was used iteratively to generate themes.


      A convenience sample of thirteen fellows from programs across the U.S. agreed to participate; eight were male and five were female. The following four themes emerged from the interviews: most learning in fellowship is self-directed, fellows are not the target audience for didactics, fellows have little independent study time, and there is a lack of organization and guidance for formal didactics (Summary Table). Additionally, we found that teleconferences were used for the majority of teaching after the start of the coronavirus pandemic.


      Summary TableEmerging themes about fellow didactics
      Themes Sub-Themes
      Self-Directed learning Seek out research articles

      All fellows use outside sources for learning

      Seek knowledge outside of own institution

      Fellows are not aware of their own knowledge gaps
      Little Independent Study Time Clinical Responsibilities and time on service leave little time to study

      Service over education

      Running conferences and organizing education felt to be more of a burden than educational

      More study time on research year vs. clinical year
      Lack of Organization No Formal Curricula from year to year

      Fellows have little orientation for how to run conferences at new institution

      Schedule is constantly changing around attending clinical responsibilities

      Fellows felt better about didactics when they could tailor topics
      Fellows not the target audience Much of formal “didactics” is geared towards residents.

      Some programs are more fellow-oriented, others are resident-oriented

      Lectures may be repeated each time new residents come on service
      Majority of teaching post-pandemic is performed via teleconference Better attendance overall

      There is less overall engagement on Zoom (turning off cameras, not answering questions)

      Less discussion amongst attendings and fellows on Zoom, which was previously felt to be best learning environment

      Video Lectures and conferences from other institutions have been found to be very helpful



      ACGME (Accreditation Council of Graduate Medical Education), SDT (Self-Determination Theory), UCSF (University of California–San Francisco)
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