Panel Discussion: MIS, Renal Stones, and Transplants
Richard E. Link, MD, PhD; Brian S. Christine, MD
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Talks by Wesley A. Mayer, MD
Programmatic and Institutional Paradigms for Building and Sustaining a Successful Wellness Program
Wesley A. Mayer, MD, presents actionable programmatic and institutional paradigms for building and sustaining a successful wellness program within one’s practice or institution while avoiding burnout. He begins by defining the elements of burnout, their impact on institution-wide productivity, and the high rate of burnout in the field of Urology.
Dr. Mayer then turns to the ACGME’s well-being requirements for Urology programs. While these requirements were intended to preserve the wellness of faculty and residents in theory, Dr. Mayer highlights that the lack of specific goals in institutional wellness programs can lead to “hedonistic” initiatives and inconsistent results.
Dr. Mayer then turns to how his own institution, the Scott Department of Urology at Baylor Medical School, sought to consistently address burnout. He outlines the paradigm created by his department, the tools they used to evaluate the success of their efforts, and the results.
He concludes by enumerating the steps other institutions can take to implement similar anti-burnout programs. He provides suggestions for national-level interventions, and reinforces the need for intentionality behind wellness programs.
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Mini Percutaneous Nephrolithotomy: Should We Find Space in Our Endourologic Toolbox?
Wesley A. Mayer, MD, discusses miniaturized percutaneous nephrolithotomy (mPCNL). He explains procedures for dilating the tract, pointing out many sizes of metal dilators and sheaths available to surgeons. He covers the vortex effect, stent placement, and nerve block. Dr. Mayer then summarizes the American Urological Association (AUA)/ Endourological Society Guideline from 2016 for the surgical management of renal stones.
Dr. Mayer then compares mPCNL to standard PCNL (sPCNL) and retrograde ureteroscopy and proposes a framework for operative decision-making. Dr. Mayer examines mPCNL vs. sPCNL, whereby studies showed no difference in volume of damaged parenchyma or in systemic response to surgery-induced tissue trauma. He shares another study that showed higher average intrapelvic pressures using mPCNL, more time spent in the “danger zone” and greater dissemination of bacteria into other organs.
Dr. Mayer describes challenges in interpreting the literature, such as what qualifies as mPCNL, outcome metrics, follow up, imaging methods used, and what constitutes “stone-free.” He shares data illustrating that stone-free rates between mPCNL and sPCNL are comparable. The data also shows that transfusion risk favored mPCNL, as did length of hospital stay. However, operative time favored sPCNL. Dr. Mayer shares a retrospective review that indicated for larger stones, sPCNL was superior.
He compares mPCNL with ureteroscopy, finding that, while length of stay is longer with mPCNL, stone-free rates are similar. One comparison examined ultra-mini PCNL (umPCNL) and ureteroscopy, and indicated that umPCNL had favorable operative time, cost, complications, and stone-free rates. Dr. Mayer outlines the drawbacks of ureteroscopy before concluding by emphasizing that size matters and practitioners should choose wisely among various treatment procedures, including mPCNL and umPCNL.
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Resident Training: Can We Be Too Hard?
Wesley A. Mayer, MD, and Marisa M. Clifton, MD, FACS, FPMRS, debate residency training and ponder whether faculty are too hard or too soft on residents.
Read MoreInnovations in Urologic Residency Education
Wesley A. Mayer, MD, Associate Professor of Medicine, Assistant Dean of Graduate Education, and Vice Chair of Education in the Scott Department of Urology at Baylor College of Medicine in Houston, Texas, discusses innovations in urologic residency education in the face of changing technology and COVID-19. He begins with a brief history of medical training, explaining that the apprenticeship model was standard until around the start of the 20th century, when William Halstead began to develop the traditional surgical education experience featuring intense and repetitive experiences with surgical patients. Dr. Mayer then lists new challenges in modern surgical training, including work-hour restrictions, influence from other high-stakes fields, an increasingly litigious environment, rising expectations from the public, a progressive physician shortfall, and generational changes in learning style and needs. He argues that to meet these challenges, modern surgical training should: leverage simulators as well as inanimate and animate models; deconstruct complex surgeries into component skills; incorporate structured objective assessment tools; utilize concise, constructive, real-time feedback; address broader stressors impacting trainees, such as wellness and burnout; develop non-surgical skills; and innovate through servant leadership. Dr. Mayer then discusses recent innovations in open surgical training, highlighting the benefits of using cost-effective models based on cheaper materials and 3D printing rather than expensive traditional benchtop models and cadaveric simulations. He moves on to look at innovations in endoscopic surgical training and innovations in laparoscopic/robotic surgical training, emphasizing the benefits of virtual reality training models and video-based coaching. Dr. Mayer summarizes the recent experience of resident education in the Scott Department, particularly focusing on the department’s participation in a trial of SIMPL, a smartphone-based surgical skills assessment tool. He then briefly expands upon innovative feedback models and ways to manage trainee wellness and burnout. Dr. Mayer also considers the effect of COVID-19 on surgical training, observing that while the pandemic led to reduced resident work hours and increased concern that residents would not be able to meet minimum case requirements, the rise of videoconferencing allowed for the positive development of nationwide urology didactics. He closes the presentation by discussing innovative educational uses of social media and the importance of non-technical skills training.
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