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Reported Cystoscopic Experience Correlates Poorly With Objective Assessment of Cystoscopic Skills

Nihira, Mikio A. MD, MPH*; Drake, Natalie L. MD; Corton, Marlene M. MD; Wai, Clifford Y. MD; Coleman, Robert L. MD§; Quiroz, Lieschen H. MD*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2012 - Volume 18 - Issue 2 - p 97–102
doi: 10.1097/SPV.0b013e318247500f
Original Articles
Journal Club

Objective Although gynecologists perform a large number of surgeries in close proximity to the ureters and the urinary bladder, traditionally, Obstetrics and Gynecology resident physicians are not formally taught to perform cystoscopy. The primary objective was to document resident physicians’ performance in diagnostic cystoscopic instrumentation and technique. The secondary objective was to examine if reported prior cystoscopic experience was associated with superior performance.

Methods Fifty-one postgraduate year 4 residents with reported experience with cystoscopy were evaluated using an operation-specific checklist and a global ratings scale based on the Objective Structured Assessment of Technical Skill model. Before evaluation, they attended a formal training session in cystoscopy, which included practice on a bench model of a simulated bladder.

Results Forty-three of the 51 residents were able to successfully perform a thorough diagnostic examination immediately after the course. Six of the 8 failures were re-evaluated 2 weeks later and successfully performed a complete examination at that time. Before the course, the residents had performed a mean of 12.2 cystoscopic examinations as the primary surgeon (median, 12; range, 2–33). The number of reported cystoscopic examinations performed before the course did not correlate with the ability to perform a thorough cystoscopic examination (r = −0.109; P = 0.496).

Conclusions For this group of residents, there was poor correlation between the number of reported cystoscopic examinations and the ability to perform diagnostic cystoscopy. Trainees may not be able to determine when they have received enough instruction in hands-on training with models before acquisition of technical skills.

Resident-reported experience with cystoscopy does not correlate with superior performance as assessed by a task-specific checklist or global rating scale.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK; †Women’s Health Institute, Cleveland Clinic Foundation, Cleveland, OH; ‡Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; and §Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.

Reprints: Mikio A. Nihira, MD, MPH, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center 920 Stanton L. Young, WP 2410, Oklahoma City, OK 73104. E-mail:

Conflicts of Interest and Source of Funding: In the past 12 months, Dr Nihira was a consultant to American Medical Systems and an investigator in separate research trials funded by American Medical Systems, by Coloplast, and by Oceana. For the remaining authors, no conflict of interest was declared.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins