title: Milestone assessment of minimally invasive surgery in Pediatric Urology fellowship programs.
abstract: BACKGROUND
  Minimally invasive surgery has become an important aspect of Pediatric Urology fellowship training. In 2014, the Accreditation Council for Graduate Medical Education published the Pediatric Urology Milestone Project as a metric of fellow proficiency in multiple facets of training, including laparoscopic/robotic procedures.
  
  
  OBJECTIVE
  The present study assessed trends in minimally invasive surgery training and utilization of the Milestones among recent Pediatric Urology fellows.
  
  
  METHODS
  Using an electronic survey instrument, Pediatric Urology fellowship program directors and fellows who completed their clinical year in 2015 were surveyed. Participants were queried regarding familiarity with the Milestone Project, utilization of the Milestones, robotic/laparoscopic case volume and training experience, and perceived competency with robotic/laparoscopic surgery at the start and end of the fellowship clinical year according to Milestone criteria. Responses were accepted between August and November 2015.
  
  
  RESULTS
  Surveys were distributed via e-mail to 35 fellows and 30 program directors. Sixteen fellows (46%) and 14 (47%) program directors responded. All fellows reported some robotic experience prior to fellowship, and 69% performed >50 robotic/laparoscopic surgeries during residency. Fellow robotic/laparoscopic case volume varied: three had 1-10 cases (19%), four had 11-20 cases (25%), and nine had >20 cases (56%). Supplementary or robotic training modalities included simulation (9), animal models (6), surgical videos (7), and courses (2). Comparison of beginning and end of fellowship robotic/laparoscopic Milestone assessment (Summary Fig.) revealed scores of <3 in (10) 62% of fellow self-assessments and 10 (75%) of program director assessments. End of training Milestone scores >4 were seen in 12 (75%) of fellow self-assessment and eight (57%) of program director assessments.
  
  
  CONCLUSIONS
  An improvement in robotic/laparoscopic Milestone scores by both fellow self-assessment and program director assessment was observed during the course of training; however, 43% of program directors rated their fellow below the graduation target of a Milestone score of 4.
  
  
  CONCLUSIONS
  The best ways to teach minimally invasive surgery in fellowship training must be critically considered.
authors.affiliation: Division of Urology, Connecticut Children's Medical Center, Hartford, CT, USA; University of Connecticut School of Medicine, Farmington, CT, USA. Electronic address: trey.smith.83@gmail.com.
authors.forename: P H
authors.initials: PH
authors.lastname: Smith
authors.affiliation: Division of Urology, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Carpenter
authors.affiliation: Division of Urology, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Herbst
authors.affiliation: Division of Urology, Connecticut Children's Medical Center, Hartford, CT, USA; University of Connecticut School of Medicine, Farmington, CT, USA.
authors.forename: C
authors.initials: C
authors.lastname: Kim
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000458:organization & administration; D004521:Educational Measurement; D005257:Fellowships and Scholarships / Q000458:organization & administration*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000193:education; D010372:Pediatrics; D065287:Robotic Surgical Procedures / Q000193:education*; D013520:Urologic Surgical Procedures / Q000193:education*
keywords: Learning curve; Milestone; Pediatric urology; Robotic surgery; Training