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The Urological Assistant: A Preliminary Report
Vol. 108, August Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1972 by The Williams & Wilkins Co.
THE UROLOGICAL ASSISTANT: A PRELIMINARY REPORT CLYDE E. BLACKARD
AND
RUSSELL T. CHURCH
Frorn the Departrnent of Surgery (Urology), Veterans Adrninistration Hospital and the University of Minnesota, Minneapolis, Minnesota
The existence of a health manpower shortage has been acknowledged recently. This manpower shortage has affected urology. In 1969 there were 5,058 practicing and resident urologists in the United States, providing a urologist-population ratio of about 1 :40,000.1 The ideal ratio is approximately 1 :30,000. 2 The majority of urologists are practicing in large metropolitan areas, thereby creating a deficiency of urological care in rural communities. Methods of alleviating the manpower shortage include inaugurating new urology training prograrns, training more residents in each of the existing programs and training allied health personnel for urology. In 1968 we established a 1-year urological assistant training program at the Minneapolis Veterans Administration Hospital. The purpose of our program is to train allied health personnel to assist and to perform routine tasks for the urologist, thereby saving him time and increasing his productivity. The urological assistant could be used in the hospital, clinic or private office. Duties of urological assistants. The role of the urological assistant is necessarily different from that of other types of physicians' assistants. The assistant in our program is trained to 1) take urological histories, 2) recognize abnormal physical findings, 3) change and irrigate urethral, suprapubic and nephrostomy catheters, 4) perform basic laboratory tests, 5) perform and interpret various urological diagnostic procedures, 6) care for urological instruments, 7) prepare and drape patients for operations, 8) assist the urologist with endoscopic and open surgical procedures, 9) provide preoperative and postoperative care, which includes instructing patients on the care of ileostomy stomas and appliances, irrigating equipment and incontinence devices, and 10) assist the urologist in the conduction of conferences and the preparation of scientific papers. Training of urological assistants. In 1970 a task force of the Association of American Medical Colleges 3 and the Board on :\1edicine of the National Academy of Sciences 4 defined 3 types of physicians' Accepted for publication September 24, 1971. 1 American Medical Association: Distribution of Physicians, Hospitals, and Hospital Beds in the United States, vol. I, 1969. 2 Boyce, W. H., Flocks, R. H., Leadbetter, W. F., Lucas, B. A., Fitzpatrick, M. J., Valk, W. L., Herbst, W. P., Jr., Lattimer, J. K., Batchelor, W. M., Frenzel, C. and Ansell, J. S.: Symposium on trends in graduate education. J. Urol., 102: 259, 1969. 3 Association of American Medical Colleges: Report of Task Force on Physician's Assistant Program. Washington, D.C., February 1970. 4 Board on Medicine, National Academy of Sci-
assistants. One type of assistant would receive specialized training in a particular clinical specialty. He would function principally under the direct supervision of a licensed physician but would assume limited responsibility for the ultimate care of the patient. It is the aim of our program to train this type of physicians' assistant or urological assistant. We have attempted to build our urological assistant training program along the guide-lines established by the Council on Health Manpower of the American Medical Association. 5 Requirements for admission. Applicants for admission to our program must have completed 4 years of high school or its equivalence. Applicants must have had 2 years of experience in a health-care occupation such as a medical corpsman, nursing assistant or laboratory technician. If the applicant is accepted he must pass the University of Minnesota General College Comprehensive Examination. Four candidates are accepted yearly into our program. Teaching facilities. The Urology Section at our hospital is totally integrated with the Division of Urology, University of Minnesota. One of us (R. T. C.) has a Bachelor of Science degree in Professional Nursing and is the full-time course director. Urology residents and staff as well as other clinicians provide lectures, demonstrations and conferences for the trainees. Personnel from Nursing, Radiology, Pharmacy and the Laboratory Services assist in the training program. Trainees receive exposure to female and pediatric patients through our affiliation with other hospitals. The course also provides onthe-job training in an office-based practice and home-care visits to private residences. Curriculum and awards. The curriculum for our original 1-year course is shown in table 1. Examinations are given periodically to evaluate the student's progress. To allow upward job and educational mobility, it was decided to add an additional year of courses in the basic sciences and humanities. Consequently, our program was recently affili~ted with the general college at the university of M'innesota, the curriculum of which is flexible (table 2). Upon satisfactory completion of the 2-year course, the student will be awarded an Associate in Arts degree and a certificate designating him a urological assistant. Cost of training each graduate. Estes and Howard stated that the cost of training a physician's assistant is approximately the same amount per year as ences: New Members of the Physician's Assistants. Washington, D.C., 1970. 5 American Medical Association House of Delegates: Council on Health Manpower. Denver, Colorado, December 1969.
188
189
UROLOGICAL ASSISTANT
TABLE
l. Clinical curriculum Hours/ Year
History, Philosophy and Ethics of Urology Basic Clinical Laboratory Techniques Medical Terminology Anatomy and Physiology of the Genitourinary Tract Pathology of the Genitourinary Tract Pharmacology Basic Urological Radiology Medical Library Re.search .Outside Physician and Private Hospital Experience Nephrology Diagnostic Procedures: Endoscopic Procedures
Radiological Procedures Biopsy Procedures Cystometry Surgical Technique Surgical Assistance Emergency Techniques Urological Conferences Total
30 60 15 30 90 60 90 15 300 30 300 180 60 60 300 300 60 120 2,100
not to the nursing service. Furthermore, we believe that the risk of legal repercussions will be minimal if State laws are changed to allow delegation of tasks by physicians to trained assistants, if there is accreditation of training programs for urological assistants and if there is certification and continuing education of all graduates by the American U rological Association. TABLE
2. Recommended general college curriculum Credits
Biological Science: Principles
Biological Science: The Human Body Biological Science: Laboratory Mathematics and Measurements I Physical Science: Principles of Chemistry Physical Science: Principles of Physics Social Science: Psychology in Modern Society Writing Laboratory: Personal Writing Writing Laboratory: Organizing Ideas Electives Total
the cost of training a medical student. 6 The total cost of training a urological assistant in our 2-year program is about $11,000. The increased cost of our program is due to a $4,000 stipend paid to the trainee during his clinical year only. Ninety-five per cent of the cost of our 2-year program is paid for by the Federal Government. Disposition of urological assistants. Since March 1969 we have accepted 13 applicants into our urological assistant training program and have graduated 7. Five of the 13 trainees are still in the program; one quit for unknown reasons. All graduates are employed by a hospital and are assigned strictly to the urology clinic or one of the related areas (table 3). Annual salaries for graduates have ranged between $6,000 and $8,000. The urological assistant has been accepted readily by most patients, physicians and nurses. Problems encountered in the program. Two major questions have arisen: 1) to whom should the assistant be responsible and 2) what legal risks are involved. We believe our urological assistant is one type of physicians'. assistant and not merely a technician. Therefore, Hke all other physicians' assistant~, he should be directly responsible to the urologist and 6 Estes, E. H., Jr. and Howard, D.R.: Potential for newer classes of personnel: experiences of the Duke physician's assistant program. J. Med. Educ., 45:
149, 1970.
5 5
1 5 5 5 5 3
3
8
45
TABLE
3. Disposition of urological assistants
Date Name- Completed Age Program MB-29
2/70
TV-21
2/70
RG-21
6/70
RB-25
12/70
CS-41
12/70
PD-21
6/71
WL-27
6/71
Job Description and Location
Urological assistant at private hospital in St. Paul since graduation Urological assistant at private hospital in St. Paul for 1 year. Currently employed at VA hospital in Minneapolis Urological and surgical technician at private hospital in Minneapolis since graduation Hemodialysis technician at county hospital in Minneapolis since graduation. Has applied for admission to Duke University Physician's Associate program Nursing assistant on spinal cord injury service at VA hospital in Miami, Florida Urological assistant at private hospital in Duluth since graduation Plans to take basic science courses for AA degree
SUMMARY
Our program for the training of urological assistants is an important advance in the area of urological training and manpower. Currently there is a shortage of about 1,700 urologists in the United States. Ours as well as similar programs will help to relieve this health manpower shortage and will ultimately be an important contribution to the Nation's health.
THE JOURNAL OF UROLOGY
Copyright© 1972 by The Williams & Wilkins Co.
THE UROLOGICAL ASSISTANT: A PRELIMINARY REPORT CLYDE E. BLACKARD
AND
RUSSELL T. CHURCH
Frorn the Departrnent of Surgery (Urology), Veterans Adrninistration Hospital and the University of Minnesota, Minneapolis, Minnesota
The existence of a health manpower shortage has been acknowledged recently. This manpower shortage has affected urology. In 1969 there were 5,058 practicing and resident urologists in the United States, providing a urologist-population ratio of about 1 :40,000.1 The ideal ratio is approximately 1 :30,000. 2 The majority of urologists are practicing in large metropolitan areas, thereby creating a deficiency of urological care in rural communities. Methods of alleviating the manpower shortage include inaugurating new urology training prograrns, training more residents in each of the existing programs and training allied health personnel for urology. In 1968 we established a 1-year urological assistant training program at the Minneapolis Veterans Administration Hospital. The purpose of our program is to train allied health personnel to assist and to perform routine tasks for the urologist, thereby saving him time and increasing his productivity. The urological assistant could be used in the hospital, clinic or private office. Duties of urological assistants. The role of the urological assistant is necessarily different from that of other types of physicians' assistants. The assistant in our program is trained to 1) take urological histories, 2) recognize abnormal physical findings, 3) change and irrigate urethral, suprapubic and nephrostomy catheters, 4) perform basic laboratory tests, 5) perform and interpret various urological diagnostic procedures, 6) care for urological instruments, 7) prepare and drape patients for operations, 8) assist the urologist with endoscopic and open surgical procedures, 9) provide preoperative and postoperative care, which includes instructing patients on the care of ileostomy stomas and appliances, irrigating equipment and incontinence devices, and 10) assist the urologist in the conduction of conferences and the preparation of scientific papers. Training of urological assistants. In 1970 a task force of the Association of American Medical Colleges 3 and the Board on :\1edicine of the National Academy of Sciences 4 defined 3 types of physicians' Accepted for publication September 24, 1971. 1 American Medical Association: Distribution of Physicians, Hospitals, and Hospital Beds in the United States, vol. I, 1969. 2 Boyce, W. H., Flocks, R. H., Leadbetter, W. F., Lucas, B. A., Fitzpatrick, M. J., Valk, W. L., Herbst, W. P., Jr., Lattimer, J. K., Batchelor, W. M., Frenzel, C. and Ansell, J. S.: Symposium on trends in graduate education. J. Urol., 102: 259, 1969. 3 Association of American Medical Colleges: Report of Task Force on Physician's Assistant Program. Washington, D.C., February 1970. 4 Board on Medicine, National Academy of Sci-
assistants. One type of assistant would receive specialized training in a particular clinical specialty. He would function principally under the direct supervision of a licensed physician but would assume limited responsibility for the ultimate care of the patient. It is the aim of our program to train this type of physicians' assistant or urological assistant. We have attempted to build our urological assistant training program along the guide-lines established by the Council on Health Manpower of the American Medical Association. 5 Requirements for admission. Applicants for admission to our program must have completed 4 years of high school or its equivalence. Applicants must have had 2 years of experience in a health-care occupation such as a medical corpsman, nursing assistant or laboratory technician. If the applicant is accepted he must pass the University of Minnesota General College Comprehensive Examination. Four candidates are accepted yearly into our program. Teaching facilities. The Urology Section at our hospital is totally integrated with the Division of Urology, University of Minnesota. One of us (R. T. C.) has a Bachelor of Science degree in Professional Nursing and is the full-time course director. Urology residents and staff as well as other clinicians provide lectures, demonstrations and conferences for the trainees. Personnel from Nursing, Radiology, Pharmacy and the Laboratory Services assist in the training program. Trainees receive exposure to female and pediatric patients through our affiliation with other hospitals. The course also provides onthe-job training in an office-based practice and home-care visits to private residences. Curriculum and awards. The curriculum for our original 1-year course is shown in table 1. Examinations are given periodically to evaluate the student's progress. To allow upward job and educational mobility, it was decided to add an additional year of courses in the basic sciences and humanities. Consequently, our program was recently affili~ted with the general college at the university of M'innesota, the curriculum of which is flexible (table 2). Upon satisfactory completion of the 2-year course, the student will be awarded an Associate in Arts degree and a certificate designating him a urological assistant. Cost of training each graduate. Estes and Howard stated that the cost of training a physician's assistant is approximately the same amount per year as ences: New Members of the Physician's Assistants. Washington, D.C., 1970. 5 American Medical Association House of Delegates: Council on Health Manpower. Denver, Colorado, December 1969.
188
189
UROLOGICAL ASSISTANT
TABLE
l. Clinical curriculum Hours/ Year
History, Philosophy and Ethics of Urology Basic Clinical Laboratory Techniques Medical Terminology Anatomy and Physiology of the Genitourinary Tract Pathology of the Genitourinary Tract Pharmacology Basic Urological Radiology Medical Library Re.search .Outside Physician and Private Hospital Experience Nephrology Diagnostic Procedures: Endoscopic Procedures
Radiological Procedures Biopsy Procedures Cystometry Surgical Technique Surgical Assistance Emergency Techniques Urological Conferences Total
30 60 15 30 90 60 90 15 300 30 300 180 60 60 300 300 60 120 2,100
not to the nursing service. Furthermore, we believe that the risk of legal repercussions will be minimal if State laws are changed to allow delegation of tasks by physicians to trained assistants, if there is accreditation of training programs for urological assistants and if there is certification and continuing education of all graduates by the American U rological Association. TABLE
2. Recommended general college curriculum Credits
Biological Science: Principles
Biological Science: The Human Body Biological Science: Laboratory Mathematics and Measurements I Physical Science: Principles of Chemistry Physical Science: Principles of Physics Social Science: Psychology in Modern Society Writing Laboratory: Personal Writing Writing Laboratory: Organizing Ideas Electives Total
the cost of training a medical student. 6 The total cost of training a urological assistant in our 2-year program is about $11,000. The increased cost of our program is due to a $4,000 stipend paid to the trainee during his clinical year only. Ninety-five per cent of the cost of our 2-year program is paid for by the Federal Government. Disposition of urological assistants. Since March 1969 we have accepted 13 applicants into our urological assistant training program and have graduated 7. Five of the 13 trainees are still in the program; one quit for unknown reasons. All graduates are employed by a hospital and are assigned strictly to the urology clinic or one of the related areas (table 3). Annual salaries for graduates have ranged between $6,000 and $8,000. The urological assistant has been accepted readily by most patients, physicians and nurses. Problems encountered in the program. Two major questions have arisen: 1) to whom should the assistant be responsible and 2) what legal risks are involved. We believe our urological assistant is one type of physicians'. assistant and not merely a technician. Therefore, Hke all other physicians' assistant~, he should be directly responsible to the urologist and 6 Estes, E. H., Jr. and Howard, D.R.: Potential for newer classes of personnel: experiences of the Duke physician's assistant program. J. Med. Educ., 45:
149, 1970.
5 5
1 5 5 5 5 3
3
8
45
TABLE
3. Disposition of urological assistants
Date Name- Completed Age Program MB-29
2/70
TV-21
2/70
RG-21
6/70
RB-25
12/70
CS-41
12/70
PD-21
6/71
WL-27
6/71
Job Description and Location
Urological assistant at private hospital in St. Paul since graduation Urological assistant at private hospital in St. Paul for 1 year. Currently employed at VA hospital in Minneapolis Urological and surgical technician at private hospital in Minneapolis since graduation Hemodialysis technician at county hospital in Minneapolis since graduation. Has applied for admission to Duke University Physician's Associate program Nursing assistant on spinal cord injury service at VA hospital in Miami, Florida Urological assistant at private hospital in Duluth since graduation Plans to take basic science courses for AA degree
SUMMARY
Our program for the training of urological assistants is an important advance in the area of urological training and manpower. Currently there is a shortage of about 1,700 urologists in the United States. Ours as well as similar programs will help to relieve this health manpower shortage and will ultimately be an important contribution to the Nation's health.