Barry Kogan, MD

With the AUA annual meeting quickly approaching, 

, chair of the AUA Office of Education, provided a snapshot of new course offerings and other AUA educational opportunities. He was interviewed by 

The AUA Office of Education courses are among the highlights of the AUA annual meeting for many of us. Can you tell us about any new courses this year?

This year the Office of Education will be offering 85 2-hour Instructional Courses, of which 30 are brand new. New courses will be available in all major areas of urology, including sexual and reproductive medicine, female pelvic medicine, reconstructive urology, lower urinary tract dysfunction, endourology, geriatric urology, public policy, new technologies, and urologic oncology. In addition, will be offering two new Hands-On Courses on office-based transperineal prostate interventions (including biopsy) and flexible ureteroscopy, for a total of six Hands-On Courses.

I imagine you repeat the courses that have had the most interest over the years. Which courses have attendees found to be most popular?

The most popular courses by number of attendees are in endourology (especially stone management), testosterone therapy, infertility update, prostate cancer (including treatment options and active surveillance), and robotic technologies.

The meeting is always pretty jam packed. What are the options for those who have conflicts for a given course? 

In 2019, we will have several ways to access the AUA Instructional Courses. The Live Course Pass is our traditional option, providing access to all 85 Instructional Courses. One can also choose the Course Pass Bundle that gives the same access to all live courses plus all online webcasts. Lastly, we will be offering a single-course ticket for those attendees who want to go to just one course. Access to the Instructional Courses can be purchased with meeting registration, through the mobile app, or at registration upon arrival in Chicago.

Not everyone can make the meeting. For those stuck on call back home, are they able to access the information presented at the courses?

Content from the annual meeting will be available on AUA

 following the meeting. Some content will be open to everyone, while other content like the Surgical Video Library will be available to our members. The entire meeting content can be accessed through the AUA2019 Virtual Meeting product, which will be available for purchase within a week of the meeting.

Given the expense and time commitment of travel, many urologists are unable to attend many meetings. In addition to Self-Assessment Study Program and the Update series, can you tell us about the some of the newer offerings of the Office of Education? 

 is an invaluable source of educational opportunities. In addition to those products you mentioned, the University offers the AUA Urology Core Curriculum, webcasts and podcasts that are constantly updated, surgical videos, and access to online materials from our annual meetings. In 2018, we completely revamped our online platform, giving our members easier access to all of the educational opportunities that we have to offer. The new AUA

 allows for easy search of materials by topic or by ABU lifelong learning categories.

Articles

With the AUA annual meeting quickly approaching, Victor W. Nitti, MD, chair of the AUA Office of Education, provides a snapshot of new course offerings and other AUA educational opportunities.

Dr. Nitti: 32 new courses on tap at AUA 2019

Editorial Council, is chief of urology at Albany Medical College, Albany, NY.

The era of team-based health care is upon us. Indeed, almost all aspects of your patient’s outcomes are influenced by your team members. If you doubt this, consider whether your receptionists, team members you may rarely have contact with, can have an influence on how patients rate your care. In recent years, in our practice, advanced-practice providers (APPs), including both nurse practitioners (NPs) and physician assistants (PAs), have become highly valued team members.

They participate in all aspects of patient care, including evaluation of new patients, pre- and postoperative care, office procedures, and drug administration. They practice both as support for our urologists but also as independent practitioners (under indirect supervision). They even do non-complex procedures in the operating room (again with indirect supervision).

Survey: Wide variation in urologist engagement with APPs

As many other practices have found, they help us to improve access, increase capacity, keep our costs low, and just as important, they allow our urologists to focus on more complex functions; and our patients feel very comfortable with them. Overall, they make me look good. With an aging population that will require more urologic care and with a shortage of urologists and an aging workforce, APPs are ideal team members to advance urologic care.

 presented at the 2018 AUA annual meeting in San Francisco highlights just how pervasive APPs are in urologic practice. Data collected from the AUA Census suggest that, in 2015, there were over 5,000 NPs/PAs working in urology practices in the U.S. (Bear in mind that there were only 11,990 AUA members in the U.S. in 2015.) Striking, though, is the variability in use of APPs. In New England, approximately 62% of practices had a PA but only 35% just further south in New York City. There are very similar numbers for NPs.

More disappointing was the difference in PA utilization between metropolitan and non-metropolitan practices (45% vs. 26% for PAs). Since rural areas are underserved by urologists and this correlates with poorer outcomes, APPs would be prime candidates to help solve this problem. Future surveys that aim to determine why this is and how it might be improved would be very valuable. Overall, I am delighted that our practice is on the “right” side of the AUA Census survey results and if your practice is not yet there, bear in mind that APPs are not just for your iPhone.

“As many other practices have found, [advanced practice providers] help us to improve access, increase capacity, keep our costs low, and just as important, they allow our urologists to focus on more complex functions,” writes Barry A. Kogan, MD.

APPs are not just for your iPhone

	Having personally worked with a single nurse practitioner in my practice for the past 15 years, I feel uniquely qualified to understand the benefits of advanced practice providers (APPs), as well as the drawbacks.

	Pediatric urologists have seen the benefits for APPs for years, but general urologists have been slow adopters. However, studies now show 62% of urologists report using APPs in their practice 

(see page 5) found that 81% of APPs report they are doing procedures, including 8% who report doing cystoscopy for diagnostic reasons and 6% who do prostate biopsies. There continues to be debate over the appropriateness of this, as well as uncertainty about adequate training. Despite the concerns, a recent publication using Centers for Medicare & Medicaid Services data documented a dramatic increase in APP urology procedures in Medicare patients (eg, a 6-fold increase in cystoscopy procedures and a 24-fold increase in cystoscopic stent removal between 2003 and 2014) 

	The nurse practitioner that I work with is not only very knowledgeable in office-based pediatric urology but also, for problems like voiding dysfunction, more available to spend extra time with patients and their families. In addition, she can also competently and safely perform standard procedures (eg, neonatal and OR circumcisions) that free me up to perform more complex procedures.

	There are few formal programs for training APPs in urology, so the burden rests with the practice. In addition, effective use of APPs requires delegating patient care to them (and being responsible for their practice!). Finally, it is essential to have confidence in your APP so that your patients will accept (and perhaps ask for) him or her.

	Considering the pros and cons (nicely summarized in a 

), my experience is, “If you try working with an APP, you’ll like it!”

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"The nurse practitioner that I work with is not only very knowledgeable in office-based pediatric urology but also, for problems like voiding dysfunction, more available to spend extra time with patients and their families," writes Barry A. Kogan, MD.

Barry Kogan, MD

Articles

Dr. Nitti: 32 new courses on tap at AUA 2019

APPs are not just for your iPhone

Working with APPs: Try it, you’ll like it