Introduction: Due to advances in prenatal imaging, pediatric urologists have a growing role in prenatal counseling and care. Studies have shown improved parental experience if prenatal consultations are performed. We sought to characterize trainee experiences with prenatal urologic diagnosis, parental counseling, and assess trainee preparedness for providing independent prenatal consultations. Methods: An online survey for pediatric urology program directors (PDs) and current fellows was distributed via electronic mail. Respondents were asked about participation expectations, personal experiences, and perceived preparedness for providing independent prenatal consultations for multiple diagnoses. Demographics and fellowship characteristics were summarized. Responses were compared across PD and fellow surveys for paired questions. Fisher’s exact test was used to examine associations between fellow and PD responses.
Results: 28 fellows and 24 PDs responded (response rates 80% and 88.9%, respectively). Table 1 shows demographics and fellowship characteristics. Most fellows (71.4%) reported participation in prenatal consultation. Most fellows reported participation in common diagnoses; few reported experience with less common diagnoses. Of the programs requiring fellow participation in prenatal consultation (37.5%), PDs reported most fellows were participating in all diagnoses with one exception: not all were participating in spina bifida (Table 2). When asked about skill development related to prenatal consultations, one PD remarked, “Grads should be comfortable, not necessarily skilled in the prenatal imaging. They should be adequately prepared to discuss prenatal urologic implications with families.” Similar sentiments were reflected in survey responses as most PDs prioritized counseling over the ability to diagnose genitourinary conditions on prenatal imaging (Table 3). Though not statistically significant, these findings reflect an overall theme of the importance of counseling. Despite this, only 44.4% of PDs reported fellows participate in consultations as a counselor counselor. When asked how well respective programs prepare graduating fellows to provide prenatal consultation, 34.6% fellows responded ‘somewhat’ and 3.8% responded ‘not at all’. 53.9% of fellows responded “yes” or “undecided” when asked if they had concerns providing independent prenatal consultation, with 92.3% reporting lack of experience with counseling as their primary concern. Meanwhile, PD responses to a similar question revealed 86.5% and 83.4% of PDs felt their program adequately prepared graduating fellows to diagnose and counsel families, respectively. Conclusion: Prenatal consultation is becoming increasingly common in practice for pediatric urologists, however fellowships have not established specific guidelines for education. Fellow exposure to prenatal consultation and opportunities for counseling vary greatly, and many report participating in a wide variety of diagnoses. These findings highlight the need to improve the approach to fetal urology education by providing more deliberate opportunities and exposure for trainees across the country.
