# Development and Implementation of the Selection, Entry, Lithotripsy, Exit, and CT (SELECT) Mnemonic and Checklist: A Structured Approach to Urolithiasis Assessment and Management for Urology Trainees and Junior Urologists

## TL;DR

This paper introduces a new mnemonic and checklist called SELECT to help urology trainees better assess and manage kidney stones.

## Contribution

The SELECT mnemonic and checklist provide a structured, five-tier approach to improve trainee confidence and decision-making in urolithiasis management.

## Key findings

- Before implementation, only 25% of residents felt confident in assessing kidney stones.
- After using SELECT, 84% of trainees reported increased confidence in stone assessment and treatment selection.

## Abstract

Introduction

Urolithiasis is a common condition in urological practice, with a particularly high burden in the Middle East due to dietary and lifestyle factors. Effective evaluation and management require a systematic approach, yet trainees often struggle with decision-making due to patient- and stone-related variability. To address these challenges, we developed the selection, entry, lithotripsy, exit, and CT (SELECT) mnemonic and checklist, a structured five-tier systematic approach designed to streamline renal stone assessment and management.

Methods

A panel of endourologists and educators identified key challenges in urolithiasis management among urology residents. A pre-implementation survey was conducted among 28 residents in the Kuwait Board of Urology program to assess confidence and challenges in renal stone evaluation and keenness for a mnemonic. Following the development of the SELECT mnemonic and checklist, trainees were introduced to the tool and instructed to utilize it over four weeks. A post-implementation survey was then conducted, and feedback was collected from both trainees and training supervisors.

Results

Before implementation, only 25% of residents reported confidence in assessing renal stone characteristics and selecting treatment modalities. Post-implementation, 84% reported improved confidence in assessment, and 80% felt more assured in treatment selection. Supervisors also noted improved diagnostic accuracy and decision-making among trainees. The mnemonic reduced reliance on senior guidance, although time constraints were a reported limitation.

Conclusion

The SELECT mnemonic and checklist offer a structured, evidence-based approach to renal stone management, improving trainee confidence and decision-making. External validation and potential scoring integration could further enhance their utility in urological education and clinical practice.