Trends of European School of Urology (ESU) training and resident education: an overview of 2 decades of EAU education programme.

BACKGROUND: Over the last 2 decades, various education and training programmes have been launched by the European School of Urology (ESU) on behalf of the European Association of Urology (EAU) Education Office. These include e-learning platforms, in-person meetings, courses, podcasts, webinars, sub-specialisation meetings and the European Urology Resident Education Programme (EUREP), all of which aim to achieve standardisation in urological education (SISE) and training at the highest level. METHODS: Data from the last 2 decades of all ESU activities were collected by the EAU/ESU office and analyzed for attendance, geographical, gender and age trends. Demographic data on registrations and attendances at EUREP were also monitored and analysed. A descriptive analysis of participation and trends is provided. RESULTS: A total of 4750 participants have completed ESU courses (including guideline courses, specialization courses and webinar courses). Similarly, a total of 5958 trainees attended the EUREP from 2004 to 2022 of which the male: female ratio was 3.75:1. However, the proportion of females increased 3.5-fold from 10.7% in 2004 to 37.1% in 2022(p < 0.001). There is a growing interest in the meeting, with increasing registrations over this time (353 in 2004 to 599 in 2023, p < 0.001). The mean age of participants is constantly decreasing (32.6 years in 2004 to 31.54 in 2022), with a mean yearly decrease of -0.18% (p < 0.001). CONCLUSION: ESU courses have had increasing interest and participation from young urologists worldwide. During EUREP, while the trainee age has decreased, there has been a surge in the proportion of female trainees. ESU is providing all modes of education and training across the world with both virtual and in-person meetings and courses, which would help in the development and preparation of urologists of the future and provide the best patient care.

Establishing postgraduate education in urology for nurses and the non-medical workforce using a partnership model.

Eleri Phillips, Urology Education Programme Lead, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Merseyside (eleri.phillips@sthk.nhs.uk) was the Gold Award winner in the Urology Nurse of the Year category of the BJN Awards 2024.

Laparoscopic Radical Prostatectomy: Assessing the Impact of Residency Training on Early Surgical Experience.

BACKGROUND: Transferring the intricate laparoscopic radical prostatectomy (LRP) technique poses a considerable challenge for novice surgeons. Fellowship programs, typically lasting three to twelve months, remain the primary avenue for acquiring laparoscopic skills. This study proposes that residency-based laparoscopy training confers distinct advantages over fellowship programs during the initial stages of LRP. METHODS: The study analyzed retrospectively collected data and operation videos from the first and second sets of fifty operations (Group 1 and Group 2) out of a total of 553 performed by the "fellow" surgeon between August 2009 and December 2022, and the first fifty operations by the "resident" surgeon from January 2022 to June 2023. Parameters examined included patient demographics, preoperative prostate-specific antigen (PSA) levels, grades, stages, operation durations, complications, postoperative outcomes, and short-term (6-month) oncological and functional results. RESULTS: No statistically significant differences were observed in prostate volume, age, body mass index, or PSA levels between Groups 2 and 3 or 1 and 3 (p > 0.05). Nevertheless, Group 3 exhibited significantly more International Society of Urological Pathology grade 3 and 4 cases than Group 1 (p = 0.004) and Group 2 (p = 0.006). Additionally, Group 3 had a shorter anastomosis time (AT) (25 min vs. 35 min, p < 0.001) and reduced estimated blood loss (EBL) (275 mL vs. 385 mL, p = 0.008) compared to Group 1. No significant differences were found among the groups regarding intraoperative complications, nerve sparing, or lymph node dissection rates. While Group 2's anastomosis time was comparable to that of Group 3 (24 min vs. 25 min, p = 0.144), it demonstrated a significantly shorter insufflation duration (150 min vs. 170 min, p < 0.001). Functional outcomes, including continence and erectile function at six months, showed no significant differences across the groups. CONCLUSIONS: This study underscores the potential benefits of integrating LRP training into a surgeon's residency, particularly in the early stages of their learning curve (LC), by reducing anastomosis and operation times and EBL in the first fifty cases. Initial findings suggest that implementing modular training in residency programs could enhance LRP proficiency, benefiting both surgeons and patients.

The impact of single-port robotic surgery: a survey among urology residents and fellows in the United States.

Our aim was to investigate the perception and future expectations of Single-Port (SP) surgery among urology trainees in the United States. A 34-item online survey was distributed to urological residency and fellowship programs across the US, covering demographic profiles, SP training opportunities, perceived educational impact, and future perspectives. Descriptive analysis and multivariable linear regression were used to assess predictors of SP adoption. 201 surveys were completed (28.6% completion rate). Among institutions with an SP platform, about 50% have used it regularly for over 2 years, though often in less than 50% of procedures. While robotic simulators are commonly available, only 17% offer both multi-port and SP simulators, and structured pre-clinical SP training is limited. Approximately 30% of respondents expressed concerns over limited hands-on experience and a steeper learning curve with SP. Around 40% felt that their robotic surgery exposure was negatively impacted by SP's introduction. SP surgery's benefits are seen mostly in the immediate post-operative period and a significant number of respondents foresee a major role for SP in urology. However, proficiency in SP surgery is not seen as crucial for career advancement or job opportunities. Academic job aspirations, SP platform availability, and SP surgery workload are predictors of future SP implementation. Trainees increasingly recognize the clinical benefits of SP procedures but express concerns about the potential negative impact on hands-on experience. Training programs should more systematically integrate SP technology into curricula. There is a correlation between training in high-volume SP centers and future SP adoption.

Conscientious Objection to Gender-Affirming Surgery: A Cross-Sectional Analysis of Plastic Surgery and Urology Residency Programs.

OBJECTIVE: Medical conscientious objection is a federally protected right of physicians to refuse participation in medically indicated services or research activities that are incompatible with their ethical, moral, or religious beliefs. Individual provider objections to gender-affirming surgery have been documented, however the prevalence of such objections is unknown. Our study aimed to characterize physician objections to gender-affirming surgery in plastic surgery and urology residencies and to assess related institutional policies. DESIGN, SETTING, PARTICIPANTS: A cross-sectional electronic survey was administered to program leadership of 239 accredited US plastic surgery and urology residencies from February to October 2023. Trainee exposure to gender-affirming surgery, programmatic experience with objections, and presence and content of institutional objection policies were collected. Bivariate analyses were performed to determine associations with objectors. RESULTS: One-hundred and twenty-four plastic surgery (n = 59) and urology (n = 65) residencies completed the survey, representing a 52% response rate. Most programs included didactic training (n = 107, 86%) and direct clinical exposure (n = 98, 79%) to gender-affirming surgery. Few (n = 24, 19%) endorsed existent objection policies. Sixteen programs (13%) experienced objections to gender-affirming surgery by trainees (n = 15), faculty (n = 6), and staff (n = 1). Neither geographic region, exposure to gender-affirming surgery, nor presence of objection policies significantly contributed to programmatic objections. Programs with formal objection policies reported increased confidence in addressing future objection events (p = 0.017). CONCLUSIONS: Objection to gender-affirming surgery is a rare, but plausible occurrence amongst plastic surgery and urology trainees. Residency programs should consider anticipatory policies to protect patients and, when feasible, provide reasonable accommodations for objecting trainees.

The Film Room: Using Artificial Intelligence to Facilitate Video Review for Urology Trainees.

Video-based educational programs offer a promising avenue to augment surgical preparation, allow for targeted feedback delivery, and facilitate surgical coaching. Recently, developments in surgical intelligence and computer vision have allowed for automated video annotation and organization, drastically decreasing the manual workload required to implement video-based educational programs. In this article, we outline the development of a novel AI-assisted video forum and describe the early use in surgical education at our institution.

[Sex education for adolescents and adults-Max Hodann (1894-1946) in action]. / Sexualaufklärung für Jugendliche und Erwachsene ­ Max Hodann (1894­1946) in Aktion.

Up to the 1970s, a cultural battle raged in Germany and Europe about the question of the sense to inform and educate young people about gender, sex, and sexuality. One physician realized early that it is important to educate adults about their bodies and their genital and genitourinary disorders. Max Hodann (1894-1946), thus, unintentionally flooded urological practices with countless patients.

A Novel Urology Preliminary Residency Curriculum Within a Department of Surgery for Unmatched Applicants.

OBJECTIVE: Traditional options for unmatched applicants in urology include pursuing a research fellowship or completing a preliminary general surgery training year. We aimed to create a novel urology-focused preliminary curriculum. DESIGN: The general surgery program commits three preliminary positions for urology-focused interns. These interns complete six months of urology rotations and six months of general surgery rotations. Additionally, they are paired with a urology faculty member to participate in a longitudinal coaching and mentorship program. SETTING: The curriculum is situated within a Department of Surgery, which includes the Division of Urology, at one academic institution. PARTICIPANTS: Eight residents have completed the urology-focused preliminary curriculum in three academic years (2022-2023). RESULTS: Six residents have obtained categorical urology positions. Four matched via the American Urological Association Urology Match into a post-graduate year 1 (PGY1) position, and two matched outside of a formal matching process into a PGY2 position. CONCLUSION: This urology-focused preliminary curriculum presents a novel strategy to address the growing number of unmatched applicants in competitive surgical subspecialties such as urology.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

BACKGROUND: Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. METHODS: This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. RESULTS: One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. CONCLUSION: Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Analyzing learning curve for supine percutaneous nephrolithotomy in urology resident training programme: comparative analysis.

INTRODUCTION: This article attempts to provide a comprehensive review of the learning objectives and importance of the supine percutaneous nephrolithotomy (PCNL) technique. MATERIAL METHOD: We retrospectively reviewed the cases of Supine PCNL between January 2018 and January 2024. We divided the groups into 3: residents between 2 and 3 years (Group 1), residents between 4 and 5 years (Group 2), and endourologist (Group 3). The 2-3-year resident started to perform PCNL for the first time, while the 4-5-year resident started to perform Supine PCNL for the first time while previously performing prone PCNL. RESULTS: Access, fluoroscopy, and operation time were higher in Group 1, shorter in Group 2, and shortest in Group 3 (p < 0.001). Postoperative length of stay and the need for additional treatment were found to be shorter (p < 0.001), and the stone-free rate (SFR) increased (p < 0.001) from Group 1 to Group 3. The highest complication rates were observed in Group 1 (p = 0.002). SFR rate increased as the number of cases increased in Group 1 patients. Success was stable after 46-60 cases in terms of SFR. In Group 2, the SFR rate was stable after 31-45. CASES: The most complications were observed in Group 1 and the least in Group 3. CONCLUSION: In 2-3-year residents, access time and fluoroscopy time decrease with experience. In 4-5-year residents, due to their expertise in prone PCNL, the operation time and fluoroscopy time decrease with the number of cases performed. SFR is higher after 46-60 cases for 2-3-year residents and 31-45 cases for 4-5-year residents.

A bench-top evaluation of the Ily® robotics assisted tele console system in ureteroscopy by medical students, residents and urologists: does prior videogaming experience help shape the learning curve?

PURPOSE: Previous studies have demonstrated an association between video-gaming experience (VGE) and improved robotics skills. We aimed to evaluate the initial learning curve for the Ily® robotics system (Sterlab, Sophia Antipolis, France) when applied to flexible ureteroscopy (FU) among both medical students and urology surgeons. METHODS: There were two groups, surgeons and students. An initial questionnaire was completed detailing basic demographics and experience. In part one, both groups performed two simple timed tasks using an Ily® mounted single-use RAU. In part two, group 1 repeated both tasks using a hand-held FU. A subjective assessment of comfort, intuitiveness and a NASA Task Load Index were then completed. RESULTS: There was a total of 28 participants. Among medical students with VGE (n = 9, 64%)., average calyceal inspection time was 185 ± 80 s; 133 ± 42 s; 121 ± 71 s. For non-gamers (n = 5, 36%), average times were longer at 221 ± 97 s; 134 ± 35 s; 143 ± 68 s respectively. Average calyceal inspection time for videogaming surgeons (n = 8, 57%) was 126 ± 95 s; 98 ± 40 s; 107 ± 71 s, respectively. For non-gamers average inspection times were longer at 150 ± 73 s; 114 ± 82 s; 111 ± 47 s, respectively. None of these differences achieved statistical significance. Surgeons trial speeds were, however, significantly faster by hand-held compared to RAU: by 103, 81 and 82 s respectively (p < 0.05). CONCLUSION: These results show that ex- or current- video gamers do not have a significant advantage in time to perform FU. Any early advantage conferred to ex- or current- gamers may be rapidly overcome.

A complete year of urology residency training under COVID-19: impact on education and health.

OBJECTIVES: To evaluate the impact of COVID-19 pandemics on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents after 1 year of socio-economic restrictions. MATERIALS AND METHODS: An electronic survey was e-mailed to all postgraduate (PG) students registered by the Brazilian Society of Urology. The survey inclu-ded an assessment of socio-demographic, clinical practice, educational, health-related and behavior parameters. We also evaluated which subareas of urology were predominantly affected. A similar survey was adapted and sent to the directors of all urology residency programs. RESULTS: COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. Urology residents reported >50% decrease in multiple surgical modalities. We highlight kidney transplantation surgeries (66.2%), minor surgeries (62.3%), endoscopic surgeries (42.6%) and reconstructive surgeries (38.8%). This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. Furthermore, PG students faced stressful situations that caused worsening of mental and physical health, such as getting redirected to assistance of COVID-19 patients (66.9%), and high rate of infection by SARS-CoV-2 (58.2%). CONCLUSIONS: The COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. PG students faced stressful situations that caused worsening of mental and physical health such as redirection to assistance of COVID-19 patients, concern about their own contamination and of family members.

Lessons learned from the Sexual Medicine Society of North America fellowship bootcamp.

BACKGROUND: Sexual Medicine Society of North America (SMSNA) fellowships offer variable experience in sexual health domains: erectile dysfunction, Peyronie's disease, male infertility, male hypogonadism (low testosterone), reconstruction (including male incontinence), benign prostatic hyperplasia, gender affirmation surgery, sexual mental health, and female sexual dysfunction. AIM: To evaluate baseline and postbootcamp understanding and trust in these domains. METHODS: In 2023, 28 of 31 urologists currently enrolled in SMSNA-endorsed fellowships participated in a 3.5-day training bootcamp in Minneapolis, Minnesota. Participants were asked to complete pre- and postbootcamp surveys. The bootcamp curriculum offered American Urological Association guidelines and case-based lectures, hands-on clinical training with cadavers (penile surgery) and models (collagenase training), and interaction with industry. OUTCOMES: Changes in knowledge, independence, and trust in performing the procedures, as well as billing issues and feedback for future bootcamps. RESULTS: Prebootcamp surveys revealed vastly varied residency experience. Reported time with an expert faculty member was greatest for benign prostatic hyperplasia and least for female sexual dysfunction, gender affirmation surgery, and low testosterone. The lowest prebootcamp confidence in performing surgery independently was for penile grafting procedures and elevating the neurovascular bundle. Postbootcamp results revealed several areas of significant improvement in confidence (P ≤ .03): intralesional injections for Peyronie's disease, manual modeling, penile plication, penile grafting procedures, and elevating the neurovascular bundle. There was a trend for improved confidence with the insertion of inflatable (P = .05) and semirigid (P = .08) penile prostheses. Nonsignificant improvement occurred in artificial urinary sphincter surgery (P = .12). Participants graded the bootcamp very highly and requested that next year's bootcamp have more content on female sexual dysfunction, male incontinence, and low testosterone, as well as more hands-on skills sessions and case-based lecture formats. CLINICAL IMPLICATIONS: Offering a bootcamp with hands-on instruction could significantly improve urologists' knowledge and confidence. STRENGTHS AND LIMITATIONS: As the main strength, this study was the first specialized bootcamp for urologists in the subject of men's health, taking into account hands-on and cadaver laboratories, as well as highlighting industrial and pharmaceutical products. The small sample size was the major limitation. CONCLUSIONS: Current SMSNA fellows present with varied levels of experience and confidence across sexual health domains. Notable confidence improvements were seen with topics that combined didactic lectures with hands-on trainings.

[Looking back on 100 years of board certification for urology in Germany : Formation of a medical subject in the context of specialization and professionalization]. / 100 Jahre Facharzt für Urologie : Zur Ausbildung eines medizinischen Faches im Kontext von Spezialisierung und Professionalisierung.

This article examines the development of urology as an independent medical discipline in Germany, with a particular focus on professionalization and specialization in the 19th and 20th centuries. Based on historical sources, the text illuminates the importance of the German medical profession's further training regulations as an instrument of medical self-administration and the classification of urology as a medical specialty in the Bremen guidelines of 1924, which established board certification in diseases of the urinary organs (urology).

Simulators in urology resident's training in retrograde intrarenal surgery.

PURPOSE: To evaluate the impact of simulators on the training of urology residents in retrograde intrarenal surgery (RIRS). METHODS: The study involved training eight urology residents, using two artificial simulators; one developed by the Universidade Estadual do Pará, using three-dimensional printing technology, and the other one patented by the medical equipment manufacturer Boston Scientific The qualification of residents took place through a training course, consisting of an adaptation phase (S0), followed by three training sessions, with weekly breaks between them (S1, S2 and S3). Study members should carry out a RIRS in a standardized way, with step-by-step supervision by the evaluator using a checklist. The participants' individual performance was verified through a theoretical assessment, before and after training (pre- and post-training), as well as by the score achieved in each session on a scale called global psychomotor skill score. In S3, residents performed an analysis of the performance and quality of the simulation, by completing the scale of student satisfaction and self confidence in learning (SSSCL). RESULTS: At the end of the course, everyone was able to perform the procedure in accordance with the standard. The training provided a learning gain and a considerable improvement in skills and competencies in RIRS, with p < 0.05. SSSCL demonstrated positive feedback, with an overall approval rating of 96%. CONCLUSIONS: Artificial simulators proved to be excellent auxiliary tools in the training of urology residents in RIRS.

Exploring Industry Payments to Urology Residents: A Longitudinal Analysis Under the Sunshine Act.

OBJECTIVE: To explore the financial interactions between urology residents and the healthcare industry over a 5-year training period, assessing the implications of these interactions on medical education and practice considering the Physician Payments Sunshine Act. DESIGN: Longitudinal analysis of Open Payments data for a single class of urology residents from 2018 to 2023. SETTING: Data were extracted from the CMS Open Payments Database and cross-referenced with residency program information from the American Urological Association (AUA) and the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: A cohort of 314 urology residents were identified to have matched in 2018, with 173 residents having reported financial interactions through the Open Payments Program (OPP), representing 55% of the cohort. RESULTS: Analysis revealed that $129,632 was disbursed to the 173 residents throughout their surgical training, with a significant majority (approximately three-quarters or around $100,000) allocated for food and beverage. A statistically significant difference in payment amounts was observed between genders, with male residents receiving an average of $869 compared to $454 for female residents. Payments increased progressively with each postgraduate year (PGY) level, peaking in the fifth year. Despite notable disparities in compensation across AUA sections, no statistically significant variation was found (p = 0.21). The study also highlighted the underestimation of industry influence due to discretionary and heterogeneous reporting practices. CONCLUSIONS: The study underscores a significant, yet potentially underreported, financial interaction between urology residents and the healthcare industry, suggesting a deepening relationship as residents progress through their training. The findings call for a more uniform reporting system to enhance transparency and provide a clearer understanding of the industry's role in medical education and practice. Additionally, many residents may not be aware that their financial interactions are being documented and made public, a factor that could influence their professional behavior and expectations.

Virtual Education in Urogynecology: Enhancing Understanding and Management of Pelvic Fistulas.

Introduction: Pelvic fistulas affect a significant number of patients globally, with a relatively low prevalence in the United States. Virtual education offers an effective, scalable solution to bridge this educational gap and lead to a deeper understanding of more common conditions, such as urinary and fecal incontinence. Methods: We developed two virtual cases on rectovaginal and vesicovaginal/ureterovaginal fistulas to enhance medical students' exposure, knowledge, and confidence regarding assessment of pelvic fistulas. The cases could be completed in approximately 30 minutes, asynchronously, and at students' own pace. The cases were integrated into an OB/GYN clerkship. We conducted a survey among students receiving the cases to gather feedback on usability, acceptability, and educational value, which guided subsequent improvements. Results: Forty medical students, ranging from first to third year, participated in the urogynecology elective; 21 (53%) completed the survey. Ninety-one percent agreed or strongly agreed they were satisfied with the cases. All respondents found the format easy to use and appropriate for their level of learning. Most reported the cases improved their confidence in nonsurgical and surgical management options for pelvic fistulas. Discussion: Offering virtual and interactive patient cases on e-learning platforms represents an innovative approach to increasing clinical exposure to urogynecologic disorders. By providing medical students with the opportunity to interact with pelvic fistulas virtually, these cases can help bridge a gap in clinical education. Future exploration is valuable for examining knowledge deficiencies and developing cost-effective, self-paced, easily accessible educational resources to advance medical training and optimize patient care.

An At-Home Laparoscopic Curriculum for Junior Residents in Surgery, Obstetrics/Gynecology, and Urology.

Introduction: Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms. Methods: We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kern's six-step approach. We implemented the curriculum over 4 months with first- to third-year residents. Results: Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28). Discussion: This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.