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INTRODUCTION: Urology is a medicalsurgicalspecialty that deals with the study, diagnosisand treatment of medical and surgical conditions of theurinary tract and retroperitoneum in both sexes and ofthe male genital tract without age limit. The traditionalmethod of training is based on the imitation of the skillsand behaviors of the tutors, creating variability in thetraining between different centers and giving a passiverole to resident internal physicians (MIR).LEGISLATIVE FRAMEWORK: The 2006 BOE establishesthe specific formative content in its theoretical, practicaland scientific facets. At the beginning of the MIR trainingperiod, the first year focuses on general surgical trainingand the remaining four on specific urological training. Thecurrent legislative framework that regulates our specialtyis one of the oldest, with no prospect of renewal, sincethis would be carried out with the development of thetrunk project, currently paralyzed after the judgment ofthe Supreme Court. Therefore, we are in a situation ofuncertainty with a legal framework in renewal plans.CURRENT STATE OF TRAINING: a National surveyshows the degree of surgical participation of theMIR is low, as well as training on models and courseattendance. In addition, the self-confidence they feel forinterventions that could be considered of low complexityis high, for activities such as consultation is moderateand for interventions of moderate-high complexity is low.CONCLUSION: The current training program isupgradeable. New studies and efforts should aim tostandardize the acquisition of surgical and non-surgicalskills, guarantee access to surgical training courses,establish a minimum of required interventions per yearand at the end of residency, foster academic training,participation in research of residents and achieve anobjective assessment of the specialty.
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Modern urological training has changed drastically in the past years, due to the global surgical training trends, advances in technology, subspecialization of the field and, working hour regulations for doctors. The lack of a standardized curriculum across Europe, puts in evidence the great difference in the requirements in every country, from the start of the residency, to obtaining the accreditation.We sought to identify problems related to medical, scientific and surgical activity during urological training, and summarize data obtained from surveys realized during the European Urology Residents Education Programme (EUREP) in 2013, and from countries such as Germany, Italy and Spain.Data from surveys reveals an evident lack of surgical confidence across all participants for major procedures, a general non-compliance with the working hour regulations, and a worrisome risk for burnout and negative consequences in resident’s personal lives. Possible solutions are discussed, involving an early preference for a particular practice, and a standardized simulation-based training.The European Association of Urology (EAU) and the European School of Urology (ESU) offer a wide range of working groups, educational and scientific activities for improving the acquisition of competencies (surgical and scientific) of residents and urologists at any point of their career. We describe a brief description of the most important EAU and ESU opportunities.
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OBJECTIVE: Urology residency trainingis a difficult and complex education period for urologyresidents. This education period differs in countries andmainly for 5 years. In this study, we aimed to assessthe expectations and the realities for Turkish urology residentsand to evaluate the adequacy of their educationin the field of urology.METHODS: In this study, 113 Turkish urology residentshave been included and residents were asked 24 questionsrelated with their surgical skills, thoughts towardstheir educations, their future plans and including demographicinformation.RESULTS: The years of residency were divided as;1st year-12 (10.6%), 2nd year-17 (15%), 3rd year-22(19.4%), 4th year-24 (21.3%) and 5th year-38 (33.7%).Mainly they suffered from the lack of practical educationand the lack of encouragement to scientific and academicworks, studies.CONCLUSION: Urological education must be standardizedand must cover the educational needs of urologyresidents.
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OBJECTIVE: Achieving residents` medicaltraining of quality is a constant concern in theConfederación Americana de Urología (CAU), the thirdUrological Society worldwide. We aim to analyze thediversity of state training programs, with the intention toidentify opportunities for global improvement within themand also to analyse the professional reality in differentcountries.METHODS: Data from 2nd and 3rd Foro Educativo CAUregarding postgraduate training and labour implicationsare reviewed. This information is complemented by theopinion of representatives involved with the academictraining in Confederación Americana de Urología,who have analyzed the reality and current status of theurological training through a 10-question survey thatdescribes different aspects of residency program in thecountries confederated in CAU.RESULTS: A total of 3,000 graduate doctors train asresidents in Urology at the CAU environment. Eachyear 670 residents begin their training program in LatinAmerica, Spain and Portugal, a territory that servesnearly 650 million people, with an active professionalforce of around 16.800 professionals. Detailed dataon training, employment and supporting reality in thecountries that comprise the CAU are presented. Wealso discuss the proportion of residents who carry outresearch and doctorate during the residency program.Finally, we examine the proportion of professionals whoreceive specific training at the end of their residence,the relative importance of this training and what are themost popular environments to carry it out.CONCLUSIONS: Current postgraduate training in CAUenvironment is heterogeneous in their programs, as wellas in the modes of accreditation and recertification.Academic activities do not seem to be properly valued.However, specific training offers better expectations ofprofessional development.
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OBJECTIVES: 44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences.METHODS: Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission.DISCUSSION: 44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident’s Book and how will be like the external rotations.CONCLUSIONS: to understand the Urology’s specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation.
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OBJECTIVES: Since the establishment of specialization of medicine through the residency system, Spanish health care has sought to maintain a balance between established needs and trained professionals, with the aim of avoiding the deficit or excess of health specialists with its consequences. The objective of the present review is to know the working conditions of urologist specialists at the end of the residency training period.METHODS: The results of a survey for urologist who completed their residency contract from 2012 to 2016 are presented, assessing working status, academic and working data during the first months after the completion of specialized training.RESULTS: A total of 42 surveys were collected. All respondents had a working contract within 6 months of completing their training. 71% had a temporary contract, most with duration of less than one year. There are more contract numbers in the public health system, although they increase progressively in the private sector. More than half of the respondents were satisfied with their work situation.CONCLUSIONS: The work insertion of the recently specialized urologists is high, reaching 100% within 6 months of finishing their specialization. Labor quality issues are not so positive, observing great working instability associated to a high proportion of temporary contracts lower than 6 months.
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OBJECTIVE: To determine the factorsrelated to stress, Burnout and depression in urology,as well as consequences in residents and urologists, inaddition to the possible applicable strategies to diminishand treat them.ACQUISITION OF THE EVIDENCE: Depression, stressand Burnout syndrome has become a problem inurology specialty. These topics have gained interest ininternational congresses and urological associations.Efforts are being made to find related factors as wellas possible strategies and applicable support programs.SYNTHESIS OF EVIDENCE: Burnout frequency is higheramong health professionals than general population,40-76% in students and residents, its incidence hasskyrocketed in recent years, in addition Urology is oneof the specialties with highest incidence and severity.Its increase has been related to work overload,documentation, administrative/bureaucratic workload,hostile work environment; its consequences include poorwork performance, medical errors, depression, substanceabuse, disruption in family and couple relationships andsuicidal ideation. Strategies for prevention includingresilience training, lifestyle balance, teamwork, andsupport programs.CONCLUSION: Stress, burnout and depressionare problems in urology, early detection, promotingindividual techniques in resilience, lifestyle and teamworkare fundamental now and for the future of the specialty.Developing and implementing support programs shouldbe seriously considered by health systems and urologicalassociations.
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Being a Surgeon today means taking on your shoulders countless responsibilities. It is definitely a high-stakes job but, even though the professionals do not go through the intense, focused and demanding training schedule as followed by the other equally risky fields, it doesn’t yet require any practical training certification. Simulation was introduced in the aviation field in the early ‘30s with the “Link Trainer”, designed to reproduce the most difficult flying case scenario: landing on an air-carrier. After almost a century, flight simulation is still becoming more sophisticated, while surgical training is slowly starting to fill the gap. The aim of a simulator is to produce an “imitation of the operation of a real-world process or system over time”. This short but effective definition explains why simulators are utilised across different fields.There is no doubt that surgeons are continuously undergoing a condition of stress, even in nonthreatening situations, while performing a procedure. This condition adds a relevant variable to surgery, meaning that mastering technical skills is not always equal to “safe surgery”. This is why “non-technical skills” (NTS) training should be a part of any simulation based training opportunity and will probably start to be always more part of the Handson Training programs
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The lack of globally established standardsfor learning urological laparoscopy has not preventedlaparoscopic techniques from evolution and continuousdevelopment. Laparoscopy coexists with robotic surgerytoday, and in the last decade there have been many techniquesthat have undergone a boom with the use of alaparoscopic approach (total and partial nephrectomy,pyeloplasty, colposacropexy, etc.).We intend to evaluate the progressive incorporation ofdifferent surgical techniques in the laparoscopic learningprogram and, on the other hand, to analyze the evolutionof training programs in urological laparoscopy tobring this type of techniques within the hospital surgicalactivity.We describe our 30-years experience in different trainingprograms in urological laparoscopy that have beensponsored by the Spanish Association of Urology (AEU),and have undergone several validity studies to assesstheir capacity in order to evaluate effectively basic andadvanced laparoscopic skills.We will also highlight the current and future trend towardstraining models based on surgical competences whereindividualized training, accreditation and specializationof tutors is crucial, and where the increase in the use oftraining and evaluation methods based on the simulationare increasingly common.
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INTRODUCTION: Urology needs modelsof competencies assessment, although there is a widerange of tools not yet integrated into the official trainingprograms.CONTEXT: At present, there is no universal frameworkfor measuring surgeons´ level of competence. Urologytraining programs should provide and consider knowledge,pyschomotor/cognitive skills, and simulator, cadaveror animal models-based training. Validity is a complexconcept that refers to the capacity of the evaluationtool, so it is necessary to demonstrate several types ofvalidation to assure the capacity of a method, reinforcedwith different reliability tests and calculation of internalconsistency between evaluators.OBJECTIVE: Based on a structured dossier of surgicalskills, classified by groups, the ESSCOLAP® Basic systemwas proposed with 5 simulator tasks to evaluatebasic laparoscopic skills. Once validated in the JUMISC(Spain), the tool was proposed to extend its scope andimplementation in other locations. RESULTS: Our system has not yet demonstrated a fullvalidity in the real clinical setting because a predictivevalidity needs to be demonstrated on the basis of clinicaldata. It also suffers from a certain range of subjectivity,thus implying clear and defined criteria for any situation.Factors like the number of evaluators and tasks to assesswill influence the reliability tests that measure the degreeof agreement between evaluators, so that a higher numberof evaluated cases would imply a greater reliabilityof our system. Finally, we assume that the incorporationof this type of tools implies an added cost, charged tothe public and private responsible institutions, which willonly be considered cost-effective when it is demonstratedits real and positive traceability in health outcomes. CONCLUSIONS: ESSCOLAP® Basic, of quick and simpleimplementation capacity, has been validated andcalibrated for the evaluation of basic technical skills inlaparoscopy.
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Nowadays in urology, laparoscopic surgeryis a reality that implies a very high percentage ofthe daily surgical activity. The interest in laparoscopy inurological pathology is undeniable, and the advantagesfor our patients with this approach are clear in most cases.But how do we deal with learning curve of this technique?What is the difficulty in laparoscopy training?What future perspectives might offer this approach?Difficulties in learning laparoscopy are easily identifiedand clear. The loss of the image in 3 dimensions, loss oftouch, great dependence on surgical instruments, amongothers. For all these reasons, it seems common sense thatthe learning of laparoscopic surgery is structured and organizedin a progressive increase in the difficulty of theexercises, which will seek to acquire the necessary skillsbefore facing the patient inside the operating room.
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Current training in urological endoscopy lacks a specific training program. However, there is a clear need for a specific and uniform program, which will ensure the training, regardless of the unit where it is carried out. So, the goal is to first evaluate the current model and then bring improvements for update. The hospital training accreditation programme are only the adjustment of the official program of the urology specialty to the specific circumstances of each center, which causes variability in training of residents. After reviewing 19 training programs belonging to 12 Spanish regions. The current outlook shows that scarcely 10% of hospitals quantify the number of procedures/year, although the Spanish program emphasizes that the achievement of the residents should be quantified. Urology residents, sense their training as inadequate and therefore their level of satisfaction is moderate. The three main problems detected by residents as an obstacle on their training are: the lack of supervision, tutors completing their own learning. Finally, the lack of quantification in surgical activities is described as a threat. This has no easy solution, since the learning curve of the most common techniques in endourology is not correctly established. Regarding aspects that can improve the current model, they highlight the need to design a specific program. The need to customize the training, the ineludible accreditation of tutors and obviously dignify the tutor´s teaching activity. Another basic aspect is the inclusion of new technologies as training tools, e-learning. As well as the implementation of an adequate competency assessment plan and the possibility of relying on simulation systems. Finally, they highlight the need to attend monographic meetings and external clinic rotations to promote critical training.
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As robotics are becoming more integrated into the medical field, robotic training is becoming more crucial in order to overcome the lack of experienced robotic surgeons. However, there are several obstacles facing the development of robotic training programs like the high cost of training and the increased operative time during the initial period of the learning curve, which, in turn increase the operative cost. Robotic-assisted laparoscopic prostatectomy is the most commonly performed robotic surgery. Moreover, robotic surgery is becoming more popular among urologic oncologists and pediatric urologists. The need for a standardized and validated robotic training curriculum was growing along with the increased number of urologic centers and institutes adopting the robotic technology. Robotic training includes proctorship, mentorship or fellowship, telementoring, simulators and video training. In this chapter, we are going to discuss the different training methods, how to evaluate robotic skills, the available robotic training curriculum, and the future perspectives.
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Urology is a medical-surgical specialty that deals with the study, diagnosis and treatment of the medical and surgical diseases of the urinary apparatus and retroperitoneum in both sexes and the male genital apparatus without age limit, due to congenital, trauma-tic, septic, metabolic, obstructive and oncological condi-tions. Urologic oncology is the broadest urological part, where research and new advances make continuous learning essential. In this chapter we treat all academic features related with training in the field of Urooncology.
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Urology is defined as the medical-surgicalspecialty that includes the study, diagnosis and treatmentof medical conditions of the urinary system. It is wellspecified by the National Commission of Specialtiesthat we must know the medical pathology that concernsus. However, on occasions, resident training focuses onthe surgical field and oncological pathology, which, althoughone of the main pillars of the specialty, is usuallyto the detriment of training in medical and functionalpathology.We conducted a survey of residents in the fourth year ofUrology in Spain, where we asked about the quality oftraining in Andrology and Functional Urology. The average rotation time is 3.5 months in each unit. Only 20%consider that their training is satisfactory and sufficientin Andrology. Seventy-five percent of residents surveyedbelieve that their training in Functional Urology is acceptableor sufficient, both medical and surgical.There are numerous fields of action to improve the trainingof residents and young urologists in this country inthe management of urological medical pathology.The future is open, and it is in our hand to set up a trainingfor urology residents within excellence and to berecognized both nationally and internationally as one ofthe great pillars of Spanish Urology.In this chapter we will analyze the current situation in thetraining of Spanish Urology Residents in urological medicalpathology, and we will focus on training in functionalurology and andrology.
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The development of an academic career gives a new dimension to the chosen specialty. It consists in combining clinical activity with teaching and research activity. In the area of surgical specialties there is currently a lack of academic positions which is necessary to overcome to maintain the quality standards. Residency and the immediate posterior period it is a good time to star our academic career. This side of our specialty demands an additional effort, great motivation, clear and determined objectives and especially dedication. Considering Urology is a medical-surgical specialty it offers a perfect scenario for the development of research activity. In this article we review some of the available options to develop an academic career starting during residency. Among them we find some indispensable if one wants to develop an universitary career and others that facilitate the learning of scientific methodology, indispensable to elaborate a research project.
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From its origins and acting through its specific committees, the E.B.U. has been dedicated to the improvement and standardization of urological training across Europe. Identifying minimal requirements for urology training, publishing a European Curriculum and defining basic rules for accreditation of educational activities, hence, offering a systematic assessment for the recognition of quality.Working through different dedicated committees, the E.B.U. oversees every aspect on the urological training in Europe. The Accreditation Committee sets standards for the accreditation of educational/scientific activities and ensures the proper evaluation of submissions for CME/CPD accreditation. The Certification Committee oversees the appropriate implementation of the EBU Certification programme and ensures a thorough quality assessment process that aims to standardise urological training across Europe. Finally, the Examination Committee, that is structured into two sub-committees one for the In Service Assessment (I.S.A.) and the written F.E.B.U. examination (Part 1) and a second for the oral F.E.B.U. examination (Part 2). The committee works to ensure that all EBU examinations and associated assessment activities are thoroughly prepared and conducted in accordance with EBU’s criteria.
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The field of Surgery is under the pressure of accelerated change where technological cycles get shorter and shorter, sometimes transformational. Learning and training have gotten a key role because learning curves for new techniques directly affect patient`s safety and learning cycles are slower. The traditional learning model within the urology department is overwhelmed. We need new training and learning methods.The aim of this article is to perform a critical analysis of the current status of learning in urological surgery and the challenges we face, evaluating how new information and communication technologies can help us to facilitate the learning process. We also present our initial experience with on line education on upper urinary tract laparoscopic and robotic surgery using the 2.0 Web tools.
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The last 25 years have brought about revolutionary changes for medicine and in particular for urology: internet was only in its infancy, medical records were written on paper, searches for medical information were done in the hospital library, medical articles were photocopied and our relationship with patients only existed face to face. Social networks had not yet appeared and even Google did not exist. Just imagine what might happen during the next 25 years, we’re going to see even more radical changes. The urologist of the future is going to see the arrival of artificial intelligence, collaborative medicine, telemedicine, machine learning, the Internet of Things and personalized robotics; in the meantime, social media will continue to transform the interaction between physician and patient. The training of urologists will also be different thanks to new learning technologies such as virtual reality or augmented reality. IBM Watson Health through its system of artificial intelligence and its learning algo-rithms will become our essential travel companion. The urologist of the future, as well as physician, will have to acquire the necessary technological skills in order to use all these new tools which are already on the horizon.
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Social media is characterized because all its services are participative. Users of 2.0 technologies can interact easily and openly with other people, share resources and communicate immediately and simultaneously. Research improves from participatory technologies by allowing groups to share reflections, methodologies, resources and results. The social media platform with greater diffusion and use in urology is possibly Twitter because it allows to realize what is known like “microblogging”, the users generate comments and brief messages through the creation of “tweets”. It is possible to determine that there are three broad areas from a scientific point of view in which social media are manifested: sharing research, resources and results. The use and applications of social media become a major responsibility in the area of health and urology, obviously for reasons of privacy, scientific rigor, ethics and the nature of the medical - legal content.
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Urology has become more complex through the years, as it comprises increasingly sophisticated medical and surgical technologies such as advanced medical tumour therapies, and endourological, laparoscopicand robotic surgical techniques. Training in urology starts during medical school and once a medical student chooses to specialize on it, becomes life-long. Becoming a good urologist requires a highly qualified education and sufficient experience. To devise a training programme of high proficiency, several important factors must be considered. There are many studies in the literature revealing the thoughts of urology residents towards their training, needs and the realities. The aim of this chapter is to review the new technologies in urology training and show the new pathway of the future of training in urology.
