[Interdisciplinary education in urology: innovations for better training]

[Influence of the working model on the education of young urologists : Education through the ages]

BACKGROUND

There is a trend of increasing discontent of urologic residents with educational programs. One point being mentioned is lack of time during residency for education and self-training. We analyzed the available time for education in our department depending on the used working model through the last 25 years.

MATERIALS AND METHODS

We calculated the absolute availability of residents during their residency for working models in 1996, 2000, 2007 and 2017. As a basis we used the working model of 1996 as no compensatory time-off for being on call was used. All days on which a delayed start is planned and no schedule in daily routine is possible had been excluded from education time. The numbers implemented in the regulation on further education in the corresponding years had been used to calculate the expenditure of time on the basis of median length of the different intervention. In addition, the patient numbers on the ward and our outpatient clinic had been documented over time.

RESULTS

With increasing patient numbers in the in- and outpatient clinic there is a continuous decreasing time available for education. The absolute available time in our department is calculated to be 3.1 years compared to 5 years in 1996. With the first day of training a resident has to complete 66.9 min of self-contained diagnostics or interventions per day in addition to clinical routine and administration to meet the requested numbers of the regulation on further education.

CONCLUSIONS

The limited time being available for the educational program is improved by the current regulation of education. To teach the complex segments of urology there is an urgent need for a well-structured curriculum, which should be used nationwide.

A multidisciplinary approach to urinary system iatrogenic injuries

Introduction

Urinary system iatrogenic injuries appear because of urological, obstetric-gynecological, and surgical manipulations in the retroperitoneal space, pelvis, or perineum. The purpose of this research was to analyze and obtain knowledge about the issue of iatrogenic injuries, to apply injury prevention algorithms, and to assess multidisciplinary perspectives in modern surgery.

Material and methods

The research was interdisciplinary and consisted of several modules: a prospective, single-centre study of urinary system iatrogenic injuries (476 patients) along with four interregional and international procedural types of research.

Results

The analysis results indicate an extremely high significance of urinary system injuries evoking numerous negative consequences that are hard to eliminate. A comparative assessment of interdisciplinary interaction demonstrates the more effective interpretation of examination results, more comprehensive and credible clinical diagnosis, more qualitative evaluation of a patient’s condition, more effective choice of initial treatment policy, and more satisfactory treatment in patients’ opinion. The research allowed for the identification of a typical procedural mistake in the urethral catheter setting causing a high risk of urethra injuries followed by urethra strictures or consecutive infections of the urinary tract.

Conclusions

More complicated treatment procedures cause a higher probability of urinary system iatrogenic injuries. The absence of unified algorithms and typical procedural mistakes cause such incidents. A partial solution to this issue could be found in a more profound interdisciplinary interaction in all treatment phases as well as in identifying and eliminating procedural mistakes.

A global snapshot of endourology residency training

BACKGROUND

Urology has become more complex over the last decades with surgical sophisticated technologies such as endoscopy, laparoscopy and robotic surgery. As these minimally invasive methods gain popularity throughout the world, this has led in some countries to a serious training gap as compared to other countries, and between generations of surgeons within national training systems. There is a huge heterogeneity in urological training between countries, whether developed or developing. This paper attempts to shed some light onto global urological training, comparing a significant number of various national systems, and to outline global tendencies in urological training. It will enable interested readers to see where their own system stands in international comparison, and hopefully enable them to identify training needs to achieve global quality standards.

MATERIALS AND METHODS

This is a questionnaire-based assessment which was sent to 240 members of U-merge from 62 countries. In addition, there is ample literature on the requirements of structured training programs and assessments, and we have tried to briefly outline the key points in this paper.

RESULTS

We received responses from 32 countries Urology residency training is hugely heterogenous between countries. Only 44% of nations use a structured training program with assessments. Others use the Halstedian apprenticeship approach. Notably, some developing countries do use modern teaching and assessment methods, whereas some developed countries still use the outmoded apprenticeship model. For the interested reader, results have been tabled in detail, and training systems described country by country.

CONCLUSIONS

Our results have shown a huge heterogeneity in quality urology training between countries and within continents. In systems without national structure of training, it can be assumed that such differences exist even between hospitals/ training institutions. There is no doubt in times of globalization with resident and doctor migration and exchanges that training needs structure and standardization. The still huge gap in developing countries to catch up and be able to afford latest surgical and learning technologies need to be addressed with the help of responsible outreach programs.

Analyse von europäischen Weiterbildungskonzepten zum Facharzt für Urologie unter besonderer Berücksichtigung der intersektoralen Weiterbildung

Hintergrund

Ziele der Arbeit sind der Vergleich der deutschen Weiterbildung zum Facharzt für Urologie mit anderen europäischen Konzepten, die Analyse lokoregionaler Unterschiede, sowie der personellen Entwicklung der deutschen Urologie in den letzten 5 Jahren. Zudem sollen finanzielle Fördermöglichkeiten für Weiterbildungsassistenten im ambulanten Sektor evaluiert werden.

Material und Methoden

Nach Analyse der neuen Musterweiterbildungsordnung (MWBO) erfolgte die Untersuchung der aktuellen Weiterbildungssituation in Deutschland im europäischen Vergleich. Es wurde eine Trendanalyse der Entwicklung von Personalstrukturen in der Urologie in den letzten Jahren durchgeführt. Zudem wurde ein intersektorales Rotationskonzept entwickelt. Zuletzt wurden finanzielle Fördermöglichkeiten für urologische Weiterbildungsassistenten durch eine standardisierte Telefonbefragung evaluiert.

Ergebnisse

Im Vergleich zu anderen europäischen Weiterbildungsinhalten zeigt sich die positive Sonderstellung der deutschen Urologie mit ihrem enormen Spektrum. In einigen Bundesländern bestehen bereits finanzielle Fördermöglichkeiten für Weiterbildungsassistenten durch die regionalen Kassenärztlichen Vereinigungen.

Diskussion

Während in anderen europäischen Ländern eine einheitliche Weiterbildung auf Staatsebene üblich ist, herrscht in Deutschland durch die Länderhoheit Heterogenität. Durch die Verlagerung vieler Weiterbildungsinhalte in den ambulanten Sektor werden zukünftig Allianzen zwischen Kliniken und Praxen im Sinne der intersektoralen Weiterbildung immer wichtiger werden. Dafür ist die Nutzung bestehender Fördermittel und als Fernziel der flächendeckende Zugang zu solchen Fördermitteln wünschenswert.