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ESU Urology Boot Camp Lisbon 2021
Prof. Ben Van Cleynenbreugel Dept. of Urology University Hospitals Leuven Leuven (BE)
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Ben. Vancleynenbreugel@ uzleuven.be
Mr. Chandra Shekhar Biyani Dept. of Urology St. James’ University Hospital Leeds (GB)
shekharbiyani@ hotmail.com
Dr. Tiago Ribeiro De Oliveira Dept. of Urology Armed Forces Hospital Lisbon University Hospital Lisbon (PT)
tiagoribeirooliveira@ sapo.pt
Over the last decades, the traditional surgical training model faced several ethical and regulatory issues that considerably impacted surgical education. In fact, studies show that not only was there a subjective decline in residents’ performance (perceived both by programme directors and residents themselves) but there was also an objective decline in proficiency and autonomy levels at the end of residency programmes.
Urology residency training remains quite heterogeneous throughout the world, not only in the total duration of training but also in the length of core surgical training and specific urological training, research requirements, working hours, surgical exposure, and evaluation methods. Studies on the current status of urological training show a relatively low surgical exposure throughout the formal training period, with only one third of residents satisfied with their surgical training and with most residents considering that training was inadequate and having lack of confidence in independently performing surgical procedures at the end of their residency. Altogether, these results showed that current urology residency programmes have limitations that may seriously compromise the quality of urological training.
In light of the limitations of traditional surgical training over the past decades, simulation-based training has been extensively explored and used as an adjunct to traditional surgical training, namely for the development of technical skills via individual hands-on practice. In recent years, the European Association of Urology (EAU), the European School of Urology (ESU), the EAU Section of Uro-technology (ESUT), the EAU Robotic Urology Section (ERUS) and the EAU Urolithiasis Section (EULIS) have developed a series of standardised and validated training programmes. Examples are the European Basic Laparoscopic Urological Skills (EBLUS), the Endoscopic Stone Treatment Step 1 (EST-S1) and the Certified Curriculum of ERUS (CC-ERUS). This has led to the implementation of several structured and integrated training curricula in urological laparoscopy, endoscopy and robotics In view of the clear success of these activities, the ESU, ESUT, ERUS and EULIS have created the Standardization in Surgical Education (SISE) program. This collaborative venture aims to implement a comprehensive approach to all training activities within the EAU, encompassing a series of structured, standardised and validated training curricula targeted at all trainee levels. The first step in the SISE programme is the ESU Urology Boot Camp.
The ESU Urology Boot Camp project The Urology Simulation Boot Camp, developed in Leeds by Mr. Shekhar Biyani (GB) and Mr. Sunjay Jain (GB), is a revolutionary course that, over five days of intensive training, aims to provide basic technical and non-technical skills for urology registrars in the United Kingdom. From the ground-breaking evidence originating from this course, the ESU Urology Boot Camp project was developed to provide technical skills training to urology residents throughout Europe, within the framework of a standardised ESU training curriculum.
At the basis of the SISE program, the ESU Urology Boot Camp is a standardised course for first-year residents, comprising a full day of intensive hands-on training and organised into four separate training modules, with the aim of providing high-quality technical skills training to enable every urology resident in Europe to acquire the necessary technical skills to perform the most frequent urological procedures before they start working with patients.
One of the most important hallmarks of the ESU Urology Boot Camp is the 1:1:1 training model, where one trainee has a dedicated training station and an experienced trainer for the entire duration of each module, therefore maximising the learning experience. With a series of different low and high-fidelity models and a considerable amount of state-of-the-art urological equipment, trainees are provided standardised hands-on training on laparoscopy, flexible and semi-rigid ureterorenoscopy, transurethral resection of the prostate and bladder tumours, flexible and rigid cystoscopy, bladder catheterisation, suprapubic catheter placement, and scrotal examination.
Following a very successful pilot course in Portugal, in 2018, four additional courses have been organised in Portugal, Belgium, and Serbia.
ESU Urology Boot Camp Lisbon 2021 After a forced one-year gap due to the restrictions of the COVID-19 pandemic, the third edition of the ESU Urology Boot Camp in Lisbon was organised in 2021. On October 30th, the course was organised by the ESU and the Lisbon Faculty of Medicine Center for Postgraduate Training in Urology (CFU), in collaboration with the Armed Forces Hospital and the Military Health Teaching, Training and Investigation Unit, with the scientific support of the Portuguese College of Physicians’ Board of Urology and with the sponsorship of Karl Storz, Teprel, Janssen, Boston Scientific, Medtronic, and Mediplus.
The intensive course programme provided participants the opportunity to acquire and train several urological skills in eight hours of hands-on training. Each participant had a dedicated model and individually guided by a trainer. This was a unique opportunity for first-year urology residents to learn a series of different technical skills that are of paramount importance in daily clinical practice. The quality of the models and equipment, the motivation and competence of the faculty, and the use of ESU’s validated training models warranted the clear success of the course amongst the participants.
Future perspectives The aim of the ESU Urology Boot Camp Working Group is to implement an ESU Urology Boot Camp course for first-year urology residents on a national level and on an annual basis. The objective is to provide first-year urology residents a platform to acquire and train basic urological technical skills, based on a standardised curriculum, prior to starting urological clinical activities. The focused training can help improve clinical proficiency and self-confidence. In 2022, aside from a new edition of the ESU Urology Boot Camp in Portugal, Belgium, and Serbia, a first edition of the course is planned for Greece and Germany.
The organisation of future ESU Urology Boot Camps will be initiated via the SISE programme platform i.e. SISE website. The ESU Urology Boot Camp Working Group will analyse all new Boot Camp requests and provide a step-by-step manual, a checklist, and a timeline for the implementation of every course to support and guide the organising committees throughout the entire process. The ESU Urology Boot Camp Working Group will also prepare a Train the Trainer course for all the faculty to ensure the highest quality of training.
To guide and facilitate the implementation of the course, a previous visit as an external observer to another Boot Camp will be part of the process. In line with this principle, Prof. Athanasios Delis (GR), the Chairman of the Hellenic Association of Urology and Boot Camp external observer, was present in the ESU Urology Boot Camp in Lisbon to coordinate the implementation of the course in Greece in 2022.
Testimonials from participants Prof. Delis (GR) shared, “I had the privilege to attend the 3rd Lisbon Urology Bootcamp, held in the Armed Forces Hospital under the auspices of the ESU. Dr. Oliveira was responsible for the excellent organisation and hospitality and I do thank him for that.
“Four modules were deployed for almost 10 hours of training and covered all aspects of training for first-year urology residents. Trainees were able to: palpate and examine external genitalia, place a bladder catheter (transurethrally or suprapubically), perform rigid and flexible cystoscopies, place ureteral stents, use rigid and flexible ureteroscopes to examine the upper urinary tract, and even do transurethral resections of prostatic adenomas and bladder tumours. Furthermore, they had the chance to use laparoscopic instruments and do their initial basic steps in laparoscopy. This hands-on training course was focused on enhancing technical skills in a one-trainer-per-trainee ratio.
“Participating as an external observer, I was able to feel the enthusiasm of the junior residents for practicing basic technical skills within the framework of a standardised ESU training programme. And this is, according to my opinion, the key to the Boot Camp’s success: to give equal opportunities to all newcomers to participate and perform basic simple steps, but first to learn them in an optimal way. It is of utmost importance not to simply learn, but to learn properly! Additionally, the organising team provided me with very important information to be better prepared for the 1st ESU Urology Bootcamp in Athens, which is planned to take place during our upcoming National Congress in Athewns in 2022.”
Boot Camp trainee, Dr. André Ye (PT) of the Santa Maria Hospital in Lisbon, stated “The ESU Urology Bootcamp fills an essential gap in the education of first-year residents with an introduction to the most essential urologic materials and skills, each one with its own complex characteristics.
“The highlight of this course is its heavily based hands-on approach with a unique one-to-one guidance ratio with an expert in the field. Needless to say, the supervision and recommendations are invaluable, with precious suggestions that will prove very helpful in the future. The quality of the realistic models is also worth noting, which succeed in representing real-life scenarios thus allowing practice in a safe environment.
“This event is defined by its pedagogical excellence, organisation, and carefully thought details to provide the best experience to the participants. It is safe to say that the Boot Camp should be mandatory for everyone who enters the Urology residency, as it inspires us to be diligent and creates a strong foundation for the years ahead. To all the faculty and staff, my sincerest thanks for this opportunity.”
Boot Camp trainee, Dr. Guilherme Bernardo (PT) of the Fernando Fonseca Hospital in Lisbon said, “The Urology Boot Camp, in my opinion, was a tremendous success, for many reasons. First of all, it was very practical and hands-on, allowing junior residents to learn in top-of-the-notch simulation devices with senior urologists, in a 1:1 ratio!
“The fact that we had plenty of time to train and interact with our mentor in each of the four stations, allowed us to learn in a stress-free environment, giving a unique learning experience. The seniors shared their “tricks” and skills, and we learned from their vast experience.
“I hope I can enrol in more Bootcamps, I believe in a standardised method of learning, in which the seniors’ skillset is the goal to achieve, and only doing that every resident will end their residency programme with the knowledge and expertise of a seasoned urologist.”
Intensive hands-on training
Enthusiastic participants and faculty members
