EBU Announces the Curriculum for Urologic Training in Europe

The European Board of Urology (EBU) European Curriculum for Urology sets out a template for urologic training throughout Europe and seeks to guide the breadth of knowledge and skills that are necessary for the trainee to become an independently practicing urologist. The curriculum is neither a syllabus, which is an exhaustive document containing the totality of contemporary urologic knowledge, nor a practical handbook to produce a competent urologic surgeon. Both of these functions, we believe, are best served by national and regional bodies that currently oversee training. In accordance with European legislation, the minimum period for specialty training is 5 yr. Because each individual learns at his or her own particular rate, a purely time-related scheme fails not only to acknowledge these differing rates but also to allow for the different opportunities that each training scheme may manifest. The curriculum follows a logical framework starting with the need for all to understand the basis of disease, history taking, proper documentation, good communication, informed consent, and adequate time management. Most of these aspects will be generic to any medical training. The need to act at all times in an ethical and professional manner is emphasized. The information to deal with emergency and elective cases is specified and the range of knowledge is outlined, but the practical solutions, in an ever-changing environment, are left to individual educators and institutions. The importance and understanding of evidence-based medicine underlies all of these areas. In the past in many parts of Europe, the criterion for adequate training was exclusively the log book of procedures carried out. In many training schemes, specific numbers of procedures were laid down to be completed by the trainee, but although the assumption was that these numbers indicated competence to do these procedures, frequently no assessment of that competence was undertaken. The EBU believes that although the accumulation of numbers in itself does not demonstrate satisfactory training (something can be done badly 100 times as easily as 10 times), a number of “core” procedures must be carried out competently to enable a urologist to practice independently and safely. There are 14 procedures that, we believe, trainees’ competence to perform is mandatory. All trainees should be able to present a satisfactory skills assessment record at the end of training. Even within this minimum skill set, some procedures in some countries are carried out by other specialties (eg, percutaneous nephrostomy by interventional radiologists). Nevertheless, we hope that this list will help focus the minds of trainers on whether such a situation is satisfactory. The assessment instrument that we have used is that of our Danish colleagues, who have applied this tool successfully. We believe that, used sequentially, the tool will monitor the trainees’ acquisition of skills. It sets a framework against which theater behavior is judged and allows for specific remedial measures to be enacted rather than relying on impressions. The curriculum also enables a log book of performed procedures each year to be documented and for both trainer and trainee to see how well the trainee is moving toward independent operating. The lists incorporate most procedures, but it is recognized that in some countries, more complex procedures will not be taught until the resident may have entered a fellowship year. In all this, there will be diversity, but we believe the core elements are fundamental. Learning is a lifelong process, and the likelihood that large areas of urologic disease will be treated and managed without surgical intervention becomes more apparent each day. The EBU recognizes that these developments will occur but passionately believes that the care of a patient with urologic disease is best delivered by a trained urologist. The urologist, like the ophthalmologist, delivers system-specific therapies. Already, more patients with urologic disease are treated medically than surgically, but the skill to deliver all urologic therapies remains paramount. As part of this process, the curriculum enables all trainees to keep an accurate record of their attendance at congresses, workshops, and courses, together with a list of congress presentations and publications in journals. Failure to adapt and keep up frequently ensures that areas of urologic practice get taken over by other specialties that focus on drugs or techniques, with no consideration for the patients’ total urologic care. The ability to demonstrate awareness of change and how to implement that change is an integral part of learning. The EBU will have a dedicated Web site for the curriculum that will be accessible to all European trainees. It will enable trainees to know how well they are doing in relation to their own national colleagues as well as to other residents across Europe. It will also furnish trainers with information about how the trainees are doing and the extent of their training in comparison to trainees throughout Europe. The EBU also provides an annual in-service assessment of knowledge to allow both trainees and trainers to monitor progress. It is hoped that the curriculum can be made of use in all systems of training, even if it may need to sit alongside a more prescriptive national model. As this curriculum will enable easy comparison, the European goal of greater harmonization will be one step closer. The fellow of the EBU (FEBU) of the future will have sat in-service tests of knowledge, passed practical assessments, and shown competence in the core procedures. On passing the final written and oral examinations, the FEBU will be a safe, competent, independent urologist. The immense efforts and resources that the European Association of Urology has devoted to teaching and training through its congresses, workshops, and training courses over the last 20 years means that the current publication of the European curriculum is appropriate. The hopes and common goals are that urologic care can be delivered safely and expertly by urologists who will be recognized as the correct specialists for managing all urologic maladies.