Year : 2015 | Volume
: 31 | Issue : 1 | Page : 1--2
Urological education: Do we need a rethink?
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Department of Urology, All India Institute of Medical Sciences, New Delhi
|How to cite this article:|
Kumar R. Urological education: Do we need a rethink?.Indian J Urol 2015;31:1-2
|How to cite this URL:|
Kumar R. Urological education: Do we need a rethink?. Indian J Urol [serial online] 2015 [cited 2020 Oct 1 ];31:1-2
Available from: http://www.indianjurol.com/text.asp?2015/31/1/1/148307
Residency training programs around the world seem to be in a state of flux. In Europe, the 48-hour work week has seen changes in the amount of work trainees get to do such that some consider sending trainees to India as a possible way to get more experience.  In the USA, a number of residency programs are cutting out the research year due to funding problems. In some European nations, residents get limited surgical exposure as they train primarily to be community urologists involved only in patient work-up and post surgical care.
In India, we continue with our 3 year training programs and, considering the rapid expansion of urology as a specialty, it may be time to rethink what we should be trying to teach in these 3 years. A common perception among teaching faculty is that trainees today wish to learn just the few basic surgical procedures that will earn them 90% of their revenues once they go out to practice. Advanced surgeries such as complex reconstructions, oncology, microsurgery are not high on their list of priorities. While this causes a lot of heartburn among teachers, is it actually wrong for a trainee to try and maximize his 3 years to learn only what he really needs? Maybe it is time we did a rethink on what we need to teach how best to do it.
The lack of doctors in the country and the severely skewed doctor-patient ratio is a well-known fact. The government has frequently mulled schemes that allow "doctors" to qualify with shorter training periods and at lesser equipped centers than the traditional medical colleges.  Is it possible for us to consider something similar for urology? If a 3 year program is only enough to train residents in basic urologic surgery, may be that is what we should aim to do. The training curriculum could be restructured so that in the 3 year program, surgical skill acquisition is restricted to a few identified areas while at the same time the trainee gains basic knowledge of more complex urology. An alternative 6 year program or a post-residency fellowship of 2 years could train those who wish to acquire additional expertise in specialized areas or those who wish to become teachers in academic centers. This division would also help address some of the inequalities in our current training centers. It is expected that most accredited centers are capable of providing training in the basic areas of urology while they falter on advanced procedures. Separating basic from advanced training would allow evaluation of trainees only for essential basic skills that are necessary to provide safe urologic care. A defined change would probably result in greater degree of satisfaction among trainees, trainers and evaluators.
This could also help boost the research outputs from our institutions. A lot of publications in our journals come from thesis written by residents. These are usually short-term, stand-alone projects aimed to fulfill a statutory requirement and consist of retrospective studies with little impact on true scientific advancement. The establishment of long-term programs or fellowships would identify individuals with a commitment to that field who would potentially be more inclined to contributing to its development.
This first issue of the journal for 2015 carries reviews on nanobacteria, metal stents, and radiologic techniques for diagnosis and therapy. These are some of the technological advancements that are occurring in urology. Among the original articles, Tiburtius and colleagues  evaluate the two commercially available thulium lasers for prostate resection and Srivastava et al.  describe one of the largest experiences in pediatric renal transplants in India. While the former article showcases cutting edge technology, the latter focuses on third world reality. In this issue we also portrait our best reviewers for the year 2014. I personally thank all our reviewers who tirelessly support scientific publication and look forward to their continued efforts.
|1||Davies P. Could a passage to India be the way to get more surgical experience? BMJ 2012;345:e6637.|
|2||Kinra S, Ben-Shlomo Y. Rural MBBS degree in India. Lancet 2010;376:1284-5.|
|3||Christian T, Andreas JG, Netsch C. A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: Yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results. Indian J Urol 2015;31:47-51.|
|4||Srivastava A, Prabhakaran S, Kumar SS, Kapoor R, Kumar R, Sharma RK, Prasad N, Ansari MS. The challenges and outcome of living donor kidney transplantation in paediatric and adolescent age group in a developing country: A critical analysis from a single centre of north India. Indian J Urol 2015;31:33-7.|