EuropeaN Training in uRologY

"<< Background >>The need for this project arose from challenges faced by European urology residents in acquiring the necessary confidence and skills to perform surgeries, especially minimally invasive procedures. Based on a review of literature and the experience of the involved centers, it was found that many residents struggle due to limited hands-on training opportunities, reduced training hours, and risks of learning on live patients. As a result, residency programs often produce specialists not fully prepared. Additionally, there are increasing concerns about initiating the learning curve on real patients, making it essential to develop training curricula that are at least partially simulation-based. Therefore, this project aims to enhance resident training and improve patient safety. It also addresses the need to harmonize training across Europe, enabling urologists to easily collaborate across borders. The ENTRY project promotes a curriculum that ensures: i) High-quality, standardized metrics-based training ii) Skill development in a safe environment before clinical practice iii) Clear benchmarks to measure training and outcomes.<< Objectives >>By implementing this project, we aimed to fill the gap in current training practices, boost residents’ performance, and improve overall surgical outcomes, thus contributing to the development of competent urologists across Europe. Specifically, by implementing a scientifically based methodology, we aimed to achieve effective training with measurable outcomes. By developing a curriculum that incorporates both eLearning and simulation outside the operating room, we sought to enhance patient safety. Additionally, by introducing metrics-based assessment, we aimed to provide European trainers with a reliable and validated tool to measure trainees’ performance and offer them precise and constructive feedback.<< Implementation >>The main activities implemented in the project included:•9 co-design sessions aimed at developing the program:o6 co-design sessions (2 per partner) with urology higher education teachers, tutors, and urology professionals.o3 co-design sessions with higher education urology residency students.The outcomes of these sessions contributed directly to achieving Result #1.•Validation workshop: This activity was divided into three events:oTwo online meetings organized by SIU (April 22, 2022; October 4, 2022).oOne in-person event hosted by Fundació Puigvert on October 25, 2022, during the international urological meeting ERUS22.Additional Key Results•Result #2: Development of eLearning materials for Urology Surgery Residency teaching.•Result #3: Development of a methodology for Urology Surgery Residency simulators.•Result #4: Development of a methodology for real-practice teaching in surgical settings.To support the implementation of these results, we developed three guidebooks for teachers and tutors, each corresponding to one of the three focus areas, providing guidance on how to utilize the new materials and methodologies effectively.The curriculum materials were pilot-tested in real scenarios, involving more than 15 teachers/tutors and dozens of urology residents.Training and Coordination Activities•We developed a ""Train the Trainers"" course (July 31 – August 4, 2024) to equip tutors with the necessary skills.•We conducted four transnational project meetings to coordinate activities across centers and plan the work.•Additionally, we held frequent informal meetings and continuous monitoring activities to ensure smooth execution, track progress, and address challenges in real-time. This ongoing collaboration enabled necessary adjustments and strengthened the partnership.Dissemination and ImpactTo maximize the project's impact, we:•Organized multiplier events to share project outcomes.•Published materials in peer-reviewed scientific journals.•Presented findings at multiple national and international conferences.<< Results >>The main result of the project is a proficiency-based progression (PBP) curriculum for transurethral bladder resection (TURBT). This curriculum was developed by project partners in collaboration with international experts and multiple stakeholders. Among the others, its development involved the Lower Urinary Tract Working Group of the European School of Urology/European Association of Urology and the Italian Society of Urology.The specific outputs include:1) Curriculum Design: In the first phase, the curriculum designed. It was outlined during the co-design sessions and validated in dedicated workshops. A manuscript was published in a leading urological journal, to disseminate the project and raise awareness about the importance of structured training curricula.12) Development of eLearning Materials for Urology Surgery Residency Training•A comprehensive eLearning package was developed, including instructional videos on the training methodology, clinical procedure, and simulator use.•A dedicated guidebook was created to assist trainees and trainers in using the eLearning resources effectively.3) Development of a Methodology for Urology Surgery Residency Simulators: after testing multiple simulators, a selected simulator was identified based on construct validity results. Experts developed performance metrics to define procedural phases, steps, errors, and critical errors. Metrics form the backbone of TURBT simulator training, providing objective criteria for skill assessment and improvement. By identifying and quantifying errors, the simulator offers real-time feedback, enabling trainees to refine their technique. Metrics also serve as proficiency benchmarks, requiring consistent performance before progression.A guidebook was produced to guide the use of the simulator and its performance metrics.4) Development of a Methodology for Real-Practice Teaching in Surgery Rooms: Project partners developed performance metrics to objectively characterize a standard TURBT procedure, identifying its phases and explicitly defining procedural events (steps, errors, and critical errors). To ensure validity and reliability, a modified Delphi process was conducted to obtain face and content validity (i.e., ensuring that the metrics accurately reflect real-world practice and are acceptable as written). Construct validity (i.e., the metrics can be reliably scored and effectively distinguish between novice and expert performance) was established by analyzing dozens of procedure videos.As a result, the TURBT procedure was systematically characterized into six procedural phases, 63 procedural steps, 47 errors, and 41 critical errors.2A guidebook was developed to support the use of these metrics in operating room (OR) teaching.1 Buffi N, Paciotti M, Gallagher AG, et al. European training in urology (ENTRY): quality-assured training for European urology residents. BJU Int. 2023;131(2):177-178. doi:10.1111/bju.159282 Paciotti M, Diana P, Gallioli A, et al. International consensus panel for transurethral resection of bladder tumours metrics: assessment of face and content validity. BJU Int. 2024;134(6):932-938. doi:10.1111/bju.16433"