Endourology training

• 25 Nov 2020 03:26:51 PM
• |General Urology

I read this article which is related to endourological training across the globe. Article has addressed several issues of training which probably are common across the globe . Attaching PDF also. 

https://pagepressjournals.org/index.php/aiua/article/view/aiua.2020.3.219/9032

Let’s see what is situation of training of residents in endourology in India. We do not have separate course for endourology training. In 3 years they have to learn everything. After finishing they have option to pursue for a fellowship program of their area of interest. However looking at the disease pattern in our country, endourology forms the key area of training. We also do not have uniformity in training.  It Varies from center to center. & training largely depends upon the workload & enthusiasm of faculty to be mentor to the residents. Many places, senior faculty is very busy with lot of other work & ultimately training of residents becomes responsibility of junior faculty or senior residents to junior residents. Majority of places, Lab , simulation is not available & training is by old fashioned principle see one, assist one & do one. We need to establish simulation labs – high fidelity labs are costly & hence residents should be rotated in such skill lab areas. After training in lab, they must get opportunity to do cases in real life situation otherwise lab training is waste. Lab training elevates their take off level so that in real scenario they learn fast.

However ultimately everything boils down to case load., facilities available. Luckily stone load at most places are high & residents are trained to do URS, PCNL well. IRRS instrument cost is hindrance but it’s learning curve is very low. But that is not the case with lap. In years to come, lap is going to be the key mode of treatment. It is impossible to train a residents fully in residency as learning curve is steep. We need to create post MCh/DNB fellowship programs to offer better training. Ultimately nothing will replace experience of doing cases in humans.

Very important is to have skillful faculty who are ready to spend time to train residents. It is not easy to wash up, keep assisting & teach residents at every step. Lack of such enthusiastic faculty is also big reason for poor training & dissatisfaction which this article has found out. In India we have to address all these aspects to make sure that our residents come out well trained – ultimately they are future of IUSI & India

Comments(6)

• 

  Venugopal P

  26 Nov 2020 09:34:57 AM

  Dear All,

  Ravi has succinctly explained the status of ‘Endourology Training in India’. It should be realized that the responsibility of such a training rests not only on the mentors but it is equally important for the trainees to be able to part take of it.

  In the table mentioned in the article, I find that in India there is 5 Yrs Duration for Endourology training, which I feel, is incorrect though one of the authors is an Indian. Ravi has correctly pointed out that in India there is no Specific Endourology Training during the three years they are in training at any centre. But as the workload in most training centres is large, the trainees can get sufficient hands on training but as has been emphasized depends on the Mentor.

  A point raised by Ravi is concerning Simulation in training. He has rightly mentioned that at many centres this is not practiced and the trainee will have to depend on hands on training on patients. For a long time still, this practice will continue and probably that cannot be helped.

  All said and done, most of the trainees when they leave the portals of their training institute, do mange to perform most of endourology procedures with adequate dexterity and many starting practice at remote centres of India do perform Endourological procedures safely. This is a tribute to most of the mentors that they are able to instill sufficient technical skills for their wards inspite of severe hardships.

  With warm regards,

  Venu 

• 

  Dr. Roy Chally

  27 Nov 2020 02:02:58 PM

      This paper is from  U merge, an organisation with many objectives,one, is to bring a uniform competent urologist at the end of his training which is globally acceptable. They sent a questionnaire world wide and got responses from 37 centres in the world. This a poor response to draw conclusions. Dr. Joseph Philraj from India is one of the authors. In endourology they have covered only URS  RIRS and PCNL. The data in the paper on India has many factual errors. We have two streams of urology education in our country and they have differences in the training protocols. So I think that the data presented in this paper can be ignored. The message in the paper that there should be quality markers in training program and quality markers in training assessments are very good points. 

       Today after after obtaining the ( M.Ch or Dip NB in urology) degree can get a registration from the Indian Medical Council to practice the speciality. He is deemed competent after the certifying exam. This a big flaw in our system. To day one can pas the qualifying exam with no training in the subject as the evaluation of competency to practice is tested only subjectively. 

        I strongly feel that the subjective testing in theory and practice should over in two years. The candidate is given the degree but not allowed to register in IMC as a consultant. The later should be done after 1 year or longer till he attains competence, assed in a separate exam. Here the quality markers of training and quality markers of training assessments are essential. 

         I totally agree with Subnis that today students access to simulation labs are a necessity. Since the major case load of practice are Prostate and Urolithiasis competence in these two areas should have priority. In this era of technology one should not forget competence in clinical skills. 

         I totally agree with Venu that we need quality and passion in mentors to teach. I also feel at least some of the trainees enrolled are not suitable or they do not have the aptitude for the profession. There is a need for a system to identify such candidates early in the training so their training could be terminated rather than failing them repeatedly at the end of their training. 

  Roy Chally

• 

  Dr. Roy Chally

  27 Nov 2020 09:43:52 PM

      This paper is from  U merge, an organisation with many objectives,one, is to bring a uniform competent urologist at the end of his training which is globally acceptable. They sent a questionnaire world wide and got responses from 37 centres in the world. This a poor response to draw conclusions. Dr. Joseph Philraj from India is one of the authors. In endourology they have covered only URS  RIRS and PCNL. The data in the paper on India has many factual errors. We have two streams of urology education in our country and they have differences in the training protocols. So I think that the data presented in this paper can be ignored. The message in the paper that there should be quality markers in training program and quality markers in training assessments are very good points. 

       Today after after obtaining the ( M.Ch or Dip NB in urology) degree can get a registration from the Indian Medical Council to practice the speciality. He is deemed competent after the certifying exam. This a big flaw in our system. To day one can pas the qualifying exam with no training in the subject as the evaluation of competency to practice is tested only subjectively. 

        I strongly feel that the subjective testing in theory and practice should over in two years. The candidate is given the degree but not allowed to register in IMC as a consultant. The later should be done after 1 year or longer till he attains competence, assed in a separate exam. Here the quality markers of training and quality markers of training assessments are essential. 

         I totally agree with Subnis that today students access to simulation labs are a necessity. Since the major case load of practice are Prostate and Urolithiasis competence in these two areas should have priority. In this era of technology one should not forget competence in clinical skills. 

         I totally agree with Venu that we need quality and passion in mentors to teach. I also feel at least some of the trainees enrolled are not suitable or they do not have the aptitude for the profession. There is a need for a system to identify such candidates early in the training so their training could be terminated rather than failing them repeatedly at the end of their training. 

  Roy Chally

• 

  Dr G G Laxman Prabhu

  30 Nov 2020 12:39:02 PM

  I am glad that I went through the initial post and insightful comments written by two extraordinarily accomplished teachers.

  
  

  Training in endourology has become lot more easier because of video endoscopy. There was a time when we were given glimpses of interventions intermittently. Then came the teaching arm attachment. We as trainees had to dangle on to it much to the annoyance of the surgeon. Today with the availability of video endoscopy, the trainees can watch the maneuvers and they can be monitored doing these subsequently. The mentor can objectively document the progress made and give feedback to the trainee.

  
  

  Availability of video recordings of procedures and simulation labs has further eased the situation

  
  

  The crux of endourology training still revolves round hands on opportunity the trainee gets. 

  
  

  There is nothing like "hands on training" because:

  
  

  A. No simulation can match real life 

  B. Simulation will never motivate the mentor to actually monitor the trainee

  C. Trainee will never get the satisfaction of having done the job well which is the only confidence booster.

  
  

  For good training we need three things:

  
  

  A. Availability of plenty of patients who are treated free

  B. Availability of good infrastructure

  C. Availability of an accomplished mentor who is willing to give time to the trainee and the patient

  Convergence of all the three is the best but as of now seems an utopian dream!

  In spite of all the constraints we still have good trainers who are gladly parting with what they have for the larger good of the trainees. May their breed increase!

  
  

  GG L Prabhu   

• 

  Venugopal P

  01 Dec 2020 08:44:50 AM

  Dear All,

  Training in Endourology is a subject that should be of considerable importance to all in Urology. Today Endourological procedures have replaced Open Urological procedures in most of the areas and even the few areas where open surgical procedures are being done nowadays are being replaced with Endourological procedures. Hence appropriate training in endourology has become the need of the day.

  Everyone practicing Urology will be having their own views as how to learn Endourology procedures and the views will be diverse. I am sure if all of us can pen down their views, it will become valuable information from which the training in endourology in India can be planned. I am sure many more will express their views. Think of how the training for you was and what you desire in training of the next generation to be.

  With warm Regards,

  Venu

• 

  Dr. Roy Chally

  05 Dec 2020 07:21:37 PM

      This paper is from  U merge, an organisation with many objectives,one, is to bring a uniform competent urologist at the end of his training which is globally acceptable. They sent a questionnaire world wide and got responses from 37 centres in the world. This a poor response to draw conclusions. Dr. Joseph Philraj from India is one of the authors. In endourology they have covered only URS  RIRS and PCNL. The data in the paper on India has many factual errors. We have two streams of urology education in our country and they have differences in the training protocols. So I think that the data presented in this paper can be ignored. The message in the paper that there should be quality markers in training program and quality markers in training assessments are very good points. 

       Today after after obtaining the ( M.Ch or Dip NB in urology) degree can get a registration from the Indian Medical Council to practice the speciality. He is deemed competent after the certifying exam. This a big flaw in our system. To day one can pas the qualifying exam with no training in the subject as the evaluation of competency to practice is tested only subjectively. 

        I strongly feel that the subjective testing in theory and practice should over in two years. The candidate is given the degree but not allowed to register in IMC as a consultant. The later should be done after 1 year or longer till he attains competence, assed in a separate exam. Here the quality markers of training and quality markers of training assessments are essential. 

         I totally agree with Subnis that today students access to simulation labs are a necessity. Since the major case load of practice are Prostate and Urolithiasis competence in these two areas should have priority. In this era of technology one should not forget competence in clinical skills. 

         I totally agree with Venu that we need quality and passion in mentors to teach. I also feel at least some of the trainees enrolled are not suitable or they do not have the aptitude for the profession. There is a need for a system to identify such candidates early in the training so their training could be terminated rather than failing them repeatedly at the end of their training. 

  Roy Chally