Urology training programs have come a long way in India from the time the first independent department of urology in India was created at George’s Hospital, Bombay, in 1961-62. Urology is considered to be one the youngest and fastest growing specialities in the field of surgery and Endourology is one such sub-speciality which has grown leaps and bounds due to tremendous advances in technology. As infrastructure and adequate expertise to train the next generation urologists is of paramount importance, the quality of training varies from one centre to the other. Let us find out from the residents themselves who have been picked from different backgrounds of training institutes across the country, about Endourology training in their respective departments.
Dr.Deepak Prakash Bhirud, a resident in Dept.of Urology, AIIMS, Rishikesh writes, Endourology is a urological sub-speciality, which from the resident’s perspective, is a very lucrative area to work or practice upon. This fascinating and versatile branch due to its minimally invasive approach and less surgical scarring have become the choice for urology residents.
With advancement in technology, minimally invasive modalities are favoured by both patients and urologists. To be frank, during the start of residency, every resident is very much attracted to endourology because of its sophisticated nature and the wonders it does to the patient management with desired outcomes. Once we start venturing into its use it gives us immense pleasure while performing endourologic procedures. It usually starts with cystoscopies and ureteroscopies using rigid scopes and progresses to the use of flexible scopes. But with time we understand the importance of this armamentarium. If not carefully handled, frequent wear and tear of the instruments can paralyse the whole OR schedule for days or weeks. The knowledge of the all energy modalities and their proper use saves the endoscopic time. Further the advanced miniaturised flexible scopes really tests your skill and patience. In one sense it is a bouquet made of different flowers which gives colors to it with each flower meaning presence of all that is needed to keep it colourful i.e complete armamentarium. Training is absolute necessity and absence of adequate training during residency can make residents life difficult. With adequate endourological skill acquisition, a non separable part of urology, one can win the hearts of patient during start of his carrier and achieve recognition.
I think endourology subspeciality during residency should be a supervised training. It should be based on particular number of cases in every endourological procedure to gain basic knowledge and grip on the subject. However the constant training in handling and care of all the instruments and accessories is mandatory to avoid wear and tear
Let us now look at the perspective of Dr. Nikhil Saurabh a final year urology resident at Gauhati Medical College, Assam which is a government medical college in a tier 2 city.
Every resident who enters the field of Urology has high hopes and desires of mastering skills required for being a Urologist par excellence. With advancement in technology, new innovations continue to add to the armamentarium of the Urologists and it becomes imperative for the resident to know as much as possible about the new techniques.
Residency introduces us to the various Subspecialities of Urology like Endourology, Urooncology, Laparoscopy, Open and reconstructive surgeries, Neurourology, Paediatric Urology and Robotic surgery etc.
It is a common knowledge that Endourology provides bread and butter to a Urologist.
This includes many surgeries, few named ones are OIU, TURP, BNI, TURBT, URSL, PCNL, HOLEP, RIRS etc. Each of these have a different learning curve depending upon resident’s ability, previous exposure, number of cases being operated in the particular Centre, teacher’s experience and complexity of the cases. Fellowships also tend to help a lot.
We have more than 350 Urology residents being added every year to our Society including both M.Ch and DNB. The training varies between a government and a private institution, between States and Universities. There is no uniformity. Each has its own advantage and disadvantage. One Centre may be performing more procedures than the other. Some may be more equipped than the other and some may have more resident to patient ratio than other.
It will not be an overstatement that my Institute belongs to that part of India which is like an orchard for the Urology cases. In my opinion, if a resident by the end of his/her residency learns to evaluate patients properly and operate a good number of cases under supervision, he or she may be on the way to have a very good start in this wonderful journey to become a good Endourologist. It is also important for the resident to put in the same amount of efforts as are his/her expectations. Sincerity, effort and good mentorship are the pillars to a bright future.
“YOU ARE ONLY AS GOOD AS TOMORROW”Arthur D. Smith
Sri Sathya Sai Institute of Higher Medical Sciences at Puttaparthi, Andhra Pradesh has been known for its affordable and charitable healthcare to millions of people over the decades. Dr. Dinesh Kumar Reddy who is an urology resident at this institute writes about his experience and perspective of urology training.
Urology remains one of the rapidly evolving surgical speciality. The field has seen major technological advancements. This results in increasing the use of endourological surgical procedures. Every institute has their pros and cons based on its location, availability of urological sub-specialities like paediatric urology, uro oncology, robotic surgery, reconstructive surgery, patient exposure and resources.
In the present competitive scenario, trainees in our institutes get the advantages of going through variety of cases. Inspite of being peripherally located, trainees get the benefits of thorough exposure of routine as well as rare and complicated case referred from the peripheral centres. Trainees perform investigations like RGU/MCU, uroflowmetry, urodynamic studies. Trainees perform various endourological procedures like URSL, PCNL, VIU, TURP, Cystolithotripsy.
Like every institute , we have few limitations like insufficient manpower and non availability of various instruments like flexible ureteroscope. Trainees in our institute has no exposure to RIRS.
Dr. Pavan Surwase, from Muljibhai Patel Urology Hospital pens down his perspective about getting trained at a high volume DNB training centre. While pursuing my surgical training, urology as a speciality provoked interest in me, as protocols of management are very well structured, offering promising results to the patient and maximal job satisfaction. Amongst all sub-specialities, endourology constitutes 70% of the urology workload, hence appropriate training in endourology is pivotal. Aiming at acquiring good clinical acumen, learning intricacies of management and procuring essential skillsets, the best option available to me was this well established and dedicated urology centre, pioneering in endourology work.
The endourology training at our institute focuses on creating identity of residents by training them in a unique way with uniform standards. The scope of work also includes quality publications and presentations. During the initial training period the residents attend OPD including new and follow-up patients. Detailed history taking and work up is done in all patients and presented to the consultants on a case-to-case basis. In an effort to alphabetise diagnosis and management, more attention is given to imaging and image-based procedures. Our faculty ensure that all residents are well versed with diagnostic ultrasonography.
At our institute, grand rounds by senior faculty are a part of daily routine. Healthy academic environment prevails in the institute with in-depth discussions made on individual patient conditions and course of action including the pre-operative and post-operative management. The gravity of pre procedural counselling and consent is ensured at every aspect of patient management to deal with ethical issues.
Fully operational dry and wet lab including simulators for PCNL and TURP are available at our institute enabling the residents to develop hand eye coordination required for the endourology procedures.
During the surgical procedure, the consultants guide the residents in each and every step which aids the residents in gaining confidence in performing the procedures. Despite this, the training also covers the instruments design, the relevant endoscopic anatomy, troubleshooting, alternative methods, complications of the procedures and how to deal with the complications. Emphasis is given on proper case selection and ergonomics of the instruments. Towards the fag-end of the residency, the trainee has the exposure to perform endourological procedures independently under the supervision of consultants.
Publications and presentations done throughout my residency has invoked interest in the subject and allowed me to introspect. At the end of 3 years of my residency I can confidently say that I have learned intricacies of endourological management. Overall, the holistic approach offered by this prestigious high-volume centre during the training period, makes the residents trained here well equipped with academic and surgical expertise.