The European Association Of Urology Robotic Training Curriculum: The Journey Has Only Just Begun

Abstract

Delivery of surgical education has multiple impediments in the contemporary era. This is of particular concern for minimally invasive surgery in urology because there is not a relatively simple mainstream laparoscopic procedure that junior trainees can use to initiate their training process [1,2]. There is a need to impart consistent surgical teaching and to negate training issues such as decreasing training hours with the introduction of the European Working Time Directive, time pressures faced by individual surgeons, financial implications, and increasing litigation [3,4]. For these reasons, the development of a validated, structured curriculum in surgical training is crucial. The emphasis of such a curriculum must be on time-efficient training methods using validated training tools. Wong and Matsumoto discuss a theory by Kopta that describes cognitive, integrative, and autonomic phases as essential steps in mastering a specific motor skill [4]. In this month’s issue of European Urology, under the auspices of the European Association of Urology (EAU) Robotic Urology Section (ERUS), Volpe et al present the curriculum for robotic prostatectomy and outcomes of the pilot study [5]. The curriculum designed by ERUS is comprehensive and has admirably managed to include the three components of the Kopta’s theory—theoretical learning (cognitive), simulation-based training (integrative), and modular training (autonomous)—in a safe and controlled environment [5]. Surgical education has evolved in recent decades, and the traditional apprenticeship model of training is generally consideredobsolete [4]. These viewswere reflected in a nationwide survey of training programme directors (TPDs) in the United Kingdom, in which 15 of 16 TPDs felt that simulators were at least desirable in urologic training [6]. A plethora of sophisticated tools for simulation-based training are available, including box trainers, high-fidelity virtual reality simulators, animal models, and advanced human cadaveric models [1,2,4,7]. Each of these tools has pros and cons. The current curriculum has very efficiently included all these available tools, making it extremely indepth and comprehensive [5]. The integration of a modular training process in the curriculum is of paramount importance and is vital to success [5]. We previously reported the requirement of a mere 32–43 endoscopic extraperitoneal radical prostatectomy procedures for a novice to achieve the desired learning curve with modular training, even for such a complex technique [8]. Apart from reducing learning curves, this training curriculum—through accreditation and certification—can ensure that future robotic prostatectomy surgeons can performwith the desired quality and hence not compromise patient care. The predictive validity of this programme remains to be seen; however the promising outcomes from this pilot study would suggest that predictive validation should be achievable [5]. This curriculumalso serves as an excellent framework for future training curriculums in other complex robotic techniques such as radical cystectomy and partial nephrectomy. A concern about this programme [5] is its widespread applicability across all training institutions in Europe. In this study, most participants were from high-volume centres, and hence the desired training goals were achievable. Whether low-volume centres have the ability to achieve similar outcomes is debateable. It may be necessary to confer training status only on centres with the appropriate caseload per trainee. This will require ERUS to define what the appropriate institutional caseload should be. E U RO P E AN URO LOG Y 6 8 ( 2 0 1 5 ) 3 0 0 – 3 0 1