Editorial

EBU Announces the Curriculum for Urologic Training in Europe

Stefan Mueller, Peter Whelan, Emanuele Montanari *

European Board of Urology, P.O. Box 30016, 6803 AA Arnhem, The Netherlands

E U R O P E A N U R O L O G Y 5 9 ( 2 0 1 1 ) 3 7 0 – 3 7 1

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journal homepage: www.europeanurology.com

The European Board of Urology (EBU) European Curriculum

for Urology sets out a template for urologic training

throughout Europe and seeks to guide the breadth of

knowledge and skills that are necessary for the trainee to

become an independently practicing urologist. The curric-

ulum is neither a syllabus, which is an exhaustive document

containing the totality of contemporary urologic knowl-

edge, nor a practical handbook to produce a competent

urologic surgeon. Both of these functions, we believe, are

best served by national and regional bodies that currently

oversee training.

In accordance with European legislation, the minimum

period for specialty training is 5 yr. Because each individual

learns at his or her own particular rate, a purely time-

related scheme fails not only to acknowledge these differing

rates but also to allow for the different opportunities that

each training scheme may manifest.

The curriculum follows a logical framework starting with

the need for all to understand the basis of disease, history

taking, proper documentation, good communication, in-

formed consent, and adequate time management. Most of

these aspects will be generic to any medical training. The

need to act at all times in an ethical and professional

manner is emphasized. The information to deal with

emergency and elective cases is specified and the range

of knowledge is outlined, but the practical solutions, in an

ever-changing environment, are left to individual educators

and institutions. The importance and understanding of

evidence-based medicine underlies all of these areas.

In the past in many parts of Europe, the criterion for

adequate training was exclusively the log book of proce-

dures carried out. In many training schemes, specific

numbers of procedures were laid down to be completed

by the trainee, but although the assumption was that these

numbers indicated competence to do these procedures,

frequently no assessment of that competence was under-

taken. The EBU believes that although the accumulation of

* Tel. +390250323123; Fax: +390250323125.E-mail address: emanuele.montanari@unimi.it (E. Montanari).

0302-2838/$ – see back matter # 2010 European Association of Urology. Publis

numbers in itself does not demonstrate satisfactory training

(something can be done badly 100 times as easily as

10 times), a number of ‘‘core’’ procedures must be carried

out competently to enable a urologist to practice indepen-

dently and safely. There are 14 procedures that, we believe,

trainees’ competence to perform is mandatory. All trainees

should be able to present a satisfactory skills assessment

record at the end of training. Even within this minimum

skill set, some procedures in some countries are carried out

by other specialties (eg, percutaneous nephrostomy by

interventional radiologists). Nevertheless, we hope that this

list will help focus the minds of trainers on whether such a

situation is satisfactory.

The assessment instrument that we have used is that of

our Danish colleagues, who have applied this tool success-

fully. We believe that, used sequentially, the tool will monitor

the trainees’ acquisition of skills. It sets a framework against

which theater behavior is judged and allows for specific

remedial measures to be enacted rather than relying on

impressions.

The curriculum also enables a log book of performed

procedures each year to be documented and for both

trainer and trainee to see how well the trainee is moving

toward independent operating. The lists incorporate most

procedures, but it is recognized that in some countries,

more complex procedures will not be taught until the

resident may have entered a fellowship year. In all this,

there will be diversity, but we believe the core elements are

fundamental.

Learning is a lifelong process, and the likelihood that

large areas of urologic disease will be treated and managed

without surgical intervention becomes more apparent each

day. The EBU recognizes that these developments will occur

but passionately believes that the care of a patient with

urologic disease is best delivered by a trained urologist. The

urologist, like the ophthalmologist, delivers system-specific

therapies. Already, more patients with urologic disease are

hed by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2010.11.034

E U R O P E A N U R O L O G Y 5 9 ( 2 0 1 1 ) 3 7 0 – 3 7 1 371

treated medically than surgically, but the skill to deliver all

urologic therapies remains paramount.

As part of this process, the curriculum enables all trainees

to keep an accurate record of their attendance at congresses,

workshops, and courses, together with a list of congress

presentations and publications in journals. Failure to adapt

and keep up frequently ensures that areas of urologic practice

get taken over by other specialties that focus on drugs or

techniques, with no consideration for the patients’ total

urologic care. The ability to demonstrate awareness of

change and how to implement that change is an integral part

of learning.

The EBU will have a dedicated Web site for the curriculum

that will be accessible to all European trainees. It will enable

trainees to know how well they are doing in relation to their

own national colleagues as well as to other residents across

Europe. It will also furnish trainers with information about

how the trainees are doing and the extent of their training in

comparison to trainees throughout Europe.

The EBU also provides an annual in-service assessment of

knowledge to allow both trainees and trainers to monitor

progress. It is hoped that the curriculum can be made of use

in all systems of training, even if it may need to sit alongside

a more prescriptive national model. As this curriculum will

enable easy comparison, the European goal of greater

harmonization will be one step closer. The fellow of the EBU

(FEBU) of the future will have sat in-service tests of

knowledge, passed practical assessments, and shown

competence in the core procedures. On passing the final

written and oral examinations, the FEBU will be a safe,

competent, independent urologist.

The immense efforts and resources that the European

Association of Urology has devoted to teaching and

training through its congresses, workshops, and training

courses over the last 20 years means that the current

publication of the European curriculum is appropriate.

The hopes and common goals are that urologic care can be

delivered safely and expertly by urologists who will be

recognized as the correct specialists for managing all

urologic maladies.

Conflicts of interest: The author has nothing to disclose.