TOWARDS COMPETENCY-BASED TRAINING IN UROLOGY Apul Goel, Ashok K Sokhal, Piyush Gupta Department of Urology, King George’s Medical University, Lucknow, India Email: drapul.goel@gmail.com Categorization of procedures as per survey response INTRODUCTION Group A – Must Know (vital) procedures Group B – Good to Know (essential) procedures Group C – Desirable to Know procedures Open Simple Nephrectomy Laparoscopic Simple Nephrectomy Radical Nephrectomy with vena cava thrombectomy Open Radical Nephrectomy Laparoscopic Radical Nephrectomy Bladder Neck Reconstruction Open Nephroureterectomy Laparoscopic Nephroureterectomy   PCN Partial Nephrectomy PCNL Radical Cystectomy with Diversion URS Bladder Augmentation Open Pyeloplasty HoLEP ( Enucleation ) Transurethral Ureterocoele Incision Radical Prostatectomy TURBT Hypospadias Repair Cystoscopic Litholapaxy Cavernosal Shunts VVF Repair Flap Urethroplasty TURP Vasovasotomy TRUS Biopsy Radical orchiectomy with / without RPLND Partial / Total Penectomy Stress Urinary Incontinence - Sling Procedures Direct Vision Internal Urethrotomy Adrenalectomy Graft Urethroplasty Excision and Primary anastomotic urethroplasty Varicelectomy Vasectomy Orchidiopexy Problems with planning uniform competency-based program India is a heterogeneous country with the economic status varying from the very rich to the very poor. The medical facilities vary from the most advanced to the very basic. These issues make it difficult to provide uniform training to the residents. Urology is primarily a surgical branch, where the students have to acquire psychomotor skills. It is difficult for both the trainees and the trainers to acquire all the skills in a limited time span of 3-years. There is a need to make a uniform policy and identify “must know” procedures that the trainee need to learn. AIM To identify core urology operative procedures across India that should be part of urology curriculum through a web-based survey. MATERIAL & METHODS A web-based survey using Survey Monkey was conducted between October 2016 and February 2017. Survey was sent to members of Urological Society of India The questionnaire broadly comprised set of 5 questions. The 5th question included list of 37-common urological procedures based on current urology practice that were to be graded. Respondents were requested to grade psycho-motor competencies into three groups: Group-A competencies were those that were essential for the trainee to learn (Must know) Group-B competencies were those that were good to acquire (Good to know) Group-C procedures were labeled as desirable to know. List of procedures that can be added into the training program. RESULTS Group A Group B Group C Unclassified Requiring Discussion AV fistula Ureteric reimplantation Exploration for Renal Trauma CAPD catheter Insertion Flexible URS Fulguration of PUV Robotic Procedures Supra-pubic catheterization Boari Flap Open or Laparoscopic Donor nephrectomy Penile Prosthesis Open Pyelo- lithotomy Open prostatectomy Open Ureteoneocystosotomy Perineal Urethrostomy Surgeries for Priapism Anti-reflux Surgeries   Inguinal block dissection Internal Iliac Ligation Laparoscopic Pyeloplasty Mini Perc Circumcision Harvesting Kidney from Cadaver Out of 3018 forwarded survey questionnaire, 485 (15.75%) responses were received. The highest number of respondents were from the private-sector (67%). Among respondents 18% representation came from north-India, 12% from east-India, 30% from west-India, 37% from south-India and 3% from the central zone. List of procedures with Likert scale presented as weighted means, median and standard deviation Procedure Minimum Maximum Median Mean SD Open Simple Nephrectomy 1 3 1.04 0.22 Open Radical Nephrectomy 1.32 0.54 Laparoscopic Simple Nephrectomy 2 1.77 0.65 Laparoscopic Radical Nephrectomy 2.17 0.68 Open Nephroureterectomy 0.52 Laparoscopic Nephroureterectomy 2.22 0.63 Radical Nephrectomy with vena cava thrombectomy 2.41 Partial Nephrectomy 1.84 0.73 PCN 1.03 0.21 PCNL 1.07 0.28 URS 1.02 0.16 Open Pyeloplasty 1.05 0.25 Transurethral Ureterocoele Incision 1.27 TURBT Cystoscopic Litholapaxy 0.19 Radical Cystectomy with Diversion 2.02 0.71 Bladder Augmentation 2.13 0.7 Bladder Neck Reconstruction 2.54 VVF Repair 1.56 0.64 TURP 0.17 HoLEP ( Enucleation ) 2.28 0.66 Radical Prostatectomy 2.27 TRUS Biopsy 1.18 0.44 Partial / Total Penectomy 1.17 0.42 Hypospadias Repair 1.76 Cavernosal Shunts 2.07 0.77 Direct Vision Internal Urethrotomy Flap Urethroplasty 1.79 Graft Urethroplasty 1.49 0.6 Excision and Primary anastomotic urethroplasty 1.3 0.53 Varicelectomy 1.12 0.35 Vasectomy 1.11 0.37 Vasovasotomy 2.21 0.75 Orchidiopexy 1.08 0.3 Radical orchiectomy with / without RPLND 1.65 Stress Urinary Incontinence - Sling Procedures 1.74 0.67 Adrenalectomy 1.95 DISCUSSION Education and training curriculum is shifting from time-based model to competency based model. Currently > 100 centres have urology training programs in India Similar attempts can be seen in various other specialties like orthopaedics in ACGME-accredited centres and in the urology itself in the Canadian system 1. CONCLUSION This survey will help to formulate a framework for designing a better curriculum. Our survey positively proves the presence of consensus in current practicing urologists of India towards the 20/35 procedures to be as a part of the core urology competency. Further additions to the classification system can be made with similar surveys which will make this system more robust and reliable. REFERENCES Rourke KF, MacNeily AE. Mapping a competency-based surgical curriculum in urology: Agreement (and discrepancies) in the Canadian national opinion. Can Urol Assoc J. 2016;10(5-6):161. CONTACT INFORMATION Email: drapul.goel@gmail.com