Introduction

Urologists pride themselves on being the experts of the surgical and medical diseases of the urinary tract and male reproductive organs. To be able to address the wide array of genitourinary conditions, they undergo a rigorous training process. The nuances of urologic training vary significantly across different countries, reflecting the unique health care landscapes and medical education systems.

Having recently participated in the inaugural Global Residents Leadership Retreat (GRLR) hosted by the AUA (Figure), the experience of meeting and engaging with high-achieving urology residents from around the world provided valuable insights into the state of urology training on a global scale. As I reflect on my experience, I am humbled to have been part of such an incredible gathering of talent and leadership potential, and am eager to share my insight and the lessons learned.

Figure. Group photo taken at the conclusion of the Global Residents Leadership Retreat.

Urology Training Landscape

The structure of urology training across the globe is diverse, with variations in the number of years, inclusion of research, and the number of residents trained. In the United States, where I live, urology residency typically spans 5 to 6 years (depending on whether there is an integrated research year), combining clinical rotations, surgical experience, and didactic learning. The incorporation of urologic research varies, with some programs placing a strong emphasis on research as a fundamental aspect of training, while others prioritize clinical exposure. Nationally, according to the AUA, there are 150 accredited urology residency programs and approximately 386 positions.¹

Some other countries have a similar training structure. In Australia, the training is completed through the Royal Australasian College of Surgeons and requires 5 years.^2,3 On the other hand, a Nepalese urologist must complete a 3-year course as well as a thesis and mandatory publication after finishing a 5½-year undergraduate MBBS (bachelor of medicine, bachelor of surgery) and 3-year MS (master of surgery) in general surgery.⁴ In Ethiopia, where urology is a relatively new field, the whole country only has 3 urology programs. When it first started in 2009, the training to become a urologist was a 3-year curriculum for general surgeons. Over the years, the program expanded into a 5-year residency program for general practitioners. There are currently 60 practicing urologists in Ethiopia, and this need has led to innovative approaches to training, such as e-learning platforms and resident exchanges.⁵

While the exact details may vary, urology residency programs worldwide share common objectives in training competent urologists equipped to handle a broad range of urologic conditions. The residency experience serves as a crucible for refining surgical skills, diagnostic acumen, and instilling a deep understanding of the complexities within the field.

Specialty Topics and Emerging Technologies

The ever-evolving landscape of medicine necessitates a continuous reassessment of training curricula to incorporate emerging technologies and evolving specialty topics. Conversations with international residents at the GRLR illuminated areas where urology training might benefit from expansion. Barring limited accessibility, emerging technologies such as robotic surgery, artificial intelligence in diagnostics, and minimally invasive procedures incorporating lasers, ultrasound, etc, are transformative forces that warrant inclusion in urology residency programs. Specialty topics like sexual medicine, transgender urology, and personalized medicine also emerged as focal points for future training considerations. Recognizing the importance of holistic patient care, discussions at the retreat emphasized the need for a well-rounded urologist capable of addressing the diverse needs of patients.

The expanding breadth of urology does not come without its difficulties, though. One study of urology trainees in Germany identified the increasing technological development, subspecialization of the field, and working-hour regulations for physicians as a challenge. The authors proposed restructuring residency training curricula around ensuring competence in these areas, emphasizing the need to be open minded and adaptable.⁶

Greatest Opportunities and Challenges

Looking ahead, the next 5 years present exciting opportunities for the field of urology. Advances in precision medicine, targeted therapies, clinical utilization of artificial intelligence, and individualized treatment plans for both benign and malignant urologic disease offer unprecedented potential for improving patient outcomes. Collaborative efforts in research and international partnerships promise to elevate the standard of urologic care globally.

However, as previously mentioned, alongside opportunities come challenges. The increasing burden of urologic conditions, an aging population with a diminishing workforce, and the rising prevalence of complex cases pose significant challenges to urology specialists. Balancing the integration of emerging technologies with the preservation of personalized patient care remains a delicate task. The ongoing challenge of disparities in access to urologic care on a global scale requires collaborative solutions and a concerted effort from the urology community.

Global Perspectives and Connections

Participating in the retreat underscored the importance of a global perspective in shaping the future of urology. Engaging with peers from diverse backgrounds and health care systems highlighted the universal challenges faced by urologists worldwide. The exchange of experiences, best practices, and innovative approaches fostered a sense of camaraderie and solidarity within the global urology community. Upon returning from the GRLR, the insights gained and the connections formed became valuable resources to share with my fellow residents and colleagues.

For those embarking on the GRLR journey in the future, my advice is to approach the experience with an open mind and a willingness to learn from diverse perspectives. Engage actively in discussions, share your experiences, and build lasting connections with fellow residents near and far.

Conclusion

The state of urology training is a dynamic interplay between tradition and innovation, shaped by the unique characteristics of health care systems in different countries. The GRLR serves not only as a platform for personal growth, but also as a conduit for shaping the future of urology on a global scale. The experience reinforced in me the importance of collaboration, knowledge exchange, and a global perspective in addressing the challenges and opportunities within the field. As urology continues to evolve, fostering international connections and staying abreast of emerging technologies will be paramount in advancing the quality of care provided by urologists worldwide.