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GLOBAL STATE OF UROLOGY Global Perspectives in Urology: Navigating Challenges and Advancements in Training and Practice

By: Chia-Min Liu, MD, Fourth-year resident, National Cheng Kung University Hospital, Tainan, Taiwan (R.O.C.) | Posted on: 18 Mar 2024

In an era marked by unprecedented connectivity and collaboration, the field of urology stands at the forefront of medical globalization, transcending geographical boundaries to foster a pursuit of excellence in patient care, research, and education. As boundaries blur and distances diminish, the exchange of knowledge, advancements in technology, and cross-cultural collaboration not only enhance the expertise of individual practitioners, but also elevate the standard of urological care on a global scale.

Participating in this year’s Global Residents Leadership Retreat in the US was a privilege that provided an invaluable opportunity to immerse myself in a melting pot of perspectives, experiences, and leadership styles within urology. Engaging with fellow residents from diverse corners of the globe served as an extraordinary platform to hone my leadership skills and gain profound insights into the multifaceted nature of leadership within our specialized field. Through discussions, workshops, and interactions, I delved into the nuances of my leadership style, refining it and enriching my understanding of effective leadership in urology. The dialogue with urology residents worldwide acted as a catalyst for mutual learning, fostering a collective knowledge exchange that transcended geographical barriers and significantly broadened my perspectives on the challenges and innovations shaping our discipline globally (Figure). Regrettably, our limited time during the retreats did not permit a comprehensive exploration including the current state of urology resident training across different countries.

Figure. Engaging in cross-cultural dialogue: urologists deliberate with international colleagues at the Global Residents Leadership Retreat, exploring global perspectives in urology.

In Taiwan, upon completion of a 6-year medical school program and the initial year of postgraduate training in general medicine, individuals become eligible to pursue residency training. Approximately 30 hospitals are authorized to train urology residents, typically enrolling around 40 trainees annually in Taiwan. Unlike the US matching system, here, recruitment of residents is conducted independently by each hospital. The duration of the training program typically spans 4 to 5 years, sometimes including a year in the general surgery department. Notably, the inclusion of kidney transplantation within the program varies significantly among hospitals. While research isn’t obligatory within the training curriculum, its emphasis tends to be more pronounced in university-affiliated hospitals.

Urology, with its diverse range of subspecialties, is a comprehensive field that extends from oncology and andrology to pediatric urology, endourology, and urogynecology. Yet, in my institution, the integration of pelvic reconstruction surgery and sexual reassignment surgery is limited, presenting an opportunity for expanding our skill set, particularly in an era of globalization where the dissemination of these practices should be readily achievable.

The horizon of urology brims with excitement as cutting-edge technologies become progressively available. From robotic surgery to microsurgery and the integration of augmented reality alongside artificial intelligence–driven image analysis, the spectrum of possibilities is vast. However, harnessing these advancements for everyday practice encounters hurdles, notably within Taiwan’s public health insurance system. Operating under a global budget, the system grapples with financial limitations exacerbated by broader health care challenges akin to those faced in countries like the UK. Taiwan’s National Health Insurance confronts fiscal dilemmas, unable to generate adequate funds from premium payments to cover the comprehensive scope of health care provision. The intricacies of politics further complicate matters, demanding legislative approval for any premium increase. Consequently, this financial landscape impedes the seamless integration of groundbreaking technologies and innovative pharmaceuticals into routine health care delivery, emphasizing the urgent need for deliberate reform and thoughtful consideration within our health care system.

As we navigate the intricate intersection of global insights and local methodologies, the urological community must continue to embrace collaboration and innovation. Together, we can shape a future where the boundaries of knowledge and care are pushed further, ultimately advancing the field of urology on a global stage.