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GLOBAL STATE OF UROLOGY The Path to Becoming a Urologist in Denmark

By: Clara Helene Glazer, MD, PhD, Copenhagen University Hospital–Herlev and Gentofte, Denmark; Christian Fuglesang S. Jensen, MD, PhD, Copenhagen University Hospital–Herlev and Gentofte, Denmark | Posted on: 18 Mar 2024

Clara Helene Glazer is a third-year urology resident in Denmark. She received her MD and PhD from University of Copenhagen where she investigated the morbidity and mortality among infertile men. As part of the PhD, she spent 3 months at the Department of Urology at Stanford University under the supervision of Dr Michael Eisenberg, where she completed 2 separate epidemiological studies based on US data.

Christian Fuglesang S. Jensen is a second-year urology resident in Denmark. He received his MD and PhD from University of Copenhagen where he investigated surgical sperm retrieval in men with nonobstructive azoospermia in collaboration with Dr Dana Ohl from the University of Michigan. Christian has been a research fellow at the University of Michigan in 2014 and 2018 and participated in the inaugural AUA Global Residents Leadership Retreat in Chicago 2023.

In Denmark, the path to becoming a urologist is rigorous and requires at least 7 years of postgraduate clinical training. After graduating from medical school, all doctors must complete a 1-year obligatory internship, regardless of their choice of specialty in the future. The position is comprised of two 6-month rotations which include a hospital rotation, such as internal medicine or general surgery, combined with family medicine. It is interesting to note that the internship placement is completely lottery based and not related to class ranking, test scores, or other qualifications of the graduate. Once the internship is complete, the doctor must apply for and complete a 1-year introductory position to urology. To our knowledge, this introductory position is unique to Denmark and besides qualifying the aspiring urologist for a resident position in the future, it may also serve as an opportunity to try out the specialty before committing to the final residency program. For this reason, there are several more introductory positions to urology than actual residency positions, which means that to qualify, extracurricular activities and research experience often are needed. As Denmark is a small country, there are only 3 overall regions where applicants may apply, with a total of 15 to 20 positions per year. It is not uncommon that several applicants, especially in the capital region, may have completed a PhD prior to entering the residency program. The official residency program is 5 years with rotations in 2 to 3 urological departments within the region.

Although the residency program in Denmark has several strengths, including a good work-life balance and the opportunity for research and independent decision-making, the program also has some limitations. Due to the small size of the country, specialty functions are often combined within specific hospitals, which means that certain high-specialty areas, such as renal transplants, may be a missed opportunity for some residents. Furthermore, the program no longer includes a clinical rotation in general surgery which inevitably has some drawbacks. The current residency program is limited to a 1-week rotation in pediatric urology which we would like to see substantially increased given the numerous encounters with children in the emergency department.

The future of urology is exciting in Denmark. From advancements in imaging/diagnostics to the rapid evolvement of minimally invasive technologies and robotics, the field of urology is progressing at a fast pace.1 One major highlight is the transition of transurethral resection of low-grade intermediate-risk Ta bladder tumor from general anesthesia to an ambulatory laser treatment setting which has proven to be less burdensome to patients with similar outcomes.2 It will be interesting to see if we are facing an upcoming paradigm shift with perhaps even more simple urological procedures being offered in an ambulatory setting in the future.

Although the future looks bright, certain obstacles also warrant mention. As the population continues to age, we must be prepared for the challenges ahead when caring for elderly patients with comorbidities. Many of these age-related comorbidities are urological and we expect an increasing number of ambulatory patients in the future. The prevalence of urological cancers will also likely continue to increase, and careful attention must continuously be made to avoid over- and underdiagnosis. Finally, although great advancements are continuously evolving in terms of surgical urology, parallel developments in oncological treatments and interventional radiology are also rapidly evolving which may lessen the need for surgical intervention.

A urology residency program in Denmark includes limited dedicated time to do research. As mentioned, some urology trainees have completed a PhD before residency, and recently there has been an increasing interest in maintaining the academic activities during the residency program. Currently, 1 urology resident, Christian F.S. Jensen, is doing a part-time residency with 20% of his time dedicated to research. This gives room for continuing and expanding academic urology activities, which are essential for developing our specialty. Christian was fortunate to be invited to the AUA’s inaugural Global Residents Leadership Retreat 2023 where he had the opportunity to network with other urology residents from around the world. The retreat highlighted the importance of building global relationships, and Christian shared his experience at a presentation during the 34th Congress of the Scandinavian Association of Urology in Bergen, Norway. As an example of the benefits of global relationships in urology, previous collaborative research and bilateral clinical visits between the University of Copenhagen and University of Michigan has resulted in the implementation of microdissection testicular sperm extraction as an offer to men with nonobstructive azoospermia in Denmark.

We encourage future participants in the AUA’s Global Residents Leadership Retreat to seize the opportunity to build global relationships and learn from each other to expand the urology care of patients in their home countries.

  1. BernsteinDE, Bernstein BS. Urological technology: where will we be in 20 years’ time?. Ther Adv Urol. 2018;10(8):235-242.
  2. Pedersen GL, Erikson MS, Mogensen K, Rosthøj S, Hermann GG. Outpatient photodynamic diagnosis-guided laser destruction of bladder tumors is as good as conventional inpatient photodynamic diagnosis-guided transurethral tumor resection in patients with recurrent intermediate-risk low-grade Ta bladder tumors. A prospective randomized noninferiority clinical trial. Eur Urol. 2023;83(2):125-130.