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GLOBAL STATE OF UROLOGY Urology Training in the UK: My Experience With the Global Residents Leadership Retreat

By: Nikita Bhatt, MBBS, MMed, MCh, FRCS (Urol), Newcastle Upon Tyne NHS Foundation Trust, United Kingdom, British Urology Researchers in Surgical Training, London, United Kingdom | Posted on: 15 Mar 2024

Having recently completed the urology training program in England, this article has provided an opportunity for me to reflect on the positives and negatives of my training program. The application for urology training in the UK is centralized through a process called national selection, which occurs once a year. It is a 5-year higher surgical training program, requiring the demonstration of basic or core surgical competencies along with membership exams from one of the 4 Royal Colleges prior to application. In 2022, this program accepted 59 candidates in the UK, with a competition ratio of 1:4. Research, audit, and quality improvement are encouraged both at the time of application and throughout the training program.

Currently, there is a shortage of urologists across the UK. Hence, the traditional emphasis on higher research degrees is diminishing, as an increasing number of trainees are opting to take consultant jobs straight after training. The current focus of the training program is to produce a urologist with core competencies capable of managing common urological conditions and surgical procedures. In the last couple of years of training, we are allowed to choose a subspecialty module (eg, female urology, andrology, oncology, endourology, advanced general urology, etc) to gain exposure in an area of further interest. Successfully completing the training program entails passing the fellowship exams in urology—a 2-stage process involving a written examination and an oral viva voce.


Figure. The British Urology Researchers in Surgical Training committee. First row (left to right): Drs Alexander Ng, Vinson Chan, Aqua Asif, Sinan Khadhouri, Veeru Kasivisvanathan, Nikita Bhatt, Kevin Gallagher, and Johann Boaz. Second row (left to right): Drs Raghav Verma, Kevin Byrnes, Cameron Alexander, Alexander Light, and Marie Edison.

While the training program in the UK offers substantial exposure to various subspecialties and technologies, the extent of exposure can vary based on the region. There is room for improvement to keep pace with the rapid technological advancements in urology. The exposure to robotic surgery during training is increasing, and I was fortunate to receive this exposure during the last couple of years of training. However, a formal method of robotic surgical exposure at earlier stages of training for those interested might be the way forward.

The greatest opportunities in urology in the UK in the next 5 years would include embracing emerging technology, whether it may be newer benign prostatic enlargement procedures, newer applications for robotic surgery (eg, in benign urology), and utilization of artificial intelligence in surgery.

The challenges facing the specialty currently in the UK are workforce planning, as the demand for urologists increases and there aren’t sufficient urologists to fill the gap. This will continue to play a role in the future as we try to meet the demands of an aging population and a burnt-out workforce. The challenge lies in retaining our well-trained and valuable workforce, which is currently a major issue in the National Health Service in the UK.

The Global Residents Leadership Retreat helped me connect with different residents across the world and understand how there are several similarities in the issues we face. Discussing the challenges and opportunities we face in urology globally helped me feel less isolated and more connected with the global workforce in urology. It also made me realize we could work together to tackle several of these issues, such as burnout, that affect our workforce on a global level.

I have used several techniques I learned at this retreat in my role as a co-chair of BURST (British Urology Researchers in Surgical Training) and as a study lead of our new project WASHOUT (Ward AdmiSsion of Haematuria: An Observational Multicentre Study). As a collaborative group, we have acquired diverse leadership and communication styles from one another. Attending this retreat not only allowed me to refine my skills but also provided an opportunity to share them with the senior committee in BURST. The method of connecting and communicating with people taught at this retreat has enabled us to successfully recruit over 355 centers across the world for this study, which is currently open for registration. Using different communication styles that transcend language and nationalities has helped me form personal connections with several collaborators across the world.

My advice to any future Global Residents Leadership Retreat participants would be to go to the retreat with an open mind, ensure you form meaningful connections with those who you meet at the retreat, and try to maintain those connections once you return. In addition, find opportunities to apply what you have learned in your daily practice and seek other avenues to continue your journey to becoming an effective leader in urology.

Pre-register for WASHOUT at