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The professional benefits of USANZ trainee week 2015

sanchia photoI landed on a bright sunny Brisbane morning for the Urological Society of Australia and New Zealand (USANZ) Trainee Week 2015 – an annual, 5 day, comprehensive, bi-national conference specifically for trainees.  I have much to be grateful for including sponsorship from BAUS, TUF, USANZ and SURG. All these organisations had realised international organisation inter-working is required to foster a higher level of teaching for trainees.

Later that day, I had opportunities to meet trainees from all over Australia and New Zealand (ANZ). The quality of training given is truly remarkable. When looked at in detail, the ANZ system focuses on general surgery training initially, prior to moving to urology as a separate speciality. The result of this are that they are superb open surgeons. This is often a dying art and difficult to gain.

Our first day started with a chance to observe mock FRACS stations. The standard of the candidates was incredibly high, despite it being a mock exam. As part of this, an overview of the FRACS exam was given by one of the FRACS senior examiners, Mr. Neil Smith. The day concluded with meetings of trainees for each region within ANZ – again another fantastic way to support the trainees. I have never seen anything quite like this. This also ensures trainees are receiving adequate training as concerns and issues are relayed directly to the training board chair. The evening concluded with a Welcome reception and barbeque at Brisbane Surf club.

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The next day started with a series of lectures on bladder cancer, led by Mr Shomik Sengupta (Melbourne) and Mr. Roger Watson (Brisbane). There were many learning points for trainees to take away, including case based management discussions, role of cystoprostatectomy and role of bladder preservation (Dr Tanya Holt, Brisbane).

Also covered were the roles of neoadjuvant vs adjuvant chemotherapy, (Dr. Niara Oliveira, Brisbane), the pros and cons of urinary diversion (Dr. Sarah Azer), and LND (Dr. Jonathan Chambers, Brisbane).  After lunch the most amazing teaching was given on uro radiology, with a focus on nuclear medicine and also on pathology. The FRACS exam is very different from any other end of training exam, as there will be both radiology and pathology stations.

The next day dawned bright and early, with a whole morning of paediatric urology.  I can think of many registrars, who would love a whole morning of teaching on this subject- it is not often easy to get access to paediatric urology.  Testicular embryology and maldescent were very nicely covered by Mr. Peter Borzi, (Brisbane). Both normal and abnormal conditions were discussed including reasons for orchidopexy with maldescent. Former USANZ President, David Winkle then spoke on translation care. Mr Pete McTaggart, then covered Adolescent voiding dysfunction, a profoundly difficult subject to manage, given the age of the patient and the disease involved.

The next focus was on the adrenal including functions of the adrenal, management of the adrenal mass and investigations and phaeochromocytoma. This again, is another area, which is not often covered or encountered in clinical practice.

The morning concluded with a Board of Urology update addressed by Mr Richard Grills, Board Chair, covering the training programme for urologists. Also covered were training policies and involvement of RACS in governing this. Most impressively, USANZ has negotiated membership for all of its’ trainees with EAU, SIU and AUA. A good step forward regarding international working and fellowship.

The next day started with a breakfast meeting, on how to pass the FRACS exam. This session was chaired by Dr. Matt Winter. Big congratulations also went out to Dr. Tim Smith, who had had a baby the day before and still attended to teach. Topics covered were perspectives of preparing emotionally, physically, and psychologically. This recognised how difficult it can be to prepare. All tips and tricks were given by former trainees, who had passed the exam. Further mock practice also occurred, being taken through a pathology exam.

A whole session was dedicated to renal cancer covering topics such as active surveillance, partial and radical nephrectomy, RFA and cryotherapy. A really fantastic lecture was given by Mr. Simon Wood on management of RCC and cyotreductive nephrectomy, followed by oncological management of metastatic RCC. This is an area, which unless you are in a renal fellowship, may not see.

The next session involved teaching on upper tract and transplant. This was absolutely brilliant at covering donor assessment, management of transplant ureter and assessment of renal function and prognosis. Unless a transplant job were done, this knowledge would not be gained.  All of this contributes to making a far better surgeon.

The afternoon focused on mastering difficult interactions with colleagues. Lastly, the day ended, with case based discussions, focused on FRACS viva practice. After having gone through that, I have a greater respect for all candidates going through post graduate exams. The evening was completed by a lovely boat ride through Brisbane and farewell dinner.

2The next day, started with a bang, with Prof Samaratunga (Brisbane) talking on prostate grading. It is wonderful to have a lady professor. It shows the forward thinking of the Australia medical field, clearly ahead of others. Next, very valuable teaching was received from Dr. Peter Swindle (Brisbane). This was followed by teaching on PSA screening by Dr John Yaxley (Brisbane).  PSMA PET was then covered by Dr. Rob Clarke (Brisbane), and its role in detection of prostate cancer. A fantastic presentation on management of elevated PSA was covered via a balloon debate- much loved by all and a different way of learning.

The conference ended with a quiz- Masters of the Uroverse. Teams from different regions of Australia battled it out for the title. It ended the conference is a very fun and unusual way. After having been to this meeting, my knowledge base has grown.

Our thanks go to Ms. Deborah Klein, the star organiser who is Education and Training Manager of USANZ, the Convener Mr. Stuart Philip and Mr. Richard Grills Chair, Board of Urology for hosting a thoroughly enjoyable event. Also to all the trainees and consultants who made us incredibly welcome.

 

Sanchia Goonewardene, University of Warwick, UK. @survivorshipuk

 

The second joint academic meeting of the Sri Lankan and British Associations of Urological Surgery (SLAUS & BAUS)

Mark Speakman

The inaugural international joint meeting of BAUS and SLAUS was held two years ago. The second joint meeting has just finished in Colombo, bringing together British and Sri Lankan urologists. We were also joined by excellent Chinese and Indian colleagues.

The meeting commenced on Monday 2nd November with a series of urological workshops. These started with an excellent laparoscopic workshop at Colombo South Teaching Hospital, led by Gordon Kooiman (King’s, UK), Wei Wang, Zhu Gang (Bejing) and Srinath Chandrasekera (Sri Lanka).

The College of Surgeons of Sri Lanka was the chosen venue for the second day of the pre-congressional sessions. This kicked off with a trans-world MDT, with John Kelleher (UK), Gordon Kooiman (UK), Mark Speakman (President of BAUS), Archana Fernando (Guy’s and St Thomas’ Hospitals, London), Sanchia Goonewardene (University of Warwick), Ranga Wickramarachi (National Hospital of Sri Lanka) and Niroshen Seneviratne, (Sri Jayawardenapura, Sri Lanka). Fifteen complex cancer cases were presented, ranging from prostate and bladder cancer to complex renal cases. The intellectual sparks flew as each side vigorously debated their management of each patient, with input from Chinese Professors Zhu Gang and Wei Wang. The MDT was wonderfully organised by Dr Ranga Wickramarachi, who brought together both faculties, with solid science and learning on both sides.

The afternoon was led by Mr Julian Shah (University College London), who presented on medico-legal issues and communication skills, with input from Sri Lankan doctors. There are an ever increasing number of medico-legal situations clinicians may find themselves in, and this workshop provided the tools for how to manage them. Also noteworthy were the acting skills of Dr Manjula Herath (Kandy Hospital, Sri Lanka) and his colleagues, who deserved an Oscar for the excellent case scenarios they enacted as a background for a critique of their communication skills. On a more serious note, these clearly highlighted issues that are becoming more and more significant in today’s practice.

The third day of the pre-congressional sessions was a trip to Galle in the south of the island for a joint meeting with the Galle Medical Association. A 6am start was complemented by teaching on the neuropathic bladder by Ms Jean Macdonald and Mr Julian Shah, as well as a workshop on penile diseases from Mr Suks Minas at the Jetwing Lighthouse hotel. There was also teaching from Galle medical personnel, notably Kareen Hareen on haematuria. Additionally, there was a lecture on LUTS/BOO from Mr Speakman, and wise lessons to all trainees present on the validity of BPH treatment. A wonderful lunch was served, with chances to interact with Sri Lankan trainees and to clearly see differences in training in both countries – although we are not that dissimilar. A relaxed afternoon beckoned, including a wonderful tour of the ancient Portuguese Galle fort and its scenery. This was followed by afternoon tea at the Closernberg Hotel, Galle.

The next day brought live surgery at Lanka Hospital, conducted by Julian Shah, and Suks Minhas (University College London), with a focus on female and functional urology. A complicated ureteric strictures managed by pyeloplasty and a complex female urethral stricture were demonstrated with live surgery. Additionally, there were video operative lectures by EAU Secretary General Professor Chris Chapple (Royal Hallamshire Hospital, Sheffield), on urethroplasty; valuable lessons for all trainees.

There was also a visit to Sri Jayawardenapura hospital from the Faculty. It was brilliant to see Sri Lankan medicine in practice, with lessons to be learnt by all BAUS faculty members. Afterwards a workshop on trauma occurred at the Faculty of Medicine, University of Sri Jayardenapura, composed of all Faculty members. The best lesson learnt was how to manage renal trauma. This was followed by a hands-on skills for ureteric reconstruction. The course, run by Peter Thompson, had been started 20 years before by Prof. Harold Ellis at RCS England. This was run by Mr Thompson, Ms Goonewardene and Prof. Wang (China). It was considered a fantastic opportunity for all trainees, with hands-on experience of anastomoses of the pig urinary system. Its success was justified the next day when, in practice, a trainee was called upon to manage a ureteric injury.

A beautiful inauguration ceremony in front of 200 people was conducted that evening at Kings Court, Cinnamon Lakeside Hotel, with traditional Kandian dancing and lighting of the oil lamp. This was followed by inauguration speeches, given by Prof. Satish Goonesinghe (Colombo), Prof. Chris Chapple (EAU), and Mr Mark Speakman (BAUS). The evening ended with entertainment from Kandian dancers, and singing from Prof. J. Shah, Prof. S. Fonseka and Mr J. Kelleher– the rock band was aptly named ‘The Professors.’

The next day, the full congress kicked off, with a presentation from Mr Thompson on the history of British urology. The audience learned about great legends, including Malcolm Coptcoat, pioneer of laparoscopic surgery at King’s College London. The next section was on urolithiasis, started by Ms S. Goonewardene on metabolic stone analysis, Ms J. Macdonald (North Middlesex Hospital) on PCNL, and finally from Dr Ranga Wickramararchi on open stone surgery. The learning outcomes demonstrated to trainees the importance of being a well-trained general urologist prior to sub speciality training.

The next section was brightened by Mark Speakman, President of BAUS, talking on surgeons’ outcome data — a really valid subject as this can greatly impact surgical practice. Training issues as part of this were also highlighted. At the end of the day, this can also be used as a continuous assessment tool to improve practice. This was followed by Prof. C. Chapple talking on OAB, a complex subject to manage. There was great interaction between trainees and Faculty, a wonderful learning experience.

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Mark Speakman, Chris Chapple, Satish Goonesinghe and Majula Herath at the Inuguration ceremony

This was followed, after a lovely tea, by Julian Shah speaking on female voiding difficulties. This was very important to all present, as it clearly highlighted other factors that can affect bladder function. After that, Prof. Chapple spoke on advances in pharmacotherapeutic management of LUTS; valuable lessons for all present. Also presented were the potential complications or failures of TURP prostatectomy, highlighting the importance of good case selection. To complete this section, the sensitive bladder was reviewed by Dr Sanjay Pandey, (India).

After lunch there were registrar presentations, varying from renal cell carcinoma to paediatric urethral valves. The afternoon was completed by a detailed uro-oncology session, with presentations from Gordon Kooiman, Mark Speakman, Suks Minhas and John Kelleher, covering a range of oncological subjects.

Each speaker was presented with a beautiful silver plaque for their involvement. The ceremony concluded with an evening dinner aboard an arc in the Colombo wetlands. The meeting closed, and was clearly one of the most successful there had ever been, with the promise of returning in years to come with further joint BAUS/SLAUS meetings.

–Mark Speakman and Sanchia Goonewardene

Mark J Speakman

Consultant Urologist, Taunton & Somerset FNHST and President BAUS
Twitter: @Parabolics

 

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