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The Urology Tag Ontology Project

This blog was first posted at https://www.symplur.com/blog/the-urology-tag-ontology-project/

 

Urology-Tag-Ontology-Project-970x300

Urologists have been on the forefront of harnessing Social Media for professional use. Urological Organizations and Journals have used Social Media to lower barriers for information dissemination [1,2] [3] [4]. Meanwhile, Social Media engagement at Urological meetings has been used to augment the experience of attendees and allow remote “attendance” for those not able to physically be present at the meetings [5,6] [7]. Academic exchange through a formal Twitter-based Journal Club on the #urojc hashtag has enjoyed international participation [8]. Social Media has also been employed to assess the Media’s and the Public’s responses to news events in the Urologic clinical space [9], and guidelines for responsible and effective Social Media use now have been developed [10] [11]. Moreover, an extremely active patient advocacy voice has been growing louder on a number of the Social Media channels.

The Urology Tag Ontology Project aims to align hashtag use for this burgeoning Urological Social Media community. Utilizing this standardized list of Social Media communication descriptors, the project hopes to facilitate communication and promote collaboration in the healthcare provider and patient communities.

In creating the list, we crowd-sourced the Urologic Social Media community at large and were fortunate to receive buy-in from key stakeholders (Table 1).

Effective and standardized hashtag use remains an organic process that clearly cannot be dictated by a simple creation of a list. Indeed, the current list attempts to strike a balance between existing hashtags that enjoy heavy use and those descriptors that key opinion leaders in a particular urologic sub-specialty would like to see gain traction. As such, we hope for the Urology Tag Ontology Project to remain a “living document,” which is reassessed and updated on a regular basis.

 

Alexander Kutikov, MD, FACS @uretericbud
Associate Professor of Urologic Oncology
Fox Chase Cancer Center, Philadelphia, USA @FoxChaseCancer
Associate Editor for Digital Media
European Urology @EUPlatinum

Henry Woo, MD @DrHWoo
Associate Professor of Surgery
University of Sydney, Sydney, Australia
Founder and Manager
International Urology Journal Club #urojc @iurojc

James Catto MB, ChB, PhD, FRCS @JimCatto
Professor in Urological Surgery
University of Sheffield
Editor-in-Chief
European Urology @EUPlatinum

 

Table 1: Urological Social Media Stakeholders Supporting Urology Tag Ontology Project
 Organization  Hashtag / Twitter Handle
 European Association of Urology (EAU)  @UroWeb
 American Urological Association  @AmerUrological
 EAU Guidelines Committee  #EAUGuidelines
 AUA Social Media Committee  N/A
 Society of Urologic Oncology / Young Urologic Oncology Committee  @SUO_YUO
 Urological Society of Australia and New Zealand  @USANZurology
 British Association of Urological Surgeons  @BAUSurology
 Endourological Society  @EndourolSoc
 European Urology Journal  @EUPlatinum
 Journal of Urology  @JUrology
 BJUI   @BJUIjournal
 Urology Gold Journal  @UroGoldJournal
 Nature Reviews in Urology Journal   @NatRevUrol
 Prostate Cancer and Prostatic Diseases Journal  @PCAN_Journal
 Journal of Sexual Medicine  @JSexMed
 Bladder Cancer Journal  @BladderCaJrnl
 Journal of Clinical Urology  @JCUrology

 

 References

[1]         Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of professional ideas across continents. European Urology 2014;66:118–9. doi:10.1016/j.eururo.2014.02.048.

[2]         Cress PE. Using Altmetrics and Social Media to Supplement Impact Factor: Maximizing Your Article’s Academic and Societal Impact. Aesthetic Surgery Journal 2014;34:1123–6. doi:10.1177/1090820X14542973.

[3]         Nason GJ, O’Kelly F, Kelly ME, Phelan N, Manecksha RP, Lawrentschuk N, et al. The emerging use of Twitter by urological journals. BJU Int 2014:n/a–n/a. doi:10.1111/bju.12840.

[4]         Loeb S, Bayne CE, Frey C, Davies BJ, Averch TD, Woo HH, et al. Use of social media in urology: data from the American Urological Association (AUA). BJU Int 2014;113:993–8. doi:10.1111/bju.12586.

[5]         Matta R, Doiron C, Leveridge MJ. The dramatic increase in social media in urology. The Journal of Urology 2014;192:494–8. doi:10.1016/j.juro.2014.02.043.

[6]         Canvasser NE, Ramo C, Morgan TM, Zheng K, Hollenbeck BK, Ghani KR. The Use Of Social Media in Endourology: An Analysis of the 2013 World Congress of Endourology Meeting. J Endourol 2014:140715142757008. doi:10.1089/end.2014.0329.

[7]         Wilkinson SE, Basto MY, Perovic G, Lawrentschuk N, Murphy DG. The social media revolution is changing the conference experience: analytics and trends from eight international meetings. BJU Int 2015;115:839–46. doi:10.1111/bju.12910.

[8]         Thangasamy IA, Leveridge M, Davies BJ, Finelli A, Stork B, Woo HH. International Urology Journal Club via Twitter: 12-Month Experience. European Urology 2014;66:112–7. doi:10.1016/j.eururo.2014.01.034.

[9]         Prabhu V, Lee T, Loeb S, Holmes JH, Gold HT, Lepor H, et al. Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen. BJU Int 2014;116:65–71. doi:10.1111/bju.12748.

[10]       Rouprêt M, Morgan TM, Bostrom PJ, Cooperberg MR, Kutikov A, Linton KD, et al. European Association of Urology (@Uroweb) recommendations on the appropriate use of social media. European Urology 2014;66:628–32. doi:10.1016/j.eururo.2014.06.046.

[11]       Murphy DG, Loeb S, Basto MY, Challacombe B, Trinh Q-D, Leveridge M, et al. Engaging responsibly with social media: the BJUI guidelines. BJU Int 2014;114:9–11. doi:10.1111/bju.12788.

 

 

 

 

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Article of the Week: Learning curves for urological procedures – a systematic review

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one.

Learning curves for urological procedures: a systematic review

Hamid Abboudi, Mohammed Shamim Khan, Khurshid A. Guru*, Saied Froghi†, Gunter de Win‡, Hendrik Van Poppel§, Prokar Dasgupta and Kamran Ahmed

MRC Centre for Transplantation, King’s College London, King’s Health Partners, Department of Urology, Guy’s Hospital, London, UK, *Roswell Park Cancer Institute, Buffalo, NY, USA, †The Oxford Cancer Centre, Oxford University, Churchill Hospital, Oxford, UK, ‡Department of Urology, University Hospital Antwerp, Antwerp, Belgium, and §Department of Urology, University Hospital, KU Leuven, Leuven, Belgium

Read the full article
OBJECTIVE
  • To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.
PATIENT AND METHODS
  • The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011.
  • Studies pertaining to learning curves of urological procedures were included.
  • Two reviewers independently identified potentially relevant articles.
  • Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed.
RESULTS
  • Forty-four studies described the learning curve for different urological procedures.
  • The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases.
  • The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number.
  • Robot-assisted radical cystectomy has a documented learning curve of 16–30 cases, depending on which outcome variable is measured.
  • Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs.
CONCLUSIONS
  • The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency.
  • The complexities associated with defining procedural competence are vast.
  • The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.
Read more articles of the week

Editorial: Is surgery a never ending learning process?

The concept of the learning curve is one of the most important issues in surgery and also one of the most overlooked. In the present issue of BJUI, Abboudi et al. [1] present an interesting review paper evaluating the concept of the learning curve in urological procedures. Specifically, the authors have conducted a methodologically consistent systematic review on the literature focused on the learning curve of some urological procedures, including mainly radical prostatectomy (RP), robot-assisted partial nephrectomy (RAPN) and percutaneous nephrolitotomy [1]. Surprisingly, nothing was available for BPH treatments, which are among the most prevalent urological procedures. 

Most of the studies are focused on robot-assisted RP (RARP), but the available literature is of poor methodological quality, including mainly surgical series evaluating a limited number of surgeons, with a heterogeneous selection of outcomes from which to study the learning curve and a focus on short-term outcomes. Conversely, the literature on retropubic RP or laparoscopic RP is of higher quality, including a few very large multi-institutional studies encompassing the performances of several surgeons (reference nos. 24, 26, 29 and 30 in the review) and adopting sophisticated statistical methodology; however, the current interest for these procedures is quite limited, RARP being more commonly preferred. With the above-mentioned limitations in mind, what we have learnt is that RARP operating time plateaus after 50–200 cases, positive surgical margin (PSM) rates after 50–1600 cases, and continence and potency after 200 cases [1]. Such data are only partially in line with the findings of a recent prospective Australian study [2], not included in the present systematic review, which evaluated the learning curve with RARP of a high-volume open surgeon (>3000 retropubic RPs performed before the study beginning). In that study, Thompson et al. [2] demonstrated that performances with RARP surpassed those with retropubic RP after ∼100 cases for sexual function scores and PSM rates in pT2 cancers, whereas ∼150 cases were needed to reach the same target with urinary function scores. Moreover, RARP performances kept on improving, with sexual and urinary scores plateauing after 600–700 and 700–800 cases, respectively. Similarly, with regard to PSMs, it was demonstrated that PSM rates in pT2 and pT3–4 cancers plateaued after 400–500 and 200–300 cases, respectively [2]. Although improvement is likely, it is not clear how much these performances might improve with further extension of the caseload. 

Taken together, those data suggest that even with robotic assistance, a high volume of cases is strongly associated withimproving oncological and functional outcomes after RARP. This is not an extraordinarily original concept, but implies that the daVinci platform, by itself, cannot guarantee excellent surgical quality and that the relevance of the surgeon is as high as ever. 

Limited data are available on other major robotic procedures, such as RAPN and robot-assisted radical cystectomy (RARC). Specifically, 20–75 cases are thought to be needed to observe a plateau in warm ischemia time (WIT) during RAPN, which is in line with our previous findings demonstrating a continuous decrease in WIT during the first 50 cases [3]. Similarly, 20–30 cases are supposed to be needed to achieve acceptable operating times, lymph node yields and PSM rates after RARC; however, those findings do not take in account the burden of robotic experience achieved with RARP before embarking in RARC, which is clearly a major issue [4]. 

Considering that the improvements in performances along the learning curve exceeded any effect sizes we might reasonably expect from a novel drug [5], it is clear that any attempt to centralise treatments for complex procedures in high-volume centres with high-volume surgeons should be attempted. Obviously, that is a very critical target, which is hard to achieve in many realities. In parallel, interventions to improve the performance of surgeons in order to,reduce the learning curve are mandatory. For example, fellowship-trained RARP surgeons have been shown to outperform experienced open or laparoscopic surgeons moving to RARP without specific training [6,7]. For those surgeons for whom fellowship is unfeasible or unpractical, structured courses with integration of simulation, dry laboratory, wet laboratory and da Vinci modular training, for example, using the model of the recently concluded European Robotic Urology Society Pilot Study, can significantly ease the first steps of the learning curve, reducing patients risk. In parallel, intensive courses focused on specific procedures could help those surgeons who had completed the initial steps of their learning curve to master the specific technical details necessary to improve outcomes.

Read the full article

Alexander Mottrie*† and Giacomo Novara†‡

*OLV Vattikuti Robotic Surgery Institute and † Department of Urology, OLV Hospital Aalst, Aalst, Belgium and ‡ Department of Surgery, Oncology and Gastroenterology, Urology Clinic University of Padua, Padua, Italy

References

1 Abboudi H, Khan MS, Guru KA et al. Learning curves for urological procedures: a systematic review. BJU Int 2014; 114: 617–29

2 Thompson JE, Egger S, Böhm M et al. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. Eur Urol 2014; 65: 521–31

3 Mottrie A, De Naeyer G, Schatteman P et al. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol 2010; 58: 127–32

4 Hayn MH, Hellenthal NJ, Hussain A et al. Does previous robot-assisted radical prostatectomy experience affect outcomes at robot-assisted radical cystectomy? Results from the International Robotic Cystectomy Consortium. Urology 2010; 76: 1111–6

5 Vickers AJ. What are the implications of the surgical learning curve? Eur Urol 2014; 65: 532–3

6 Kwon EO, Bautista TC, Jung H et al. Impact of robotic training onsurgical and pathologic outcomes during robot-assisted laparoscopicradical prostatectomy. Urology 2010; 76: 363–8

7 Leroy TJ, Thiel DD, Duchene DA et al. Safety and peri-operative outcomes during learning curve of robot-assisted laparoscopicprostatectomy: a multi-institutional study of fellowship-trainedrobotic surgeons versus experienced open radical prostatectomysurgeons incorporating robot-assisted laparoscopic prostatectomy. J Endourol 2010; 24: 1665–9

 

Engaging responsibly with social media: the BJUI Guidelines

  • The final, peer-reviewed version of this paper has been accepted for publication in BJUI.
    You can find it here. Please cite this article as doi: 10.1111/bju.12788

    The social media revolution is well underway. Facebook, Twitter, YouTube, Instagram, Weibo, Blogger, LinkedIn, and many other social media platforms, have now penetrated deeply into our lives and have transformed the way in which we communicate and engage with society. The statistics are staggering. As of mid-2014, the total number of global users of the following platforms has exceeded billions of people from every nation in the world:

    • Facebook – over 1.3 billion users
    • Twitter – over 280 million active users
    • YouTube – over 1 billion people view YouTube each month
    • Instagram – over 200 million users
    • LinkedIn – over 270 million users

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Social media has also become very popular among-st healthcare professionals both on a personal and professional basis. The reach and engagement which social media enables, along with the incredible speed with which information is disseminated, clearly creates opportunities for advances in healthcare communication. However, because healthcare professionals also have serious professional responsibilities which extend to their communication with others, there are dangers lurking in social media due to the inherent lack of privacy and control.

As a result, major professional bodies have now issued guidance for their members regarding their behaviour using social media. These include bodies representing medical students, general practitioners, physicians, oncologists, the wider medical community, as well as major regulatory bodies such as the Federation of State Medical Boards and the General Medical Council (GMC) in the UK, whose role is to licence medical practitioners. The guidance from the latter, part of the GMC’s Good Medical Practice policy, has significant implications as failure to comply with this guidance could impact a doctor’s licence to practice. All health care providers engaging in social media need to familiarize themselves with the relevant institutional, local, and national guidelines and policies.

There are many examples of healthcare providers who have faced disciplinary action following content posted on social media platforms. For example, posting photos of a drunk patient to Instagram and Facebook [1] is likely to result in serious disciplinary and legal action. In another case, a doctor in the USA was dismissed from her hospital and censured by the State Medical Board when she posted online details of a trauma patient [2]. Although her posting did not reveal the patient’s name, enough information was posted for others in the community to identify the patient. Furthermore, a review of physician violations of online professionalism and disciplinary action taken by State Medical Boards in the USA demonstrated that this case was not isolated [3]. Over 90% of State Medical Boards reported that at least one of several online professionalism violations had been reported to each of them. The most common violations were inappropriate patient communication online, often of a sexual nature. While the most frequent plaintiffs were patients and their families, it is noteworthy that complaints by other physicians were reported in half of State Medical Boards. Overall, serious disciplinary action including licence restriction, suspension or revocation occurred in over half of cases. There is clearly a need for healthcare professionals to be aware of their responsibility when communicating online.

So what of urology and social media? There is no doubt that many urologists have embraced social media with great enthusiasm, and urology has been one of the specialties leading the way [4-7]. The BJUI has been at the forefront of this enthusiasm as we have implemented a wide-ranging and evolving social media strategy including an active presence on the main social media platforms, a popular blog site, and a strategy to integrate our journal content across these platforms [8]. We now also recognise achievements in social media in urology through our annual Social Media Awards and by introducing a formal teaching course at the 2013 British Association of Urological Surgeons (BAUS) Annual Meeting, the first such course at a major urology meeting. While continuing to encourage the development of social media in urology as one of our key strategies, we also recognise that there are risks inherent in engaging in social media and that clinicians must be aware of these risks.

We therefore propose the following guidelines for healthcare professionals to ensure responsible engagement with social media. Much of this content is in alignment with advice issued by the other bodies listed above.

 

  1. Always consider that your content will exist forever and be available to everyone. Although some social media platforms have privacy settings, these are not foolproof and one should never presume that a post on a social media platform will remain private. It should instead be assumed that all social media platforms lack privacy and that content will exist forever.
  2. If you are posting as a doctor, you should identify yourself. The GMC guidance has specifically commented on anonymity. They advise that if you are identifying yourself as a doctor then you should also give your name, as a certain level of trust is given to advice from a doctor. People posting anonymously should be very careful in this regard as content could always be traced back to its origins, particularly if it became a matter for complaint.
  3. State that your views are your own if your institutions are identifiable. It is commonplace for clinicians to identify their institutional affiliation in their social media profile. While not an excuse for unprofessional activity, it is good practice to state that your views are your own, particularly if you occupy leadership positions within that institution.
  4. Your digital profile and behaviour online must align with the standards of your profession. Whatever standards are expected of the licencing body for your profession must be upheld in all communications online. You should also be aware that what you post, even in a perceived personal environment such as Facebook, is potentially accessible by your employers. As employers they will have a certain standard of behaviour that they expect. For example, use of inappropriate language or images of drunkenness could result in disciplinary action.
  5. Avoid impropriety – always disclose potential conflicts of interest. The American Society of Clinical Oncology (ASCO) includes this important point in their guidance. Influencers in social media can hold powerful sway and clinicians have a responsibility to use this influence responsibly and manage any potential conflicts.
  6. Maintain a professional boundary between you and your patient. It is not unusual for patients to be interested in their doctor’s social network. While most people do not restrict their Twitter and instagram followers for public profiles (and therefore all tweets must uphold professional standards), it is reasonable to politely decline a friend request on Facebook by stating that you keep your personal and professional social networks separate. The BMA guidance specifically advises against patients and doctors becoming friends on Facebook and advises that they politely refuse giving the reasons why.
  7. Do not post content in anger and always be respectful. It is considered inappropriate to post personal or derogatory comments about patients OR colleagues in public. Defamation law could apply to any comment made in the public domain.
  8. Protect patient privacy and confidentially at all times. There is an ethical and legal duty to protect patient confidentiality at all times, and this equally applies to online communication including social media. If posting a video or image, consent needs to be obtained for this even if the patient is not directly identifiable. Content within a post or image, including its date and location and your own identity, may indirectly identify a patient to others. The GMC guidance also states that you must not ‘discuss individual patients or their care with those patients or anyone else’. Thus posting about a case you have just seen could be in breach of these recommendations.
  9. Alert colleagues if you feel they have posted content which may be deemed inappropriate for a doctor. Quite unintentionally, colleagues may post content which may be regarded as unprofessional for any of the reasons listed above. Although a digital shadow may always persist, deleting the online content before it becomes more widely disseminated may help mitigate the damage.
  10. Always be truthful and strive for accuracy. All online content in social media should be considered permanent. It should also be considered that anyone in the world could potentially access this content. Therefore, truthfulness and accuracy are simple standards which should be upheld as much as possible.

Social media is a very exciting area of digital communication and is full of opportunities for clinicians to engage, to educate and to be educated. However, risks exist and an understanding of the boundaries of professional responsibility is required to avoid potential problems. Adherence to simple guidelines such as those proposed here may help clinicians achieve these aims.

Declan G Murphy1-2, Stacy Loeb3, Marnique Y Basto1, Benjamin Challacombe4, Quoc-Dien Trinh5, Mike Leveridge6, Todd Morgan7, Prokar Dasgupta4, Matthew Bultitude4

1University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia, 2Epworth Prostate Centre, Epworth Healthcare Richmond, Melbourne, Australia, 3New York University, USA, 4Guy’s Hospital, King’s College London, UK, 5Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA, 6Department of Urology, Queen’s University, Kingston, ON, Canada, 7Department of Urology, University of Michigan, Ann Arbor, MI, USA

References

  1. ABC News. Chicago doctor allegedly posted photos of drunk patient on social media. Available at: https://jobs.aol.com/articles/2013/08/21/chicago-doctor-drunk-patient-photos-facebook/
  2. Above the Law. ER doc forgets patient info is private, gets fired for facebook overshare. Available at: https://abovethelaw.com/2011/04/er-doc-forgets-patient-info-is-private-gets-fired-for-facebook-overshare/.
  3. Greysen SR, Chretien KC, Kind T, Young A, Gross CP. Physician violations of online professionalism and disciplinary actions: a national survey of state medical boards. JAMA 2012; 307: 1141-1142.
  4. Prabhu V, Lee T, Loeb S et al. Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen. BJU Int 2014; doi: 10.1111/bju.12748
  5. Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of professional ideas across continents. Eur Urol 2014; doi: 10.1016/j.eururo.2014.02.048
  6. Loeb S, Bayne CE, Frey C, et al. Use of social media in urology: data from the American Urological Association. BJU Int 2013; doi: 10.1111/bju.12586
  7. Matta R, Doiron C, Leveridge MJ. The dramatic rise of social media in urology: trends in Twitter use at the American and Canadian Urological Association Annual Meetings in 2012 and 2013. J Urol 2014; doi: 10.1016/j.juro.2014.02.043
  8. Murphy DG, Basto M. Social media @BJUIjournal – what a start! BJU Int 2013; 111: 1007-1009

The final, peer-reviewed version of this paper has now been accepted for publication in BJUI. You can find it here. Please cite this article as doi: 10.1111/bju.12788

 

Future Proofing Urology – Conference Highlights from the USANZ ASM 2014

Dr Marnique Basto (@DrMarniqueB) 

 

 

Delegates of #USANZ14 received a sunny welcome at this year’s 67th annual scientific meeting in Brisbane, affectionately coined by Aussies as ‘Bris-vegas’ attributed to a love of Elvis and the city’s growing live music scene. The reins were passed from Professor Damien Bolton and A/Professor Nathan Lawrentschuk (@lawrentschuk) who convened last year’s ASM in Melbourne to Greg Malone (@DrGregJMal) and Eric Chung. @BJUIjournal Editor-in-chief Prokar Dasgupta (@prokarurol) praised the USANZ organising committee for their tremendous hospitality.

A star studded international faculty made the long-haul down under including Shahrokh Shariat, Alan Partin, Gerry Andriole, James Eastham, Rainy Umbas, Per-Anders Abrahamsson, Monique Roobol, Hein Van Poppel, Jean de la Rosette, Gerald Brock, Brad Leibovich, Gary Lemack, Tom Lue, Jonathan Coleman, Michael Jewett, Oliver Traxer, Eric Small, Adrian Joyce, Roger Kirby, Gopal Badlani, Sunil Shroff, Eila Skinner, Jaspreet Sandhu, Matthew Rettig, Pilar Laguna, Jaime Landman, Irwin Goldstein, Todd Morgan and Gregor Goldner.

The hype around #USANZ14, however, had kicked off well before conference doors opened with @USANZUrology mounting the largest pre-conference social media (SoMe) campaign of any Urology conference internationally to date. Over 200 tweets were generated in the five-day lead-up from the @Urologymeeting account, doubling last year’s efforts of the social media team at the Prostate Cancer World Congress in Melbourne. It’s fair to say Australia is setting a blazing pace in the use of SoMe to amplify the Urology conference experience and generate international engagement and global reach.

“Future proofing urology” was the conference theme this year to promote and foster multidisciplinary collegiality and evidenced urological practice. The theme was entwined throughout the four-day conference with the final day showcasing a multidisciplinary forum with international experts discussing complex cases. Additionally the Australian and New Zealand Urological Trials (@ANZUPtrials) session highlighted the interplay between urology, radiation and medical oncology and the current trials underway. 

USANZ president David Winkle officially opened conference proceedings and we had the honour of Scottish-born Australian Scientist Professor Ian Frazer AC, the mastermind behind the Human Papilloma Virus vaccine and the fight against cervical cancer, deliver the Harry Harris oration. Professor Frazer’s ongoing dedication to implementing vaccination programs in low GDP countries such as Vanuatu and Butan was truly inspirational. Harry Harris was the first full time Urology specialist in Australia, and suitably the award of the seven newest fellows of the USANZ collegiate followed. Congratulations to all.

A lively point-counterpoint debate on the viability of prostate cancer prevention then ensued between Shahrokh Shariat (@DrShariat) on the negative and Gerald Andriole (@uropro) on the affirmative. Interestingly both parties used the same sets of data to reach opposite conclusions. The ability to use the opposition’s prior publications against them became the clincher in several of the debates throughout the conference; however, it was the ‘no show’ of hands from the audience when asked “who currently uses chemoprevention?” that reinforced the inevitable conclusion.

The BJUI session was then underway and A/Prof Nathan Lawrentschuk, Associate Editor of the BJUI USANZ supplement, outlined his vision for the journal going forward. The winner of the BJUI Global Prize awarded to a trainee who significantly contributed to the best international article went to Dr. Ghalip Lidawi for his paper titled High detection rate of significant prostate tumours in anterior zones using transperineal template saturation biopsy. In an Oscar-style award ceremony Dr Lidawi was broadcast from Tel Aviv. Professor Alan Partin (@alan_partin) went on to deliver a brilliant and balanced rationale behind why Gleason 6 IS prostate cancer and potentially coined the alternative name PENIS (‘Prostatic epithelial neoplasm of indeterminate significance’).  News of ‘PENIS of the prostate’ hit social media channels instantly with Urologists chiming in from the US to give their opinion within minutes and before Dr Partin had even stepped down from the podium.

Dr. Ghalip Lidawi accepting his BJUI Global Prize via video message (photo courtesy of Imogen Patterson).

After the opening plenary each morning, the 950 delegates were treated to a range of concurrent sessions from the faculty, which included localised prostate cancer, endourology, andrology/prostheses, high risk prostate cancer, LUTS/BPH, prostate cancer multidisciplinary forum, urology general, bladder cancer, kidney cancer and abstract poster presentations. There was a concurrent nursing program also running during the USANZ schedule that proves year after year to be a huge success.

A stand out session of the meeting was on high-risk prostate cancer section on Monday afternoon. Professor James Eastham (who is rumoured to have just joined twitter!) discussed the role of pelvic lymph node dissection (PLND) for diagnostic and therapeutic purposes with reference to the Memorial Sloan Kettering (MSK) experience and the role of salvage PLND after radical prostatectomy for choline PET detected retroperitoneal or pelvic node recurrence. Professor Hein van Poppel went on to support the role of surgery in high-risk disease in this session, while Drs Shariat and Per Anders Abrahamsson discussed the latest in hormonal adjuvant therapy. 

What makes USANZ special?

The abstract submissions this meeting far superseded last year in volume and quality requiring two concurrent poster presentation sessions running most of the conference. The use of transperineal template biopsy was a prominent theme again in the abstract series, as was active surveillance for low risk prostate cancer. Pleasingly we saw the development of large international collaborations involving Australia such as the Vattikuti Global Quality Initiative on Robotic Urologic Surgery where Mr Daniel Moon has collaborated with nine hospitals throughout Europe, North America and India on their growing robotic partial nephrectomy series. 

Each year a select group of our young talented trainees compete for the prestigious Keith Kirkland (KK) clinical and Villis Marshall (VM) basic science prizes. This year Dr Kenny Rao (@DrKennyRao) was awarded the VM prize from a field of five candidates for his work titled ‘Zinc preconditioning protects the rat kidney against ischaemic injury’. Dr Helen Nicholson (@DrHLN) took out the KK prize over 10 other candidates for her work; ‘Does the timing of intraoperative non-steroidal anti-inflammatory analgesia affect pain outcomes in ureteroscopy? A prospective, single-blinded, randomised controlled trial’. These were awarded at the gala ball located at the Brisbane townhall, a venue soon to be filled by some of the most prominent in the world for the G20 summit. Other awards on the night included the Alban Gee for best poster to Shomik Sengupta (@shomik_s), the BAUS trophy (@BAUSUrology) to Michael Holmes and the Abbvie Platinum award to Niall Corcoran.

Unlike any other Urology meetings worldwide, the USANZ ASM is compulsory for all trainees from their third year on and is encouraged in the first two years. Trainees were treated to a breakfast meeting with Dr Shahrokh Shariat who imparted 14 career tips and then assisted @lawrentschuk in grilling trainees on difficult case studies in preparation for their fellowship exams. A brilliant learning opportunity! Trainees also got to meet one-on-one with international faculty members of their choice to facilitate potential future fellowships in somewhat of a staged ‘speed-dating’ affair – 10 minutes chat, then move on. To top off the trainee program, the @BJUIjournal delivered an extremely practical and useful workshop focussed on getting published in the digital and social media era where blogs are encouraged, tweets are citable and your CV now contains a social media section.

A SoMe session attracted a lot of attention from international delegates and twitter activity on the #USANZ14 hashtag skyrocketed as we were joined by Stacy Loeb (@LoebStacy) in Moscow, Alexander Kutikov (@uretericbud) in the US and Rajiv Singal (@DrRKSingal) in Canada. Declan Murphy (@declangmurphy), Henry Woo (@DrHWoo) and Todd Morgan (@wandering_gu) put on a masterful (and non-nauseating) prezi display with the audience taken on an e-health journey of novel gadgets and devices including one that measured tumescence and sends the file automatically to the physician records. The possibilities are endless! Twitter boards were back in force; a sign of a quality and successful conference according to @declangmurphy. The wifi at the conference venue could not be faulted!

Controversial areas of SoMe were also broached including the APRAH Advertising Guidelines that came into effect this week, Monday March 17. Australian Plastic surgeon Jill Tomlinson (@jilltomlinson) has actively opposed the guidelines that will see physicians responsible for all testimonials associated with them on the internet. The policy mandates this information be removed otherwise a fine of up to $5000 is possible, many feel this places an unreasonable burden on health practitioners to be responsible for content that they may potentially be unaware of. Read Jill Tomlinson’s letter to APRAH here.

The @BJUIJournal and its editors @prokarurol, @lawrentschuk, @declangmurphy and @alan_partin (left to right below) and off screen @drHwoo were prominent SoMe influencers of the meeting two years running. We were also delighted to have Mike Leveridge (@_theurologist) from Canada attending, one of the pioneering uro-twitterati. A mention goes out to fellow countryman @drrksingal who was again mistaken for being at the conference due to his strong SoMe presence from afar. The twitter activity for the conference period March 16 (00:00) to March 19 (23:59) generated nearly 1.4 million impressions and 2,326 tweets or approximately 344K impressions and 581 tweets per day. Based on the study conducted by our team examining metrics of all eight major urological conferences of 2013, #USANZ14 would comparatively rate second only to the AUA in the international engagement and global reach attained. Congratulations to @USANZUrology and @Urologymeeting for enhancing our conference experience and sending our message out to almost 1.4 million potential viewers in just a 4-day period. 

The BJUI Workshop featured Editor-in-Chief Prokar Dasgupta and Associate Editors Nathan Lawrentschuk, Declan Murphy and Alan Partin.

In 2015 we take a trip to Adelaide for the 68th Annual Scientific Meeting of USANZ with experts already confirmed including Steven Kaplan, Martin Koyle, Morgan Rupert, Matthew Cooperberg and Glenn Preminger. See you all there!

 

Dr Marnique Basto (@DrMarniqueB) is a USANZ trainee from Victoria who has recently completed a Masters of Surgery in the health economics of robotic surgery and has an interest in SoMe in Urology.

Check out the new BJUI Instagram feed for more photos from #usanz14 www.instagram.com/bjui_journal

 

 

Urological Fellowships – the unwritten but almost essential step to a future specialist consultant practice?

Preamble:
Training in urology in the UK, and indeed globally has seen significant changes in the last decade. This has mirrored the changing face of health care provision within and outside the NHS. For award of a Certificate of Completion of Training (CCT), the Joint Committee on Surgical Training (JCST) has recommended specific guideline criteria for different specialties, including urology. The current structure of urological training in the UK has evolved to prepare a trainee by the completion of training at bare minimum for a general urologist. However, depending on the training environment, trainers and trainee enthusiasm with an early focus of interest, many trainees achieve more than just this bare minimum by way of modular training, especially in their final years of training. Some will carry on with acquisition of specialist skills as junior consultants, but increasingly trainees are opting to go for fellowships in their area of specialist interest. This is almost becoming an unwritten essential step for getting a plum specialist post.

When to start?
Those trainees with a special interest in a particular area (and wish to pursue this after CCT) should start the thought process by the end of second year, and their initial groundwork to identify suitable fellowships by third year. Why the rush? Simple reason: the application time to the start of some fellowships typically lags by a year or more. For example, many North American institutional fellowships have application submission deadlines in January, followed by interviews in February-May, for a fellowship that will start in July the following year (18 month lag!). This rush is even more important if the fellowship is intended to be undertaken prior to end of training as an ‘out of programme experience’ or ‘out of programme training’, as the rules have recently changed as of April 2013 where some Local Education and Training Boards (LETBs), previously called ‘Deaneries’, under the Health Education England will not allow OOPE or OOPT in the final year of training. Refer to www.gmc-uk.org and www.hee.nhs.uk for more details on OOPT and OOPE.

When to go on fellowship?
The options are either doing your fellowship before completing training as an OOPE / OOPT or going on a post-CCT fellowship. When to go depends on your individual interest, personal circumstances, fellowship criteria, your choice and importantly the support of your programme director and local surgical training committee. The advantage of an OOPE/OOPT fellowship before CCT is that when you come back, you have your registrar job and salary to come back to. You also don’t lose your grace period at the end of CCT. The disadvantage is that you may come back specialised and ready for a consultant job, but since you haven’t yet completed your full training, you could miss some good job opportunities while you go back to being a registrar for a year. The advantage of a post-CCT fellowship is that you can start looking for jobs during your fellowship and ideally walk into a consultant (or locum consultant) job, but this requires diligently keeping in touch while you are away. The disadvantage is that you may not have anything to come back to, and you lose your grace period. Either way, it’s a gamble.

Where to go?
Traditionally, the two most popular destinations for fellowships are USA and Australia. Emerging spots include Canada, Europe and home-based UK fellowships. Each place has its pros and cons. Australian fellowships, usually for a year, are supposedly good hands-on experience with a fantastic salary package, proportional to frequency of calls. However they grossly lack research and formal learning opportunities. American and Canadian fellowships are usually 2 years with a year of research and a year of clinical/operative work. The research exposure as well as publishing, critical appraisal and exposure to knowledge is fantastic. For US fellowships, trainees have to sit the USMLE and be ECFMG certified. Canadian fellowships are becoming popular with British trainees as holding the FRCS (Urol) suffices, and there is no need to sit any other exams. They also offer a fine mix of research opportunities and hands-on operative experience. For oncology fellowships, visit www.suonet.org. Good financial planning is crucial, especially for North American fellowships.

 

Jaimin Bhatt
University of Toronto Health Network, Princess Margaret Hospital, Toronto, Canada
Post-CCT SUO Fellow in Urologic Oncology. Completed his urological training in the Oxford deanery (now called Health Education Thames Valley)

 

Article of the week: Behind the curve: residents’ access to RAL is poor in Europe

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by prominent members of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of Dr. Furriel discussing his paper.

If you only have time to read one article this week, it should be this one.

Training of European urology residents in laparoscopy: results of a pan-European survey

Frederico T.G. Furriel, Maria P. Laguna*, Arnaldo J.C. Figueiredo, Pedro T.C. Nunes and Jens J. Rassweiler

Department of Urology and Renal Transplantation, University Hospital of Coimbra, Coimbra, Portugal, *Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Department of Urology, Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany

Read the full article

OBJECTIVE

• To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments.

MATERIALS AND METHODS

• A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012.

• Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated.

• Data was analysed with descriptive statistics.

RESULTS

• In all, 219 European urology residents answered the survey.

• Conventional laparoscopy was available in 74% of the respondents’ departments, while robotic surgery was available in 17% of the departments.

• Of the respondents, 27% were first surgeons and 43% were assistants in conventional laparoscopic procedures. Only 23% of the residents rated their laparoscopic experience as at least ‘satisfactory’; 32% of the residents did not attend any course or fellowship on laparoscopy.

• Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory.

• The motivation to perform laparoscopy was rated as ‘high’ or ‘very high’ by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy.

CONCLUSIONS

• Urological laparoscopy is available in most European training institutions, with residents playing an active role in the procedure. However, most of them consider their laparoscopic experience to be poor.

• Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged.

 

Read Previous Articles of the Week

 

Editorial: Minimally invasive surgical training: do we need new standards?

The pan-European survey conducted by Furriel et al. [1] in this issue of BJUI is a timely address of a hot topic in urology.

More than 20 years have passed since the first laparoscopic nephrectomy was performed by Clayman et al. [2] in 1991, and now all urological major interventions have been performed with one or more different minimally invasive techniques (standard, single-site or robot-assisted laparoscopy); some of them have passed the judgment of time becoming ‘gold standard’ treatments, while others are still under evaluation. Specifically, the European Association of Urology (EAU) guidelines recommend laparoscopic radical nephrectomy as the ‘standard of care’ over open surgery, report favorable outcomes for robot-assisted laparoscopic radical prostatectomy, and propose as optional treatments laparoscopic or robot-assisted partial nephrectomy and radical cystectomy [3].

Obviously, this surgical revolution brings two major new issues: (i) Starting from academic and training centres, hundreds of Urology Departments throughout Europe need to update their surgical knowledge and expertise, making senior urologists perform up-to-date procedures; (ii) Residents and young urologists require adequate and possibly standardised training in minimally invasive surgery, learning at least the basic laparoscopic skills. The study by Furriel et al. [1] correctly highlights both problems.

First, according to the survey, penetration of laparoscopy in the most important urological training centres is unexpectedly low. In fact, more than one out of four centers (26%) do not perform minimally invasive surgery, even for the ‘standards of care’, such as laparoscopic radical nephrectomy. Moreover, as the survey was conducted specifically on the topic of minimally invasive surgery, it is probable that unexposed residents were less interested in responding, making the data of penetration probably even worse than reported. This fact reflects a serious problem present in most training centres. While previously surgery slowly evolved, laparoscopy and technology brought sudden innovations, putting several senior urologists ‘out of the game’. Hence, today, training is needed not only for residents, but also for consultants. In the meantime, it is important that residents are trained in centres were minimally invasive surgery is already widely available. In this perspective, European educational authorities should endeavour to certificate the residents’ training centres, for example on the basis of adherence to EAU guidelines. Academic or non-academic training centres not adherent to guidelines (and thus not performing minimally invasive surgery) should therefore be deprived of residents.

Secondly, training residents in minimally invasive surgery can be approached in different ways, from low-cost self-made dry laboratories to expensive virtual reality or robotic three-dimensional simulators. According to the survey, >40% of centres have no training facilities available. It has been shown that self-built, cheap, dry laboratories are as efficient in training as the industrial ones [4], so that it is not a matter of costs but a matter of interest. We strongly believe that watching surgical videos, observing live surgeries and using (low-cost or not) dry laboratories are fundamental steps in acquiring the basic skills in laparoscopy, while the modular training proposed by Stolzenburg et al. [5] for laparoscopic radical prostatectomy is the best live training model and can be exported to other kinds of surgery, such as radical or partial nephrectomy. In the centres where robot-assisted surgery is available, working as a table-side assistant is another good way to acquire laparoscopic skills.

A great debate is currently ongoing about credentialing in minimally invasive surgery training [6]. Pragmatically, when the European training centres are certificated for adherence to the EAU guidelines, there will be no need for a specific credentialing in laparoscopic skills, because it will be included in the standard training path, together with endoscopic and open surgery.

In conclusion, the survey by Furriel et al. [1] shows that times are changed: the old axiom ‘big cut, big surgeon’ is not valid anymore. The emerging urological generations know it, and ask to be adequately trained. Training centres must evolve, because in 2013 minimally invasive surgery has formally to be considered as part of the standard urological armoury.

Antonio Galfano and Aldo Massimo Bocciardi
Department of Urology, Ospedale Niguarda Ca’ Granda, Milan, Italy

Read the full article

References

  1. Furriel F, Laguna MP, Figueiredo A, Nunes P, Rassweiler JJ. Training of European urology residents in laparoscopy: results of a pan-European surveyBJU Int 2013; 112: 1223–1228
  2. Clayman RV, Kavoussi LR, Soper NJ et al. Laparoscopic nephrectomyN Engl J Med 1991; 324: 1370–1371
  3. EAU Guidelines, edition presented at the 28th EAU Annual Congress, Milan 2013. ISBN 978-90-79754-71-7. EAU Guidelines Office, Arnhem, The Netherlands. Available at: https://www.uroweb.org/guidelines/online-guidelines/. Accessed September 2013
  4. Beatty JD. How to build an inexpensive laparoscopic webcam-based trainerBJU Int 2005; 96: 679–682
  5. Stolzenburg JU, Schwaibold H, Bhanot SM et al. Modular surgical training for endoscopic extraperitoneal radical prostatectomy. BJU Int 2005; 96: 1022–1027
  6. Lee JY, Mucksavage P, Sundaram CP, McDougall EM. Best practices for robotic surgery training and credentialingJ Urol 2011;185: 1191–1197

Video: How do urology residents rate their laparoscopic experience?

Training of European urology residents in laparoscopy: results of a pan-European survey

Frederico T.G. Furriel, Maria P. Laguna*, Arnaldo J.C. Figueiredo, Pedro T.C. Nunes and Jens J. Rassweiler

Department of Urology and Renal Transplantation, University Hospital of Coimbra, Coimbra, Portugal, *Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Department of Urology, Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany

Read the full article

OBJECTIVE

• To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments.

MATERIALS AND METHODS

• A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012.

• Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated.

• Data was analysed with descriptive statistics.

RESULTS

• In all, 219 European urology residents answered the survey.

• Conventional laparoscopy was available in 74% of the respondents’ departments, while robotic surgery was available in 17% of the departments.

• Of the respondents, 27% were first surgeons and 43% were assistants in conventional laparoscopic procedures. Only 23% of the residents rated their laparoscopic experience as at least ‘satisfactory’; 32% of the residents did not attend any course or fellowship on laparoscopy.

• Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory.

• The motivation to perform laparoscopy was rated as ‘high’ or ‘very high’ by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy.

CONCLUSIONS

• Urological laparoscopy is available in most European training institutions, with residents playing an active role in the procedure. However, most of them consider their laparoscopic experience to be poor.

• Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged.

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