The European Society for Residents in Urology: what have we learnt and where are we going?
K. Walsh, 163 Bromswood Road, London SW11 6JX, UK.
The European Society for Residents in Urology (ESRU) was established in 1991, as an independent body representing residents within Europe. A desire for political and financial integration throughout Europe has now emerged. Sharing ideas, pooling resources and acting as a combined unit it should be possible to improve the quality of life for Europeans. If the national banks of the participating countries can find some common ground, then the delivery of health-care and the training of urologists in particular can be structured to deliver a service to meet the needs of the 21st century.
The ESRU is organized by and represents urological trainees. As the honorary president we are fortunate to have one of the pioneers of European urological collaboration, Professor John Blandy. The executive committee communicates frequently (by e-mail) and meets four times a year. Twice a year there is an ESRU meeting where the representatives of each European country are encouraged to report on new developments and concerns that have arisen about training issues, job vacancies and career structure. Many European countries have their own trainee organizations and they elect members to represent them at ESRU meetings. Where countries lack such organization, they can be represented if an enlightened professor nominates a trainee from his or her unit to attend the meetings. However, the aim is to assist each country to establish their own organization, promote better dissemination of information and easier data collection to and from residents.
The ESRU is not a trade union and has no desire to be seen as a body of agitators; ESRU works closely with the European Board of Urology (EBU) and European Association of Urology (EAU). The ESRU is represented on several committees within these organizations. The opinion of ESRU is not only sought but also often welcomed when decisions about the future direction of urological issues throughout Europe are being formulated. It is important that this voice is heard and that ESRU remains completely independent to air the unique frustrations of the training situation.
Although ESRU members meet and discuss policy at European conferences, the concept behind ESRU is to encourage the formation of a trainee-led organization within each country that can work in co-operation with the national urological association. Satellite meetings have taken place in recent years at national congresses in Germany and Spain, to inform trainees about ESRU and their trainee organizations.
Objectives and activities
1. ESRU aims to promote a good quality of training throughout Europe. This is achieved by gathering information about the structure and delivery of training in different European countries.
ESRU has recently analysed a questionnaire that was distributed to trainees from around Europe. This allows the recognition of perceived deficient areas in training and the presentation of these data to the major organisers of European training, the EBU and EAU. It is hoped that this will create change for the better. By comparing standards in different countries improvements will be introduced where required.
Residents must be equipped with theoretical knowledge and sound practical skills before embarking on the practice of urology. The ESRU hopes to encourage the development of good training institutions to achieve these goals. Standards of requirement for trainers will be introduced and monitored regularly.
Within these institutions there must be a range of subspeciality exposure for residents and adequate staff-to-resident ratios so that skills can be learnt.
ESRU will try to assert some control on the numbers of residents who are in training and match them to projected vacancies
2. A forum for discussion
ESRU will act as a platform for residents from different countries to compare training. By meeting twice a year the ESRU can share advances and problems that have been encountered by different regions.
3. Clinical visits
ESRU is involved in supporting trainees who wish to visit European centres for short-term clinical visits and research posts. With the help of the European Urological Scholarship Programme (EUSP), ESRU will encourage residents to spend a period of study in units throughout Europe. Money is available and residents can apply for financial help for a research grant or to observe in the form of a clinical attachment.
ESRU organizes an annual scientific meeting of state-of-the-art lectures from leading urologists in conjunction with the EAU congress, where topics considered controversial or of special interest are presented. Unlike the usual such lecture where questions are not encouraged, ESRU has been able to generate lively discussion on several issues over the years. In association with this event the ESRU has organized a poster and oral scientific session designed specifically for young residents to learn the skills of podium presentation; this has proved valuable experience for many.
ESRU is involved in the annual AECU course, which is aimed at participants of the forthcoming FEBU examination. The collection of material from each of the speakers is edited and prepared in a course booklet, which is distributed to all who attend.
6. Social integration
It is important that residents form friendships that will encourage collaboration in the future. The ESRU has a reputation for being a generous host and annually holds a dinner for residents. It is only by this constant process of meeting to share ideas and aspirations early in a career that progress will be eventually made.
The ESRU questionnaire
A pilot study was conducted in the Netherlands, using a broad-based questionnaire distributed to residents throughout Europe. The questionnaire was designed to determine how information would be distributed and collected within Europe, and to identify specific areas appropriate to a more rigorous question format for the future. From 260 responses some trends were identified that were of concern to urology residents and the aim now is to obtain more specific details about these areas from different countries.
All responses to the current questionnaire were pooled, the data collected and presented in the form of tables and charts. The findings of greatest interest were that 92% of European trainees agreed that the basic national and European guidelines should be implemented, but only 65% said they were in place in their country; 44% of trainees felt that there were too many residents in training; 76% of trainees would have welcomed a tailored training programme working towards a subspecialist goal but only 25% had one. Only 52% of trainees had a compulsory annual examination and 56% an exit examination; 76% wished for allocated research time but only 48% said it was available. Only 56% of trainees felt that an exchange programme would be possible during their training. Most trainees felt comfortable with endoscopic surgery and the investigation of urological complaints, but their log books revealed a lack of experience with open operative procedures. From the results of this questionnaire, ESRU plans to ask trainees how these problems could be tackled, so future goals for change can be formulated.
The ESRU has an active and frequently visited web site (http://www.esru.com). Information on all activities is updated and links with other urological sites of interest are easily accessed. The goal is for each national trainee association to link with the ESRU home-page, to ease communication and clinical visits between countries. Information about the European scholarship programme is available, and the programme for the next international meeting in Geneva, in association with the EAU.
It is imperative that ESRU continues to grow and maintain the high level of participation from many countries. ESRU must establish more links with eastern Europe. By working closely with the EBU and EAU, ESRU hopes to offer good value for residents attending courses run by these organizations. There should be more visits among institutions throughout Europe. Residents will be encouraged to participate in the FEBU examination, to improve standards of education across the continent. ESRU hopes to form a delegation that could visit and inspect units, and recommend them for short-term clinical visits based on the experiences of residents.
An important subcommittee of the EBU, the Residency Review Committee, has the task of assessing institutions throughout Europe and their suitability for urological training. ESRU is fortunate to participate within this organization, as it is perceived that, in time, recognition from this body will be essential for the proper registration of trainees. It is essential that residents are involved in this process as it occurs, so that a balanced view of each particular post can be obtained.
The ESRU hopes to improve its methods of communication and data collection, to act as a proper conduit through which residents' views can be expressed and important information distributed. It is beyond the control of the ESRU to alter training throughout Europe, but by open discussion and sharing of ideas, the ESRU hopes to act as a stimulus for all countries to reflect on what is good and bad about their training programmes, and to indicate where changes are needed. ESRU may be the essential first step to bringing about change for the better.