MENTORING IN LAPAROSCOPIC UROLOGY
Version of Record online: 6 DEC 2006
Volume 99, Issue 1, pages 7–8, January 2007
How to Cite
Sullivan, M. E. and Jones, A. (2007), MENTORING IN LAPAROSCOPIC UROLOGY. BJU International, 99: 7–8. doi: 10.1111/j.1464-410X.2007.06605.x
- Issue online: 6 DEC 2006
- Version of Record online: 6 DEC 2006
- Accepted for publication 20 September 2006
‘Mentors are guides. They lead us along the journey of our lives. We trust them because they have been there before. They embody our hopes, cast light on the way ahead, interpret arcane signs, warn us of lurking dangers and point out unexpected delights along the way’. Mentoring is a developmental stage in the life of all professionals. Effective mentors need to be exemplary role models, skilled in questioning, recognising their students as individuals with private lives, assuring a supportive environment for learning, comfortable with ignorance, liberal with feedback and showing patience .
With the increasing use of laparoscopic procedures worldwide to deal with many urological conditions and increasing numbers of patients wishing to be treated this way, the urological fraternity faced a difficult problem due to the limited number of surgeons able to offer a laparoscopic approach. Consultants, new and old, were faced with the problem of how to train themselves adequately if they wanted to offer a laparoscopic service. The laparoscopic urologists who existed faced the problem of how to adequately deliver safe practice to a generation of urologists.
In 2004, BAUS presented guidelines for urological laparoscopic training in the UK , which included mentored operating until independent practice appeared safe. This was to be combined with a basic skills course, complemented by assisting and observing at various laparoscopic urological procedures and independent practice on bench models, followed by an advanced skills course with operative experience on cadaveric or animal models.
However, they did not define the requirements to be a mentor (although it was suggested that > 50 cases within 2 years was thought adequate) and it appears that many of these mentors were self-appointed. The guidelines also stated that competence was not recognised as an endpoint.
Laparoscopic urological mentors face their own problems. The relationship is not the classical student-teacher one, as most of the ‘students’ are consultants and therefore their peers. The ability to be an effective mentor could clearly be compromised by this ‘altered relationship’. The new consultant contract and study-leave restrictions also make it difficult for mentors to make repeated visits to their ‘students’, and therefore their role is potentially limited.
It is also not clear how involved individual mentors have been with each case in terms of performing parts of the operation, particularly at the first sign of concern, and how they have determined when it is safe for the ‘student’ to ‘go solo’. No specific ‘end-points’ of mentoring are in place. The BAUS nephrectomy audit provided some means of following the progress of laparoscopic urologists in the UK, but this is not a compulsory exercise. The audit has shown some promising results , but transfusion rates and hospital stay remain high. The influence of the mentor and what percentage of all laparoscopic nephrectomies performed in the UK annually are being reported is also still unclear. Nevertheless, these guidelines were probably making the best of a difficult situation, particularly with established consultant urological surgeons.
One approach that circumvents some of these problems is telesurgical mentoring, an approach championed by Schulam et al. . This allows the mentor to advise from their personal office and offer the service to several ‘students’ operating in their own institutions. Travelling could clearly be eradicated, but this will still be a time-consuming approach and might not be easy within the context of new working patterns in the UK.
An approach adopted by the authors has been one of mutual mentoring. Both authors pursued a laparoscopic fellowship at the same stage and have then performed joint procedures (a form of ‘mutual mentoring’) at each of their new institutions. We found this invaluable in terms of camera assistance, a ‘second opinion’ during surgery and joint operating with the longer cases. Unlike conventional mentoring, where help is usually limited to a few cases, this approach benefits both parties equally, and is therefore much more sustainable (>150 cases in our system). However, as a universal model it is geographically restrictive.
With the changes in specialist registrar training in urology in the UK, it is likely that future laparoscopic urologists will be required to do a fellowship of 2 or 3 years. This is to be encouraged: fellowships appear to decrease the impact of the ‘learning-curve’ in laparoscopic urology . Clearly, if the delivery of laparoscopic services can be optimized via this pathway, we owe it to our patients to implement it.
- 1Effective teaching and mentoring: Realising the transformational power of adult learning experiences. San Francisco: Josey-Bass, 1986.