Kieran O’Flynn

Photodynamic therapy for superficial bladder cancer

In photodynamic therapy, a photosensitizing drug is activated by visible light and in the presence of oxygen, results in local cell death. This evolving modality is now being used to treat and palliate a very wide variety of human solid tumors and carcinoma-in-situ lesions. With regard to bladder cancer, advances in drug development and modern light delivery techniques mean that photodynamic therapy shows promise in the treatment of superficial bladder cancer resistant to conventional treatments.

Indicative operative numbers in urology training in the UK and Ireland

Objectives: In 2011 the Joint Committee on Surgical Training (JCST) issued guidelines for the award of a Certificate of Completed Training (CCT) in urology, including a list of 15 operative procedure groups for which a trainee must have achieved a minimum level of exposure (termed indicative number) and competence. This study evaluated whether the expected exposure correlated with that achieved by UK and Irish trainees. Methods: The operative logbooks of trainees who applied for a CCT in urology from 2010 to 2012 were reviewed. All exposure for each operative group, irrespective of the degree of supervision, was combined to give total operative experience. Results: Data on 154 trainees were available. More than 75% achieved the indicative number for radical prostatectomy, nephrectomy, ureteroscopy, PCNL and inguino-scrotal surgery. Only 70%, 68%, 64%, 25%, 21% and 8% reached the required level for cystectomy, TURBT, TURP, andrology, female and paediatric groin surgery, respectively. There was significant geographical variation in exposure, with the majority of trainees not achieving the minimum level for some procedure groups in certain training regions. Conclusions: There is a disparity between the operative exposure expected by the JCST and that achieved by urology trainees. To prevent large numbers of trainees failing to meet JCST requirements, an urgent and significant change to urology training, or further modification of the current guidelines, is required.

Ranking of urology registrar placements within a region. An SAC pilot

Background: There is a continual desire to improve educational standards, demonstrate quality assurance of training and to respond to the growing pressure to reduce SpR numbers. Any reduction would need to be based on an assessment which looks at educational value and trainee experience. We describe our experience using a tool to rank urology registrar posts in a single region. Methods and materials: An assessment scoring tool was created with equal trainee and trainer components. The trainee and trainer elements were developed from the proposed JCST trainee assessment and the GMC standards for trainers, with a maximum score of 200 achievable. Higher scores could be obtained by the unit being pro-active with educational activities. This tool was completed by all the training units and trainees within a single region. Results: Results were obtained from all units within the region, with scores ranging from 130 to 168 (mean 149). Units scoring highly in trainee components also scored highly in the trainer component. Conclusion: This tool allows objective assessment of training posts using evidence from the training unit, trainee and TPD. Incorporating this data into the annual ARCP would potentially improve the process. There was widespread support for repeating the exercise and the tool provided a powerful means of engagement in improving training.

British Association of Urological Surgeons standards for management of acute ureteric colic

These guidelines have been developed by the British Association of Urological Surgeons to give a framework to clinicians, based primarily in the UK, for the management of patients presenting acutely with ureteric colic. They have been developed by consensus with reference to the American Urological Association/Endourological Society guidelines on the surgical management of stones and the European Association of Urology guidelines on urolithiasis, and adapted to the logistics of those practicing within the National Health Service. Grades of recommendation and levels of evidence are based upon the system adopted by the European Association of Urology.

A five-year review of operative experience and indicative numbers in urological training in the UK and Ireland:

Objective: The Joint Committee of Surgical Training guidelines for the award of a Certificate of Completion of Training in urology were updated in 2015. In 2015, we published operative logbook data from Certificate of Completion of Training in urology applications in 2010–2012 in line with the original 2011 guidelines. This study reviewed a contemporary cohort against the 2015 guidelines and this previous cohort to evaluate whether the number of trainees achieving these requirements had changed. Materials and methods: All Certificate of Completion of Training in Urology application logbooks from March 2014–October 2015 (77 in total, 2015 cohort) were reviewed and compared to 154 logbooks in 2010–2012 (2012 cohort). Results: There was a significant increase (p<0.05) in the percentage of trainees achieving indicative exposure in 10 domains in the 2015 cohort according to the updated guidelines. Percentage increases included male lower urinary tract symptoms procedures from 68.2% to 88.3%, transurethral resection of bladder tumour from 64.3% to 89.6%, paediatric urology from 1.9% to 23.4%, female incontinence from 9.7% to 33.8% and andrology from 9.1% to 42.9%. There were significant reductions (p<0.01) in mean operative numbers for transurethral resection of bladder tumour and male lower urinary tract symptoms procedures from 184 to 162 and 187 to 161, respectively. One trainee in the 2015 cohort achieved requirements in all 17 domains and 55% failed to meet the requirement in ⩾5 domains. Conclusions: While an increasing number of trainees currently meet Joint Committee of Surgical Training expectations, some domains remain at low levels. Despite this, no trainee to date has not been awarded a Certificate of Completion of Training as a direct consequence of this, but this could become a possibility in the near future, and it is the responsibility of Local Education Training Boards and trainees to ensure that indicative numbers are both achievable and achieved.

The future shape of urological training

The recent publication of the ‘Shape of Training Review’ by Professor David Greenaway has re-ignited the debate about the direction of UK postgraduate training in an era where there is significant challenges delivering high-quality care to an ageing population. This article sets out a vision of how BAUS believes that care should develop to meet the anticipated increase need for urological care, ensuring the right balance between specialist and generalist care.

The 3 ‘R’s—Re-Validation, Re-Licensing and Re-Certification How Will it Affect Urologists?

The publication of the Governments White Paper on re-validation and GMC proposals will have a profound effect on urologists and the way they practice. This paper looks at the components of re-validation and ‘Good Medical Practice’ and examines how clinicians, particularly urologists, may be assessed to ensure they remain on the specialist register.