Urology Curriculum

2 Purpose

The purpose of the curriculum for Urology is to produce, at certification, competent doctors, able to deliver excellent outcomes for patients as consultant surgeons in the UK. The curriculum will provide consultant surgeons with the generic professional and specialty-specific capabilities needed to manage patients presenting with the full range of acute and elective Urology conditions. Trainees will continue to develop their skills in the generality of Urology (both acute and elective such that they are competent to deal with 95% of cases presenting during an unselected emergency ‘take’. Additionally, trainees will be expected to be competent to manage the full range of acute and elective conditions in the generality of their chosen special interest, including the operation. It is acknowledged that the responsibility for patients in this specialist area will include care for patients up to, including and beyond the point of operation. Trainees will be entrusted to undertake the role of the Urology Specialty Registrar (StR) during training and will be qualified at certification to apply for consultant posts in Urology in the UK.

Patient safety and competent practice are both essential and the curriculum has been designed so that the learning experience itself should not affect patient safety. Patient safety is the first priority of training demonstrated through safety-critical content, expected levels of performance, critical progression points, required breadth of experience and levels of trainer supervision needed for safe and professional practice. Upon satisfactory completion of training programmes, we expect trainees to be able to work safely and competently in the defined area of practice and to be able to manage or mitigate relevant risks effectively. A feature of the curriculum is that it promotes and encourages excellence through the setting of high-level outcomes, supervision levels for excellence, and tailored assessment and feedback, allowing trainees to progress at their own rate.

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK.

The curriculum has been developed with extensive input and representation from stakeholders including trainees, trainers, patient and lay representatives, education providers and NHS employers. Previous attempts at revising the Urology curriculum were centred on defining a series of core diagnostic and therapeutic capabilities in a five year training programme. The previous curriculum failed to equip trainees with those skills needed to deliver an unselected take in adult and paediatric emergency urology and to support colleagues from other specialities in the secondary care setting.

Additionally, the curriculum provides for areas of special interest in which trainees can develop areas of expertise which in turn have been proven to deliver better outcomes for patients. The curriculum framework articulates the standard required to work at the consultant level, and at key progression points during training, as well as encouraging the pursuit of excellence in all aspects of clinical and wider practice. Service providers and patients benefit from consultant urologists who are trained in the generality of the specialty but who also have special interest skills to provide more specialist care. The curriculum ensures that trainees will, at certification, have both a special interest skill and full range of general emergency and elective skills.

In addition to service changes, there has been scrutiny of individual surgeon outcome data and associated increased patient expectations. These workforce and service demands together with patient expectations have driven the change to the Urology curriculum.

The Shape of Training (SoT) review1 and Excellence by Design: standards for postgraduate curricula2 also provided opportunities to reform postgraduate training. The Urology curriculum will produce a workforce fit for the needs of patients, producing doctors who are more patient-focused, more general and who have more flexibility in their career structure. The GMC’s introduction of updated standards for curricula and assessment processes laid out in Excellence by Design requires all medical curricula to be based on high-level outcomes. The high-level outcomes in this curriculum are called Capabilities in Practice (CiPs) and integrate parts of the syllabus to describe the professional tasks within the scope of specialty practice. At the centre of each of these groups of tasks are Generic Professional Capabilities3 (GPCs), interdependent essential capabilities that underpin professional medical practice and are common to all who practise medicine. The GPCs are in keeping with Good Medical Practice (GMP)4. Equipping all trainees with these transferable capabilities should result in a more flexible, adaptable workforce.

Trainees will continue to develop the required skills principally within the established hospital setting where increasingly a ‘one-stop’ approach to diagnosis and management relies on the availability of endoscopy and radiological imaging, which has significantly impacted on the need for repeat attendance in the out-patient setting and/or in-patient investigation. Where opportunities arise within the community setting (subject to appropriate contractual and governance issues) trainees will be encouraged to work alongside Urological Clinical Nurse Specialists (CNS) to support and investigate patients in the community (including but not limited to urodynamics, intermittent self-catheterisation etc.). The curriculum will emphasise aspects of multi-disciplinary team (MDT) practice, the importance of effective communication and the role of community-based care whilst not losing sight of the need for excellence in all hospital based care. An appreciation of what is suitable for community-based care, what is right for district general hospital (DGH) care and what requires tertiary referral will be part of what the trainees will learn in this curriculum.

All the shared CiPs are transferable to other surgical specialties and some may be transferable to non-surgical specialties. In addition, core knowledge and skills gained in any surgical specialty training programme are transferable for entry into Urology. Trainees who choose to move to or from a different speciality training programme having previously gained skills transferable to Urology, therefore, may be able to have a shorter than usual training pathway in their new training programme. While most of the detailed and specialty-specific syllabus is not transferable because the knowledge and detailed technical skills are specific to the practice of urological surgery, some limited areas of the syllabus may be transferable. There are also some opportunities where even quite specialty-specific skills are transferable (such as to the fields or uro-gynaecology as with female incontinence and endocrine adrenal surgery to general surgery etc.). Also, generic operative skills are transferable to any craft specialty.

This flexible approach, with acquisition of transferable capabilities, allows surgical training to adapt to current and future patient and workforce needs and change in the requirements of surgery with the advent of new treatments and technologies.

Uncoupled trainees will enter phase 2 after completion of core surgical training (phase 1) and successfully gaining a National Training Number (NTN) through the national selection process.

Run-through trainees enter phase 2 after having achieved an outcome 1 at their Annual Review of Competence Progression (ARCP) at the end of ST2.

Training is delivered in three phases, phase 1 (two years, of core surgical training or Urology themed run-through training), phase 2 (three years) and phase 3 (two years). There is generic Urology training until the end of phase 2, allowing flexibility in special interest choice until relatively late in the training pathway (figure 1).

The second two phases (P2 and P3) are covered in this curriculum. Trainees in a run-through programme will follow the core surgical curriculum in phase 1 (ST1-2).

Trainees who demonstrate exceptionally rapid development in knowledge, technical skills and acquisition of capabilities can complete training more rapidly than this indicative time. There may also be a small number of trainees who develop more slowly and require an extension of training in line with A Reference Guide for Postgraduate Foundation and Specialty Training in the UK (the Gold Guide)5. Trainees who opt for training less than full time (LTFT) have their indicative training time extended on a pro-rata basis.

Figure 1: Urology training pathway. Trainees can enter urology training at phase 1, following the curriculum for core training in surgery and running through without further selection into phase 2 of the Urology curriculum, or trainees can enter at phase 2, having successfully completed the curriculum for core surgical training and been successful at a national selection process into Urology training. Core surgical training is uncoupled from specialty training for the majority of trainees. The availability of posts is at the discretion of the statutory postgraduate medical education bodies.

Phases of training

Phase 1 (indicative two years): Trainees entering a urology run-through training pilot at ST1 will follow a urology themed core surgical training curriculum in the first two years of training, and pass, without further selection, into phase 2 of specialist urology training on the successful completion of the outcomes shared with the core surgical training curriculum, gaining a pass in the Intercollegiate Membership examination of the Royal Colleges of Surgeons (MRCS) and an ARCP outcome 1 at the end of phase 1.

Phase 2 (indicative three years): Trainees will gain many of the GPCs and the knowledge, clinical and technical skills in urological surgery, as defined in the CiPs and syllabus. Uncoupled trainees should have acquired generic skills, both technical and non-technical, during core surgical training. At the end of phase 2 there is a critical progression point where trainees will demonstrate competencies in knowledge, and professional behaviours commensurate with a day-one consultant in Urology and become eligible to sit the Intercollegiate Specialty Board (ISB) examination in Urology. A critical progression point at the end of phase 2 will guide ARCP panels as to the level of competencies to be achieved.

Phase 3 (indicative two years): Trainees will further develop the technical skills in the elective and emergency aspects of the specialty and will undertake more focussed training in a particular area of special interest. A special interest area module will be followed after discussion with the Training Programme Director (TPD) and will be based on the preference of the trainee, the needs of the service and the ability of the programme to support the trainee in that special interest. Whilst we anticipate programmes will offer most or all of the special interest areas, either within the programme or by arrangement with a neighbouring programme, there is no requirement for any one programme to offer all the areas of special interest. There may additionally be instances where there are more trainees in a cohort who wish to pursue an area of a specific special interest than a programme can accommodate, and the TPD may need to suggest a different special interest to some of these trainees. On completion of phase 3 trainees will have reached supervision level IV in each of the shared CiPs and acquired all GPCs and recorded a pass in the ISB examination in Urology. This, in addition to the achievement of all certification requirements described, will allow the award of ARCP outcome 6 and recommendation for certification and entry onto the specialist register. Trainees who do not meet the requirements of phase 3 within the indicative 2 years may require an extension of training time in accordance with the Gold Guide.

A number of special interest modules are currently considered suitable for delivery in phase 3. These are: Endo-urology; Andrology and Infertility; Female, Functional and Reconstructive Urology; Advanced General Urology (including the specialist management of Benign Prostatic Hyperplasia (BPH) which may include Holmium laser enucleation (HoLEP) and laser ablative surgery etc.); and Urological Oncology Surgery (which will consist of those components relating to Renal Cancer Surgery and the management of benign upper tract pathology such as renal cysts and Pelvi-Ureteric Junction (PUJ) obstruction, Prostate Cancer and Bladder Cancer) and one or more components of which may be completed within this period depending on progression.

1 Shape of training: Securing the future of excellent patient care

2 Excellence by design: standards for postgraduate curricula

3 Generic professional capabilities framework

4 Good Medical Practice

5 Gold Guide 8th edition