CHRISMED Journal of Health and Research

EDITORIAL
Year
: 2021  |  Volume : 8  |  Issue : 1  |  Page : 1--2

Focused aptitude and pathway to be an accomplished urologist


C Danny Darlington1, Rohan J Mammen2, Kim J Mammen3,  
1 Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Renal Transplantation, Pondicherry Institute of Medical Sciences, Puducherry, India
3 Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Correspondence Address:
C Danny Darlington
Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry
India




How to cite this article:
Darlington C D, Mammen RJ, Mammen KJ. Focused aptitude and pathway to be an accomplished urologist.CHRISMED J Health Res 2021;8:1-2


How to cite this URL:
Darlington C D, Mammen RJ, Mammen KJ. Focused aptitude and pathway to be an accomplished urologist. CHRISMED J Health Res [serial online] 2021 [cited 2021 Dec 2 ];8:1-2
Available from: https://www.cjhr.org/text.asp?2021/8/1/1/318795


Full Text



Urology is one of the highly sought out surgical super-specialties among Indian medical students. A huge percentage of medical students and surgical residents aspire to take up a career in urology. A typical medical student spends 5½ years in undergraduate medical training followed by 3 years of postgraduation in general surgical or medical units, being selected through a common entrance test. After the postgraduation, aspiring candidates opt for a super-specialization course of 3 years including urology, if they are successful in the nationwide common entrance examination. These examinations are highly competitive and require perseverance and consistent hard work.

Only a very small percentage of medical students who aspire for urology reach the pinnacle of success. This can be due to several reasons – lack of motivation, community and family factors, depression and stress-related factors, health factors, and the absence of a good guide or mentor, to name a few.[1],[2] However, a goal without a plan is just a wish. Hence, students and surgical residents should have a clear plan of execution of goal-directed steps right from their training period, which culminates in a successful career. The aim of this structured training proposed below is to provide produce highly competent urologists focused on a subspecialty. It also leads to a thorough mix of ideas, thereby encouraging innovative approaches to the management of urological diseases in the country.

The shaping of a successful doctor begins at school. Aspirants must preferably get educated in a public school system with English as the primary medium of instruction. The top twenty colleges in India are preferred for undergraduate medical training as they offer a wide range of training in the field which can better guide them to take up further career decisions.[3] As doctors practicing internal medicine and general practitioners would also encounter urological diseases, emphasis should be given to including urology training in the undergraduate curriculum.[4],[5] Medical students generally tend to select surgical disciplines to which they are most exposed in their medical school.[6] Attending operative sessions, gender, and personality of medical students also determine if a medical student chooses a surgical career.[7] Leadership training activities should be encouraged to create future leaders in urology. Motivated undergraduate students should be encouraged to conduct at least two Indian Council of Medical Research projects with a minimum of two publications in indexed journals. The Urological Society of India (USI) can encourage research among medical students by sponsoring research activities through grants and scholarships. Paper presentations at national and international conferences should be encouraged. To attract bright students into urology, USI can allot slots for paper presentation in national conferences (USICON) or conduct quiz competitions and recognize young aspiring urologists of the future. A subsidized registration charge for undergraduate students in national and zonal conferences is another option. Student memberships to national and international urological societies should be encouraged to provide insights into the field of urology. Students willing to get trained abroad should be encouraged to clear the appropriate examinations – the United States Medical Licensing Examination (USMLE) Steps 1, 2, and 3 for the USA or the Professional and Linguistic Assessments Board for the UK. For such students, a 2-week clinical attachment in the country of choice should be encouraged in the internship schedule.

The 3-year residency in general surgery should be preferably done in the top twenty medical colleges in India. The examinations for Membership of the Royal College of Surgeons (MRCS – Parts 1 and 2) can be taken at this juncture. It is also preferable to sit for the examination for General Surgery by the Diplomate of National Board (DNB). The 3-year duration should be utilized to conduct research activities and publish at least two papers in indexed journals. Residents should be encouraged to present in national and international conferences.

Urology residency should be done in a high-volume center with exposure to all subspecialties in urology. In the case of centers with limited exposure to a subspecialty, there should not be any hesitation in rotating the residents to other hospitals for that subspecialty training. Residents should be encouraged to present and publish at least three research papers as first or second authors during the 3-year tenure. They can also participate in several fellowships sponsored by the USI, American Urological Association, British Association of Urological Surgeons, European Association of Urology, and Endourology Society. Mock examinations, masterclasses, and UroMet courses organized by the USI are a boon to residents and attract residents from all parts of the country. The final year of residency should also include preparation for the International English Language Testing System in addition to MCh and/or DNB urology examinations.

Once out of the urology training, the candidate should aspire for a fellowship of his/her choice. Fellowship of National Board and Post-Doctoral Certificate Course are offered in the country by the National Board of Examinations. Meanwhile, applicants who have cleared USMLE and MRCS can apply for 2-year fellowships in the USA and UK, respectively. These may include a urology residency in the USA with American Board of Urology certification, specialist registrar posts in case of the UK and Canada, or fellowship training posts leading on to Fellow of the Royal College of Surgeons (Urology) and Fellow of the Royal Australasian College of Surgeons. These structured and focused fellowships transform candidates into highly competent urologists who can then return to their home country and go on to become stalwarts and opinion leaders of their subspecialty.

The advantage of this structured approach to a career in urology is the huge amount of time available to execute it, thereby reducing stress and avoiding burnouts among medical students and residents. In the era of evidence-based medicine, future urologists should be trained to be surgeon-scientists apart from acquiring surgical expertise. Urologists should be encouraged to actively participate in teaching undergraduate students. They should guide them in conducting good quality research which will answer plenty of questions unique to the Indian population. Ultimately, life-long learning and continuous career development should be the goal as change is the only constant.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Chowdhury R, Mukherjee A, Mitra K, Naskar S, Karmakar PR, Lahiri SK. Perceived psychological stress among undergraduate medical students: Role of academic factors. Indian J Public Health 2017;61:55-7.
2Garg K, Agarwal M, Dalal PK. Stress among medical students: A cross-sectional study from a North Indian Medical University. Indian J Psychiatry 2017;59:502-4.
3MHRD, National Institute Ranking Framework (NIRF). Available from: https://www.nirfindia.org/2019/MedicalRanking.html. [Last accessed on 2020 May 03].
4Kaplan AG, Kolla SB, Gamboa AJ, Box GN, Louie MK, Andrade L, et al. Preliminary evaluation of a genitourinary skills training curriculum for medical students. J Urol 2009;182:668-73.
5Cohen SA. The AUA curriculum for medical students: Current resources and developments. Curr Urol Rep 2019;20:86.
6O'Herrin JK, Lewis BJ, Rikkers LF, Chen H. Medical student operative experience correlates with a match to a categorical surgical program. Am J Surg 2003;186:125-8.
7Peel JK, Schlachta CM, Alkhamesi NA. A systematic review of the factors affecting choice of surgery as a career. Can J Surg 2018;61:58-67.