What is the best way to practice and learn as a healthcare provider (HCP) in urologic surgery?

Best Approach to Learning Urologic Surgery

Healthcare providers should follow a structured, competency-based training curriculum that progresses through graduated steps: didactic learning, video observation, hands-on simulation in dry labs and animal models, bedside assistance, and finally supervised console/operative time—with advancement based on demonstrated proficiency rather than case numbers. 1

Core Training Framework

The optimal learning pathway requires a multicomponent approach rather than relying solely on didactic sessions, as evidence demonstrates that didactic-only continuing medical education does not effectively change physician performance or improve patient outcomes. 1 Interactive sessions providing hands-on skill practice are critical for effecting change in professional practice. 1

Structured Progression Model

Your training should advance through these specific stages in order:

• Procedure-specific familiarization through video observation and live OR case observation to understand anatomical landmarks, critical steps, and potential complications 1
• Dry lab training using inanimate models to develop basic technical skills and instrument handling without patient risk 1
• Animal model training (porcine or cadaveric) for procedure-specific hands-on practice that simulates real tissue handling and bleeding 1
• Bedside assistance where you serve as the assistant surgeon, learning positioning, port placement, and troubleshooting while observing expert technique 1
• Graduated console/operative time using a step-wise approach where you perform increasingly complex portions of procedures under direct supervision 1

Proficiency-Based Advancement

Advancement between stages must be based on demonstrated proficiency, not simply completing a set number of cases. 1 After demonstrating competency at each procedural step through formal evaluation or expert judgment, you progress to the next sequentially difficult component until you can integrate all skills into complete procedure execution. 1

Mentorship and Supervision Requirements

Expert surgeon mentorship with formative feedback is essential throughout your learning curve. 1 Video recording and review of your operative performance with a mentor provides valuable formative feedback that accelerates skill acquisition. 1

Proctoring Standards

• Initial cases require observation by an expert proctor who assesses your skills and provides recommendations before you receive unrestricted privileges 1
• Grant temporary privileges for initial supervised cases rather than full privileges upfront, as withdrawing privileges later requires reporting to the National Practitioners Data Bank 1
• The proctor should be a true expert (not someone who has only performed 20 cases themselves, which is the current industry standard but inadequate for ensuring trainee competency) 1

Specific Training Programs

For Postgraduate Urologists

Comprehensive mini-fellowship programs lasting 5 days that integrate didactic tutorials, live OR observation, dry lab training, and hands-on animal/cadaver labs demonstrate 80% take rates at 3 years. 1 While these programs cost $3,800-$10,000 per surgeon, they provide the multicomponent training necessary for successful clinical integration. 1

If you lack access to an established robotic program with trained OR staff and expert colleagues, seek structured continuing medical education through organizations like the AUA rather than industry-only courses, as many industry courses lack competency-based curricula. 1

For Residents and Fellows

Training programs should use proficiency-based, graduated step-wise models since urology lacks short, simple procedures (like laparoscopic cholecystectomy) for gaining early basic experience—your first robotic cases are often complex. 1

Critical Pitfalls to Avoid

Do not rely solely on case volume as a measure of competency—the number of cases required to achieve proficiency varies based on your innate skill level, prior laparoscopic experience, case density during learning, and presence of peer collaborative learning. 1

Avoid learning from inexperienced mentors—many academic institutions have experienced trainees mentoring novice trainees rather than expert surgeons teaching, which perpetuates suboptimal technique. 1

Do not skip simulation training—jumping directly to clinical cases without preclinical preparation compromises patient safety during your learning curve. 1

Emerging Technologies

Dual-console robotic systems allow expert surgeons to provide real-time direction and supervision during procedures, though the additional $500,000 cost limits availability. 1 Remote teleproctoring using telemedicine technology is emerging as a practical alternative for expert observation without geographic constraints. 1

Team Training

Ensure your entire OR team receives standardized training, not just the surgeon—establishing standard criteria for training and supervision of all surgical team members is essential for safe program initiation. 1 The practice-based learning cycle (identifying improvement areas, participating in learning programs, implementing new skills, checking outcomes) applies to every team member. 1

Validation and Assessment

Your training program should use validated assessment tools to certify competency in desired skills, with concurrent validation occurring throughout curriculum design rather than only at completion. 1 Credentialing should involve demonstration of proficiency and safety in executing basic robotic skills and procedural tasks through an iterative process ensuring accountability. 1