Definition and Training Requirements of the Sub-Speciality Paediatric Urology

Definition of the subspecialty

Paediatric Urology is the subspecialty of both specialities, Urology and Paediatric Surgery, concerned with clinical recognition, diagnosis, prevention, treatment (surgical and non-surgical), and the rehabilitation of congenital and acquired diseases, malformations and functional problems of the genitourinary system in children and adolescents. It also encompasses the promotion of good genitourinary system health in children and adolescents.

 General aspects of Training in Paediatric Urology

Paediatric Urology Training is a subspecialty training which is done at Fellowship level for board certified Urologists or Paediatric surgeons. The European Board of Paediatric Urology (EBPU) within the Multidisciplinary Joint Committee of Paediatric Urology (MJC PU) is the monitoring authority for recognition of quality, accreditation and certification. It is the equivalent of the European Boards of full specialists (UEMS). The EBPU within the MJC PU is responsible for defining regulations concerning required training, conducting site-visits to training programmes, and certifying examinations.

The training programme can be established at a Paediatric Urology, a Urology, or a Paediatric Surgery department. EBPU provides official recognition of Paediatric Urology Training Programme performed at a paediatric urology centre within the UEMS countries. The length of training is at least full time two years with both years being spent in a EBPU recognized training programmes. The fellowship can also be done in another high-volume paediatric urology centre within the UEMS countries without a recognized training programme. However, then 4 full time years of training is required for FEAFU qualification. Maternity / paternity leave will prolong the training period accordingly. For a fellow with a part time job, a 50% of workload should be required as minimal for appropriate paediatric urology training and the training period is prolongated accordingly.

I. Training Requirements for Trainees

1. Content of training

a. Theoretical knowledge

The trainee is a surgical specialist who has certification in Urology or in Paediatric Surgery from a National Competent Authority. To build up her or his experience, the trainee should be involved in the treatment of sufficient number of out-patients and in-patients and perform a sufficient number of surgical and other practical procedures of sufficient diversity. She/he also must be willing to take part in the education of residents of the institution. She/he must participate in research activities and produce a scientific output during her/his training.

The trainee should have sufficient linguistic ability to communicate with patients and colleagues and to study international literature. The trainee should keep a personal logbook according to national rules and to the recommendations of the UEMS/ EBPU. At the end of the training a final report and evaluation should be sent to the EBPU and the fellow is encouraged to take the written and oral exam to become a FEAPU. A copy of the surgical logbook should also be sent together with a review of the program to the EBPU. The logbook should contain detailed data about the trainee’s clinical and operative experience and academic performance and is the Background to become a FEAPU.

b. Practical skills

The candidate has to take active part (as a supervised surgeon, performing the surgery or assisting the surgery to residents) in a sufficient number of paediatric urology operative procedures equally divided during the training period covering the entire field of paediatric urology as specified below. The surgical procedures should be divided among:

  • surgical procedures on the kidney and the upper urinary tract
  • surgical procedures on the lower urinary tract
  • surgical procedures on the external genitalia
  • endoscopic surgical procedures (including laparoscopy)

The candidate should take active part in a large number of diagnostic and minor procedures like diagnostic endoscopy, ultrasound and urodynamic studies.

c. Professionalism

The fellow should affirm her/his loyalty to the profession she/he is about to enter (Paediatric Urology). He/she should be mindful always of her/his great responsibility to preserve the health and the life of the patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honour and fidelity, to perform faithfully her/his professional duties, to employ only those recognized methods of treatment consistent with good judgment and with her/his skill and ability, keeping in mind always nature's laws and the body's inherent capacity for recovery.

The fellow should be ever vigilant in aiding in the general welfare of the community, sustaining its laws and institutions, not engaging in those practices which will in any way bring shame or discredit upon her/him - self or her/his profession.

The fellow should endeavour to work in accord with her/his colleagues in a spirit of progressive cooperation and never by word or by act cast imputations upon them or their rightful practices.

The fellow should act with respect and esteem upon all those who have taught her/him the art.

2. Organisation of training

a. Assessment and evaluation

To be considered for certification as a Fellow of the European Academy of Paediatric Urology (FEAPU) the trainees who finish two years of training in an EBPU accredited centre will present her/his logbook together with the evaluation from the programme director to the EBPU.

Those trainees who are considered to have had sufficient training will be able to take the EBPU quality assessment for certification.

The exam consists of two parts, the oral exam with 100 MCQ’s can be taken any time during the fellow-ship, whereas the oral exam consisting 4 different clinical scenarios can only be taken at the end or after the fellowship.

After successful completion of the quality assessment the EBPU will issue the trainee with the certificate of Fellow of the European Academy of Paediatric Urology (FEAPU).

b. Schedule and timing of fellowship training

Minimum duration of training is a two-year full-time fellowship in an EBPU accredited Paediatric Urology training centre, or 4 years full-time fellowship in a non-certified training programme within the UEMS recognized countries. Maternity / paternity leave will prolong the training period accordingly. For a fellow with a part time job, a 50% of workload should be required as minimal for appropriate paediatric urology training and the training period is prolongated accordingly. The trainee can apply for a fellowship in Paediatric Urology when becoming a surgical specialist who has certification in Urology or in Paediatric Surgery from a National Competent Authority.

II. Training Requirements for Trainers

1. Process for recognition as trainer

a. Requested qualification and experience

The programme director should have been practicing in Paediatric Urology for at least 5 years after specialist accreditation in either Urology or Paediatric Surgery. The head of the programme of paediatric urology must have a special interest in education and training in all aspects of paediatric urology. She/he must be willing to devote time to supervise trainees in outpatient clinics, surgery and research activity. She/he must give evidence to the EBPU of current and continuing scientific work. The head of the paediatric urology programme should be a Fellow of the European Academy of Paediatric Urology.

b. Core competencies

The programme director should have a substantial knowledge and practical experience in covering the field of Paediatric. Leadership and Teaching experience should be documented.

2. Quality management for trainers

The programme director is responsible for a training programme that includes the educational goals and the details of the educational components attributed. This should be a written statement and should be readily available for review. The programme director is responsible for monitoring the quality of training and should make a regular evaluation of a trainee’s overall performance and make yearly reports to be included in trainee’s logbooks.

III. Training Requirements for Training Institutions

1. Process for recognition as training centre

a. Requirement on clinical activities

The programme, that can train paediatric urology fellows will be accredited by European Board of Paediatric Urology within the Multidisciplinary Joint Committee of Paediatric Urology (MJC PU).

The training programme must be within the countries, where the UEMS regulations apply.

Paediatric Urology Training programmes must apply directly to the EBPU within the MJC PU for certification. Applications should include detailed information concerning the institution(s), medical and academic facilities and the training programme including a written training programme for the whole fellowship period of 2 years.

Accreditation is based on the number of admissions to the training program including day care, outpatient and inpatient care; number and diversity of all practical and surgical procedures; appropriate access to other relevant specialties; staff members, fellows under training and record of scientific publications.

Paediatric Urology training should take place in an institution or a group of institutions, which are of sufficient size to offer the trainee a full range of medical and academic facilities concerning paediatric urology.

b. Requirement on equipment, accommodation

The institution should have access to ultrasound, fluoroscopy, MRI, CT-scan, nuclear medicine and urodynamic equipment.

The institution should have a 24-hour operating theatre and adequate operating theatre equipment for paediatric urology cases. The training programme should be associated or collaborating with the following departments which are also departments with a training programme.

  • Paediatrics including nephrology, oncology, endocrinology, neurology, psychology and neonatal care divisions.
  • Radiology with expertise in children.
  • Foetal medicine.
  • Nuclear medicine.
  • Anaesthesiology with special responsibility for paediatric anaesthesia.
  • Paediatric Surgery and Urology
  • Physiotherapy and rehabilitation
  • Orthopaedics with special responsibility for paediatric cases
  • Neurosurgery with special responsibility for paediatric cases
  • Urotherapy

A medical library and/or online access should be available near the institution. Library services should include electronic retrieval of information and should have collections of texts and journals easily accessible.

2. Quality Management within Training institutions

There should be a written training programme structured for each trainee in accordance with EBPU recommendations. The programme of training must give graded and progressive responsibility to the trainee. The programme should include educational components that are all related to certain goals.

The written training programme should provide each trainee with:

  • Experience and clinical competence in a variety of paediatric urology cases including inpatient and outpatient care.
  • Experience in surgical aspects in a variety of paediatric urology cases
  • Exposure to neonatal units and paediatric intensive care
  • Familiarity with all contemporary imaging modalities
  • Implementation and evaluation of urodynamic studies in children
  • Experience in multidisciplinary management of nephrology cases
  • Experience in multidisciplinary management of myelodysplasia cases.
  • Experience in multidisciplinary management of problems related to disorders of sexual differentiation
  • Exposure to foetal medicine
  • Exposure to paediatric renal transplantation

The training programme should also support participation in clinical and experimental research. Active participation in local and/or international paediatric urology meetings (particularly with presentations) should be encouraged. The programme of training should be planned to maintain an ongoing scholarly activity including:

  • Weekly clinical discussions and rounds
  • Regular programme of teaching
  • Regular journal clubs
  • Regular clinical and experimental research conferences
  • Discussions of morbidity and mortality.

Experience in clinical and operative aspects of paediatric urology and scholarly activity of the trainee should be recorded in a logbook

Manpower planning

There should be a minimum number of 2 faculty members with documented qualifications to instruct and supervise adequately all paediatric urology trainees in the programme. All members of the faculty should be able to devote sufficient time to meet the teaching needs of the programme. The head and the teachers should be practicing in Paediatric Urology in its full extent and should be involved with paediatric urology more than 80% of their full-time clinical responsibility. The director of the paediatric urology programme must be able to expose the trainee to paediatric urology for at least 80% of her/his clinical experience during regular hours.

There should be a written statement about the assignments and responsibilities of each member of the faculty. There should be regular staff meetings held by the faculty to review the programme goals, objectives and performance.

The EBPU would not restrict the numbers of fellows to be educated in a specific training centre. If a training centre is certified, the responsibility of the quality of the future fellows (and paediatric urologists) lies in the hands of the programme director. However, generally it is not advisable to educate more than one fellow at the time. One trainee is considered as optimal for the accredited centre. Recertification as a training centre after a 5-year period depends partly on satisfactory log books from trainees having been through the training programme.

Regular report & External auditing

Applications for recognition as training centre are reviewed by EBPU and if accepted site-visits will be performed. Upon review of the visitors report the EBPU is mandated to give accreditation. Each accredited programme must document academic and medical activities. Accreditation is valid for 5 years. In order to maintain accreditation, the training programme must reapply every 5 years to the EBPU within the MJC PU.

Transparency of training programmes

Each accredited programme is available at the EBPU webpage list of certified training programmes with a list of their past fellows and introduction of their centre

Structure for coordination of training

A yearly programme director meeting with participation of all programme directors of accredited centres, the EBPU president and chairman of the ESPU educational committee is held in connection to the annual congress of the European Society for Paediatric Urology (ESPU). The EBPU is responsible to organise the meeting.

The agenda includes structure and coordination of postgraduate training in Paediatric Urology.