JCU - January 2022 - 74

74
Journal of Clinical Urology 15(1)
implementation of INs did increase trainee exposure to procedures
(or at least the recording thereof), unfortunately this
also not infrequently led to trainees chasing training opportunities
in their final year which they and their trainer(s)
knew they would never use.5 Apart from the futility of such
an approach we must wonder about the ethics of subjecting
patients to 'unnecessary' training opportunities. Indeed,
trainees were rarely denied a CCT despite the fact that INs
were consistently failed to be met by trainees (for example,
in 2015, only 1.3% of urology trainees attaining a CCT
met all IN requirements).5 Later expansion to include operative
numbers gained during core surgical training but not
from other sources potentially disadvantaged those spending
time in clinical fellow posts or immigrating for speciality
training. Now, progression solely based on competency
means skills developed outside a recognised training programme
need only be assessed to prove competency.
IP PBA requirements by the end of phase and for special
interest modules are demonstrated in Tables 4 and 5,
respectively.
Table 3. Independence levels
Level I
Level II
It is likely that this change is the one that will be met
with most concern by trainees, given their positive
views of INs.3 It should be reiterated though, that
breadth of exposure is still expected within the wider
curriculum (and indeed, tailored by the special interest
selected), and it is simply the documentation of this
exposure outside the area of interest to the trainees that
has been removed.1
Critical conditions
Critical conditions, first defined in the trauma and orthopaedic
curriculum as 'any conditions where a misdiagnosis
could be associated with devastating consequences
for life or limb', are a new feature of the 2021 curriculum.
These mandatory WBAs recorded in the form of
either clinical evaluation exercise or case-based discussion
(CBD) use the levels of competency found in the
2016 curriculum. Fourteen conditions (Table 6) are considered,
with level 3 (appropriate for central period of
speciality training) required in all before entering phase 3
and level 4 (appropriate for certification) in all before
achieving a CCT.
Able to observe only: no execution
Able and trusted to act with direct supervision
a) Supervisor present throughout
b) Supervisor present for part
Level III
Able and trusted to act with indirect supervision
Level IV Able and trusted to act at the level of a day 1
consultant
Level V
Able and trusted to act at a level beyond that
expected of a day 1 consultant
Table 4. Core index procedures
Procedure
Urology trainees view critical conditions favourably, feeling
these help to focus learning in the early years of training,
empower them to undertake CBDs with trainers, and encourage
trainers to assess their knowledge in greater depth.3
Paediatric urology exposure
While traditionally seen as a significant barrier to achieving
a CCT by trainees, the 80 sessions minimum exposure
to paediatric urology remains unchanged in the new
curriculum.1,3 This is in line with the intention of higher
urological training producing district general hospital
Required evidence for completion
of phase 2:
Four PBAs at the following level for
each IP from at least two assessors
Urodynamics
Transrectal/transperineal prostate biopsy
LUTS procedures including TURP
TURBT
Peno-scrotal procedures including
orchidopexy for torsion
Ureteroscopy and laser lithotripsy
4
3
3
3
3
3
Required evidence for completion of
phase 3:
Nine PBAs at the following level for
each IP from at least three assessors
4
4
4
4
4
4
PBA: procedure-based assessment; IP: index procedure; LUTS: lower urinary tract symptoms; TURP: transurethral resection of the prostate;
TURBT: transurethral resection of bladder tumour.

JCU - January 2022

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JCU - January 2022 - Cover1
JCU - January 2022 - Contents
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JCU - January 2022 - Cover3
JCU - January 2022 - Cover4
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