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EDITORIAL |
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| Year : 2023 | Volume
: 28
| Issue : 2 | Page : 91-92 |
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Current Status and Scope of Pediatric Urology Fellowship Training in India
Ramesh Babu
Professor and Senior Consultant, Department of Paediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| Date of Submission | 25-Dec-2022 |
| Date of Decision | 26-Dec-2022 |
| Date of Acceptance | 31-Dec-2022 |
| Date of Web Publication | 03-Mar-2023 |
Correspondence Address:
Ramesh Babu
Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaps.jiaps_183_22
How to cite this article:
Babu R. Current Status and Scope of Pediatric Urology Fellowship Training in India. J Indian Assoc Pediatr Surg 2023;28:91-2 |
Focused subspecialization is well established in several surgical fields such as hepatobiliary surgery, colorectal surgery, hand surgery, and spine surgery. Faculties of pediatrics and anesthesia already have a wide array of subspecialty fellowship training courses for eligible candidates. While the Indian Academy of Pediatrics is issuing fellowship courses in pediatric nephrology, neonatology, etc., in the case of pediatric anesthesia, the Indian Association of Paediatric Anaesthetists is coordinating their fellowship program. Several subchapters of the Indian Association of Pediatric Surgeons (IAPS) have been established well over a decade. Minimally invasive surgery and pediatric urology fellowship (PUF) program are already in vogue in several pediatric surgical centers at present in India.
In fact, the PUF program in India is more than a decade old now, often started by the local institutes with similar guidelines on the course structure. The PUF certificate is often issued by the local university or the medical center – not registerable with the National Medical Council at the moment. The Society of Pediatric Urology (SPU), a subchapter of IAPS, is admitting those who completed PUF directly as a fellow of SPU, offering an added validation of their credentials. Currently, there are >10 centers providing pediatric urologic training and fellowship in India. Pediatric surgeons have been at the forefront of initiating and promoting PUF program in India.[1],2],[3],[4] Almost all PUF programs are run at pediatric surgical centers with sufficient pediatric urology workload but for one (an adult urology unit practicing pediatric urology). Recently a 2-year post-M.Ch pediatric urology postdoctoral fellowship course has been introduced by the National Board of Examination (NBE). This course is yet to be started in any institute at the moment.
With more than a decade of established PUF programs, it is essential to know the status of the trainees. Addressing the disparities in PUF operative experience can give an insight into the scope of the program and areas of improvement.[5] Suson et al.[6] looked at the differences in early operative experience during PUF training and found that the experience on major procedures was significantly less compared to minor operations. Grant et al.[7] reported that many PUF trainees lacked appropriate time, guidance, and/or mentorship to facilitate self-directed learning. They identified a need for more structure in PUF clinical didactics.
With this background, we did a survey by contacting the surgeons who did the PUF training in India over the past 10 years and sent them a questionnaire to assess the current status and further scope of the pediatric urologists in India. We identified around 21 candidates, out of which 19 could be contacted and 16 filled up the questionnaire (15 with pediatric surgery background and one urology background). Among the 16 candidates, eight of them practice in corporate hospitals, three in private medical colleges, four in trust/charitable hospitals, and one was doing own private practice. Half of the candidates chose PUF to refine their skills before starting pediatric surgery or urology career, whereas the remaining 50% chose this field as a career in pediatric urology. However, only 4/16 (25%) were able to practice full-time pediatric urology and most (75%) went back to the majority parent specialty practice due to a lack of opportunities. All who had exclusive/majority pediatric urology practice were practicing in corporate setups. Independent practice of pediatric urology was reported to be commercially difficult for them and hence they reverted back to their specialty-based practice to sustain commercial viability.
Fellowship training was useful to hone laparoscopic skills, advanced hypospadias skills, and endourology skills like PUV fulguration and STING procedure for almost all candidates. They also felt more confident and felt better at decision-making. The disparity in exposure to areas such as robotic surgery, endourologic stone removal procedures, and renal transplantation were a few notable lacunae in the existing training curriculum. Wang et al.[8] in a survey analyzed whether PUF trainees are being taught what they were expected. Ninety percent of the respondents felt their fellowship successfully prepared them for discussing surgical options and performing the procedures; 74% felt well trained to manage perioperative complications and 65% felt well trained to manage nonsurgical problems. Faculty feedback/supervision, independent reading, and conferences were rated as very effective methods of teaching (87%). The top three procedures they wished they had learned were: laparoscopic/robotic surgery, hypospadias repair, and augmentation/Mitrofanoff.
Duffy et al.[9] felt that the optimal time to institute a fellowship should be made with a fellow as the priority resident. They also felt that periodic reviews of the data should also be performed to maintain consistent, positive experiences for fellowship, and residency training. Sack et al.[10] in their article on navigating the pediatric urology market reported that 41% thought the number of desirable positions was expectedly or surprisingly low even at well-established PUF training setups like the USA. Even in this survey, a majority felt a lack of jobs, lack of access to instrumentation (URS, robotics), and lack of support from other colleagues was an impediment to pursuing pediatric urology practice. The creation of more pediatric urology units/faculty positions in medical colleges is likely to address similar job concerns of PUF trainees in India.
Although this audit is limited by sample size, insights from these findings would be useful in improving pediatric urology training. A recent article on a global view of pediatric urology[11] showed that there is a decreasing interest in subspecialization due to multiple factors. In this present survey also several trainees were reluctant to spend 2 further years for PUF training – as in the 2-year NBE program. Ernst[12] reported that the most important factors trainees consider when choosing PUF programs were: clinical autonomy, reputation of program, and structure of program.
While we now are clear that pediatric urology in India has come of age, thanks to the contributions of pediatric surgeons, we should also be aware that subspecialization is the mantra in urology.[1] The way forward is to create dedicated pediatric urology units within pediatric surgery departments in all major teaching institutes. The creation of such units will not only help in improving the options of PUF programs but will also help in giving pediatric urology in India, its legitimate status, which is long overdue.
 References | |  |
| 1. | Babu R, Chandrasekharam VV. Pediatric urology in India has come of age. J Indian Assoc Pediatr Surg 2022;27:513-4.  [Full text] |
| 2. | Bajpai M. Pediatric urology: Development, eligibility, practice. J Indian Assoc Pediatr Surg 2009;14:47-9. [ PUBMED] [Full text] |
| 3. | Raveenthiran V, Sarin YK, Bajpai M. Pediatric urology in India. Indian J Urol 2008;24:422-4. [ PUBMED] [Full text] |
| 4. | |
| 5. | Silvestre J, Hernandez JM, Lee DI. Disparities in pediatric operative experience during urology residency training. Urology 2019;127:24-9. |
| 6. | Suson KD, Wolfe-Christensen C, Elder JS, Lakshmanan Y. Differences in early career operative experiences among pediatric urologists. J Pediatr Urol 2018;14:333.e1- 333.e7. |
| 7. | Grant C, Szabova A, Williamson SH, Smith L. How do pediatric urology fellows learn outside of direct patient care? A qualitative study. J Pediatr Urol 2022;18:835-41. |
| 8. | Wang MH, Chen B, Kern D, Gearhart S. Pediatric urology fellowship training: Are we teaching what they need to learn? J Pediatr Urol 2013;9:318-21. |
| 9. | Duffy JW 3 rd, Thomas JC, Makari JH, Gold DG, Demarco RT, Adams MC, et al. The impact of a fellowship on resident training in an academic pediatric urology practice. J Urol 2008;179:720-3. |
| 10. | Sack BS, Yerkes EB, Van Batavia JP. Uncharted territory: Navigating the pediatric urology job market. J Pediatr Urol 2019;15:180-4. |
| 11. | |
| 12. | Ernst M, Ebert K, Rehfuss A, McLeod D, Alpert S. A survey of pediatric urology fellowship applicants: Past priorities to guide future possibilities. J Pediatr Urol 2022;18:787.e1-787.e8. |
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