Curriculum-based training improves transurethral resection of bladder tumour performance compared to conventional training: the EuropeaN Training in uRologY (ENTRY) project.

Abstract

To evaluate the efficacy in residents of the EuropeaN Training in uRologY (ENTRY) training curriculum for transurethral resection of bladder tumour (TURBT) vs conventional methodology, as TURBT is one of the most performed procedures by residents and early-career urologists. We compared resident performance in TURBT trained through the ENTRY curriculum vs a conventional methodology. All residents underwent a TURBT educational rotation of 4 months supervised by uro-oncology attendings. In the conventional methodology group TURBT training was a standard tutoring in the operating room (OR). The ENTRY curriculum group underwent a pre-clinical: theoretical learning of metrics with a tutor and dry laboratory; and a surgical phase: supervised OR training by trained mentors. We evaluated 162 patients undergoing TURBT. Of these 74 (46%) TURBTs were performed by three conventionally-trained residents and 88 (54%) TURBT by three ENTRY curriculum-trained residents. Despite not being statistically different (P = 0.07), the reduction in high-grade perforation (DEpth of Endoscopic Perforation [DEEP] scale 2-3) in the ENTRY curriculum-trained group (12% vs 4.5%) was clinically meaningful. Postoperative complications was significantly lower in the ENTRY curriculum-trained group, for overall (13% vs 30%, P = 0.007), minor (10% vs 23%, P = 0.04), and major events (2.3% vs 6.8%, P = 0.1). Detrusor muscle presence was significantly higher in the ENTRY curriculum-trained group (91% vs 80%, P = 0.04). The ENTRY training curriculum for residents is effective in improving pivotal clinical outcomes in TURBT training vs conventional training. This training is a step towards standardised training and optimal outcomes in urology education.