Loving the international environment and the medical field, I have always been interested to feel the pulse of Urology not only in my city- at my workplace, but also in other places around the world. During my studies, I went with an ERASMUS scholarship in Spain and since then, I realized how important it is to stay connected with colleagues across the borders and be familiar with different learning styles, approaches and ways of resource management. I think that globalizing Medicine is an exponential way to train doctors and provide better quality healthcare. Before I attend my first International Congress as a young Urology Resident, I decided to write what I found on PubMed about the urological training in Europe and give you some info about the Romanian Program.
After graduating the Medical University, whoever studied 6 years in Romania has to obtain the license for the medical practice- the legal right to practice the medical profession. This consists of a final exam, usually held in September, that has 3 parts. The first one is a final paper you have to write during your last years of study. For example, mine was called “Life quality and perception of trauma in cancer patients” and it was a systematic review of 159 scientific studies indexed in PubMed database. The second part is a practical exam with a real patient and the last part is a theoretical exam with multiple choice questions. After all this, you finally obtain the license to practice medicine. I will leave you here a video about my University named “Iuliu Hațieganu”, located in Cluj Napoca, the heart of Transilvania.
A few months later, usually in November, in Romania there is a National Residency Exam that consists of 200 simple and multiple choice questions you have to solve in 4 hours. Depending on this grade only, the students are put in an order, with the ability to choose a Medical Specialty, in the limit of the places provided by the Ministry of Health in each city, for each specialty. It’s transparent and objective. And on 1st of January, you start working as a Resident in your chosen specialty, with a startup salary of 1000 Euros. Some specialties have an extra % raise if they have some risks associated with their work environment such as Psychiatry, Surgery, Emergency Medicine and others. In some countries there is an internship before entering the specialty or a common trunk training, but it’s not the case for Romania- we have an approach that is dominant in European countries (44%)- the graduates starting up directly as Urology Residents. The Urology Residency Program in Romania includes a 5 years post-graduate education and it’s more than the European mean (range) for urological training of 3.9 years (2-7 years).
In Romania, the Urological Residency Program is structured as follows:
-> Urology & Urodynamics (4 years)
-> Rotations (1 year):
– General surgery (6 months)
– Vascular surgery (2 months)
– Medical imaging and Radiology (2 months)
– General Echography (6 weeks)
– Bioethics (2 weeks)
You can choose your city and hospital, so your main activity may be concentrated on the profile of the teaching hospital. The European tendency in more than half of the countries is to be formed as a Resident in only one Urological department. For example, my training is mainly focused on onco-urology, at the Institute of Oncology “Prof. Dr. Ion Chiricuță”, but I have to cover the entire curriculum recommended by the European Board of Urology and I also have rotations in other departments of different specialties. My activity is supervised by a personal tutor and we have defined goals for my learning experience- with annual examinations and a log-book with our progress, research activity, publications and attendance to scientific meetings and workshops. It is also mandatory for the Urology Resident trained in Romania to have the EBU Online In-service assessment, organized by the European Board of Urology. To be able to pass the final exam and become a specialist, a board will examine the overall activity as a Resident, having a written exam and a practical one for the surgical/ endoscopic/ clinical abilities.
It is very interesting to see how the therapeutic act evolves, as I am part of a generation of residents that start learning how to operate not by opening up the patient, but laparoscopic or with the Da Vinci robot. The technology advances, the minimally invasive techniques are preferred and as I am getting used to the laparoscopic 3D surgical approach, it is hard to imagine how the same surgeries were taking hours to be performed 2D. It seems that the trend is for sub specialization for a better surgical confidence as the learning curve is steep.
The European Association of Urology (EAU) and the European School of Urology (ESU) offer a wide range of working groups, educational and scientific activities so that we can improve the acquisition of competencies (surgical and scientific), at any point of our career. Therefore, a future post will list all these opportunities and online learning resources, as I am discovering them!
Romanian Urology Residency Program
Current status of urological training in Europe (2018)
Training and General and Financial Conditions of European Residents in Urology: An International Survey (2004)
Urological training in Europe: similarities and differences (2005)