The European Board of Urology (EBU) recently recertified the Department of Urology at St. Gallen, reflecting the department’s efforts to continually update and maintain the quality of its training and medical services in the field of urology.
The Kantonsspital St. Gallen is a tertiary referral centre and is the largest hospital in the eastern region of Switzerland with an estimated 550,000 population. The Department of Urology was founded in 1970 and headed by Klaus Bandhauer for the first 25 years. Daniel Ackermann chaired the department from 1995 to 2001 and was succeeded by this author ince 2001.
The department has a 40-bed capacity, a day care unit and an outpatient clinic with the number of patient admissions reaching a range between 420 and 8,000 in recent years. St. Gallen’s urology department received EBU certification for the first time in 2003.
Our seven residents and two medical students are regularly taught by six board-certified staff members. After completing medical school, a resident has to successfully conclude a training period of at least six years to become a board-certified urologist by the Foederatio Medicorum Helveticorum (FMH). Residency includes two years of general surgery, three years of urology and a year of urology or gynaecology. Every candidate has to spend at least three years in a category A institution. As of now there are only six such training programmes in Switzerland (See Table). Twelve other urological institutions are acknowledged as one-year training centres.
At the end of the residency, every young urologist has to pass the official examination of the EBU and a practical examination in his own hospital where a committee will check his ability and knowledge in the operating room and at the bedside. In addition, many Swiss urologists also participate in European exams to become a Fellow of the EBU (FEBU).
The training of residents in St. Gallen is formally structured in four levels and within these levels there are subspecialties such as Urological Oncology, Neuro-Urology, Stone Diseases, Andrology, etc. The content is based on the guidelines of the European Association of Urology (EAU) (1). In addition to their clinical work, residents are strongly encouraged to conduct clinical studies and present the results at national and international meetings. Furthermore, the Kantonsspital St. Gallen has an excellent interdisciplinary medical research centre where urologists have the opportunity to perform basic research.
For all residents it is mandatory to participate in the annual in-service assessment of the EBU. They have also to present difficult or/and interesting cases during the periodic multidisciplinary tumour board meeting and during conferences with nephrologists and pathologists. Moreover, participants have to prepare lectures on special topics for in-house presentation or reference. Residents, on the other hand, have the opportunity every year to anonymously judge the performance of the staff
members using the written survey from the FMH.
Compared with other urological institutions in Switzerland (benchmark), St. Gallen has consistently achieved better scores in all domains which include overall performance, professional competence, learning culture, implementing culture, identifying cultural errors, implementing culture-based decisions, company culture and evidence-based medicine.
I strongly encourage other urological institutions in Europe to apply for the EBU certification (www.ebu.com) since there are numerous benefits (2). To name a few: an EBU certification is a “Mark of Excellence” and quality control. And while going through the EBU certification process, a training centre is given an opportunity to evaluate its programme, enabling it to closely examining questions such as institutional organisation and educational structure, amongst others.
Moreover, an EBU-certified training centre boosts its status amongst partners when efforts to implement a quality control process are continually pursued. For instance, our EBU-certified department receives a great deal of applications from residents who are keen to work for us. Applicants come from Germany, Austria and other countries, reflecting the need to apply at certified centres since they can better facilitate the exchange of residents amongst European institutes. Thus, many residents find out which centres are certified on the Internet which help them make an informed choice.
Our hospital selects the best residents who are invited to come and work for us for a maximum of four years. At present we can only accept 10% of the total number of applicants. The advantage for residents is that they are offered a structured, high-level education every year. Furthermore, a certified department maintains a better position in the hospital compared to other departments. Last but not least, our EBU certificates are prominently placed on the ward and in the outpatient clinic, informing our patients of the efforts we make to provide better medical care.
1. Parsons KF, Irani J, Hanus T, Loch T, Llorente Abarca C, Mitropoulos D, Schmid H-P, Sylvester R, Chapple CR (eds.).
Guidelines. European Association of Urology, 2009 edition, p. 1-1248.
2. Schmid H-P. Urology training programme committee certifies outstanding training centres (Interview). Eur Urol Today 2007;19:23.