Art in Flexible step 2 prepares for minimally invasive field

06 December 2019 Juul Seesing

Designed for third-year residents to meet the contemporary needs in the treatment of urolithiasis, Art in Flexible is a mix of complementary hands-on training sessions and theoretical insights. Divided into three steps each being reached by fewer participants, the format prepares residents to perform the endoscopic stone treatment procedure with the increasing use of minimally invasive approaches. Art in Flexible step 2 took place at the KARL STORZ Visitor and Training Centre in Berlin from the 3rd to the 5th of December 2019.

Through assessment by tutors with the aid of the Pi (Performance Improvement)-score algorithm, 16 participants were chosen out of the 48 residents who enrolled in Art in Flexible step 1 which focused on the Endoscopic Stone Treatment step 1 (EST-s1) protocol. Step 2 centred on “complex skills; those manoeuvres that require more training before performing a full procedure for the first time,” according to Dr. Domenico Veneziano (IT), Art in Flexible’s overall coordinator. “Following our modular hands-on training structure, step 2 focused on the use of lasers and their configuration for fragmentation and dusting, plus the acquisition of stone basketing skills for urinary tract clearance.”

Being the brainchild of a collaboration between the European School of Urology (ESU), the EAU Section of Urolithiasis (EULIS), and the EAU Section of Uro-Technology (ESUT) with the support from KARL STORZ and Cook Medical, Art in Flexible is both an educational and talent-scouting programme – and this excites participants, Dr. Veneziano noticed. “The EST-s2 protocol allows participants to apply the skills acquired during the basic step to more advanced tools, getting much closer to the actual clinical setting. We are still improving and finalising the four tasks, but the residents already love it.”

A passion for excellence
Two residents, Dr. Stefan Tiganu (RO) and Dr. Wouter Goedertier (BE), gained a favourable impression about the second step of Art in Flexible. “It was a very well-organised training,“ Dr. Goedertier said. “A perfect mix of theoretical classes, interesting case discussions, and realistic hands-on training. We were able to perform several important steps in flexible ureteroscopy and stone management. There was also a tutor for every 2 to 3 residents. This made the course very interactive.” Dr. Tiganu added, “Our tutors explained to beginners how things worked and gave many tips and tricks to those who already knew how to carry out a procedure. It was an unbelievable experience.”

The 4 most skilled and most enthusiastic residents were selected to proceed to the third and final step of the course, which takes place in Caceres, Spain, in February 2020. Prof. Bhaskar Somani (GB), chairman of step 2, elaborated on the selection process, “All the trainees were good and worked hard. Eventually, motivation and a passion for excellence were the most significant factors in the decision-making process. The selectees clearly showed a hunger to learn and to succeed as endourologist. For example, one of the trainees who had not done many ureteroscopic procedures prior to the course developed the skills and not only performed a procedure, but also fragmented and dusted the stones as per the curriculum — thus being picked up for step 3.”

Take home message
No matter whether a participant advanced to the next step or not, he or she travelled home having obtained valuable information. Dr. Tiganu provided us with an example, “High intrarenal pressure and temperature rise are two of the most important issues related to the stone procedure that can occur and that we should be aware of. This is the top thing I have learned from step 2. My take home message was that most of the urological procedures can be taught without any risk for patients or at least while considerably lowering the risk for patients if a proper hands-on module is developed.”

While the current edition of Art in Flexible is yet to come to an end, the new edition is already around the corner. The first step is scheduled to take place from 26 to 28 May 2020, again in Berlin. Keep an eye on www.artinflexible.uroweb.org to stay up to date about the application process. Please be aware that an application will only be accepted if you are an EAU member, if you deliver a letter from your department proving that you are a third-year resident, and if you have full availability for the whole programme.

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