Current exposure to urology in medical undergraduate curriculums is relatively sparse in comparison to the other surgical specialties with one study reporting just 42% of students having a compulsory attachment. These attachments were an average length of just one week [1]. Postgraduate opportunities have also reduced with more foundation rotations (FY1/FY2) including jobs in psychiatry and general practice in an attempt to improve recruitment in these specialities.
Foundation trainees can be left without basic urology knowledge and skills that would help their future practice. Furthermore, they have limited insight into urology as a specialty so may never consider it as a career.
Why I wanted to do a taster week
I decided to organise a taster week as, while I was confident I would pursue a surgical career, I wanted a chance to explore urology as a specialty prior to selecting my rotations for core surgical training. My previous interactions with urologists had all been extremely positive. The trainees and consultants whom I had met appeared to have genuine enthusiasm about their work and encouraged me to learn more about the profession.
For me, urology as a speciality is extremely appealing due to its diversity and progressive nature. There are a wide range of presentations and procedures, and the technology and techniques used are at the forefront of modern surgery. During my taster I was particularly interested in learning more about the care of renal cancer patients undergoing robotic nephrectomies, as this was a technique being developed during my time as a medical student.
Guidelines about taster weeks
The Foundation Programme defines a taster as a period of time, usually two to five days, spent in a specialty in which the foundation trainee has not previously worked [2]. The aim is to provide an insight into the work of the specialty and to promote career reflection. Each foundation school has its own application process to organise tasters, often mirroring their local policy for study leave.
To organise a taster week, foundation doctors are required to discuss the option with their educational supervisor, gain written acceptance from the consultant supervising the taster, and submit an application to the postgraduate medical education team for approval. The expectation is that the taster will take place within the trainee’s foundation school, however exceptions can be made if the desired experience cannot be provided locally.
How I organised my taster
I organised my taster week by approaching a fellow foundation trainee rotating in urology to gather more information about the department. They put me in touch with the educational lead in urology and advised me on how to make the most of the opportunities available. I contacted the consultant to express my interest in urology, my desire for a taster, and what I hoped to achieve during the week. Together we agreed a set of objectives and drafted a provisional timetable.
Content of my taster week
During my taster week I was able to experience urology in a variety of clinical settings and shadow clinicians at different levels of their training from core trainees to consultants. This included attending theatres, outpatient and diagnostic clinics, multidisciplinary meetings, ward rounds and shadowing the registrar on-call.
I found attending the operating theatre particularly rewarding, as I was able to observe the surgical management of presentations I had seen while working as a doctor in the emergency department. Later in the week I was fortunate to have the opportunity to complete simple urological procedures under supervision including urethral dilation, flexible cystoscopy, and ureteroscopy. This was an unexpected bonus and was a highlight of the taster week.
During the week I was able to find some audit and research opportunities. I hope completing these projects, with possible presentation and publication, will boost my application for core surgical training.
How a department should organise tasters
On reflection there are a few ways to help both the trainee and departmental team have a rewarding and smooth experience. Departments should ideally be accustomed to having foundation trainees for specialty taster weeks. There should be a designated clinician of contact, likely suited to a consultant with a particular interest in teaching or training. There have been recent recommendations for departments to have structured taster programmes, however this is currently sparsely implemented and likely impractical given the differing subspecialty interests of trainees [2].
Taster week opportunities can be advertised by the department when delivering teaching to foundation doctors, via the medical education department and through social media.
“Tasters are a great opportunity to learn first-hand from those in urology training about the programme and what the day to day job entails”
Prior to the taster, objectives and a provisional timetable should be discussed with the clinician of contact in order for the trainee to achieve the maximum experience during this short invaluable period. There should be flexibility in the timetable to accommodate for the clinical workload of the department and also the evolving interests of the trainee. Following the taster, the trainee should have a debrief with the clinician of contact to reflect on the experience, and to discuss future ambitions in the specialty, whether it be research opportunities or further practical experience.
Recommendations for people interested in organising a taster
From a foundation trainee perspective, organising a taster week is fairly straightforward, although it takes a degree of organisation and proactivity. Taster opportunities are advertised in newsletters, often sporadically, by foundation schools. Additionally, postgraduate medical education teams will have a register of local tasters already available. The easiest way for trainees to organise a taster tailored to their needs is to familiarise themselves with the local department and make contact with the team.
In general, it is easier to arrange leave for tasters when on-call commitments are less, which is often during foundation year two community placements. Trainees should aim to experience the speciality in a wide variety of clinical settings and with clinicians at differing stages of their training. Tasters are a great opportunity to learn first-hand from those in urology training about the programme and what the day to day job entails.
While initially organising a taster week may feel like a daunting process, the experiences to be gained from them are invaluable. On the whole clinicians are extremely willing to accommodate enthusiastic trainees and go out of their way to inspire those considering a career in urology.
References
1. Derbyshire L, O’Flynn K. Medical Students’ exposure to urology, a web-based survey. British Journal of Medical and Surgical Urology 2012;5(1):4-10.
2. The UK Foundation Programme Office. The Foundation Programme Reference Guide. 2018.
www.foundationprogramme.nhs.uk/
sites/default/files/2018-07/
Reference%20Guide.pdf
[accessed 15 October 2019].
3. Foundation for Excellence. An Evaluation of the Foundation Programme (The Collins Report). 2010.
www.copmed.org.uk/
publications-archive/
foundation-for-excellence
[accessed 15 October 2019].
Acknowledgement: I would like to thank the urology department at Royal Free Hospital for accommodating my taster week.
We want and need to attract the very best trainees to urology. One of the most attractive aspects of urology is how encouraging and supportive most trainers are. Anyone interested in a taster week in their region is welcome to contact the local BSoT representative – details on the BAUS website (https://www.baus.org.uk/professionals/bsot/default.aspx).
