Education and training evolution in urolithiasis: A perspective from European School of Urology

Objective: With the worldwide increase in urolithiasis prevalence, the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis. Methods: A PubMed search using the key words "simulation", "training", "ureteroscopy", "RIRS", "URS", "percutaneous nephrolithotomy", "PCNL", "virtual reality", "augmented real-ity", "artificial intelligence", "healthcare", "curriculum", and "assessment" was used to examine how education and training in urolithiasis have adapted over recent years. Focus was placed on the role of high-and low-fidelity simulation models, virtual reality and artificial intelligence, and standardised assessment and curriculum. Results: This review supports the necessity to incorporate technology, simulation, and other skill enhancement training modalities into surgical training. However, these cannot solely replace mentored training with an experienced professional supervisor. Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training, it is just as important for stratification of robust curricula with validated assessment. We also propose a pathway for future training. Conclusion: Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition, refinement, and improving operative out-comes. Success is achieved by maintaining a delicate balance between machine and in person mentor-based training. A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.