Addressing Disparities in Urological Training Across Low- and Middle-Income Countries. Comment on Baqain et al. Post-Graduate Urology Training in Low- and Middle-Income Countries. Soc. Int. Urol. J. 2024, 5, 339–348

The global demand for urologists is increasing, particularly in low- and middle-income countries (LMICs), where urological problems continue to pose a significant public health burden. The paper by Baqain et al. sheds light on the glaring disparities in urological training between high-income countries (HICs) and LMICs, highlighting the need for urgent reform in medical education and healthcare infrastructure in the latter. One of the study’s primary results is that residency programs vary significantly between LMICs, with durations ranging from 4 to 6 years. In contrast, most HICs take a more planned and uniform approach to urology training, with programs often lasting five years [1].

These LMIC programs frequently use obsolete curricula, have insufficient resources, and lack uniformity in clinical research responsibilities and resident compensation. Such disparities not only impede the advancement of urology as a field, but also lead to a scarcity of trained urologists in these areas [2].

The report underlines that, while LMICs are increasingly recognizing the need to upgrade urology training, problems remain due to limited financial resources, infrastructure deficiencies, and a shortage of professors. For example, despite the growing importance of minimally invasive surgery (MIS) in urology, many training programs in low- and middle-income countries continue to rely mainly on traditional hands-on teaching, with limited access to modern equipment such as simulators and robotic surgical tools. Ather et al. [3] stressed that the future of patient-centered urology care will depend on a significant improvement in education and training. This issue is of particular importance in developing countries, where standardized practice models are still rare in healthcare systems. This inequality emphasizes the need for novel educational frameworks that can bridge the technology divide between LMICs and HICs.

One prospective answer to these issues is the increasing use of telemedicine and simulation-based education (SME) in urology training. Telemedicine use has increased in the post-pandemic era, allowing residents in low- and middle-income countries to receive remote training, mentoring, and real-time surgical supervision from professionals in high-income countries. Teleproctoring initiatives, in which international surgeons provide remote assistance, have been shown to be beneficial in improving student skill sets in resource-limited situations [4]. Furthermore, international collaborations with institutions such as The College of Surgeons of East, Central, and Southern Africa (COSECSA) have helped to raise training standards, even in the most underserved areas [5].

Even with these developments, more efforts need to be made to guarantee that urology training programs in LMICs are on par with those in HICs. The creation of standardized curricula that are adapted to the unique requirements and limitations of LMICs is essential, as Baqain et al. correctly point out. Modern surgical procedures, clinical research, and ensuring that residents have access to sufficient surgical case volumes throughout their training are all important components of such curricula [1].

Furthermore, international collaboration should go beyond individual training programs and focus on structural reforms. This could include establishing more fellowship programs in low- and middle-income countries that are authorized by associations such as the Endourology Society, Urolink, IVUmed, and the Société Internationale d’Urologie (SIU), as well as increasing funding for medical infrastructure. These activities are critical for developing a sustained pipeline of trained urologists in low- and middle-income countries, ultimately enhancing education and patient outcomes [6,7,8]. Endourology is crucial in modern urology but is under-practiced in Africa due to various factors. Nedjim et al. [9] outlined strategies to improve endourology practice in Africa, including local needs identification, training, and technological adaptation, aiming to provide valuable information on its advancement.

In conclusion, the discrepancies in urological training between HICs and LMICs are significant, but not insurmountable. LMICs can overcome current medical education obstacles by combining international collaboration, telemedicine, and the establishment of locally suitable educational frameworks. As Baqain et al. propose, addressing these gaps will require a coordinated effort to ensure equitable access to high-quality urological care around the world [1].