BackgroundTraditional urologic surgery involves invasive procedures with lengthy hospitalization and recovery. Since its introduction in the 1980s, minimally invasive surgery (MIS) has caused a paradigm shift in surgery. MIS has been shown to cause less tissue trauma than open surgery and the inflammatory cascade triggered results in fewer adhesions than open surgery. In addition, patients experience reduced postoperative pain and shorter hospitalization. Considering the positive impact of MIS on clinical outcomes and the healthcare system, many surgeons and educators have embraced MIS techniques. However, the way students and surgeons are taught MIS procedures differs greatly between institutions (if even available) due to high costs, and medical disciplines leading to variation in competences and quality. In order to successfully implement MIS and let European patients and the healthcare system fully benefit from all advantages of MIS, a transnational approach is needed to develop a standardized curriculum for a uniform and high-quality transfer of surgical skills.ObjectivesAs such, the objective of this project is to develop a standardized high-quality curriculum for urologic surgery residents and surgeons covering several key MIS procedures (laparoscopy, endoscopic stone treatment and transurethral treatment). The curriculum will be validated, which includes the development of examination and certification criteria, ultimately leading to a standardized, validated and certified curriculum of high-quality. Also, due to the low costs by making use of innovative eLearning techniques, the program can easily be implemented at all universities and hospitals throughout Europe. ParticipantsThe SISE training program will be developed transnationally by 7 different institutions covering 6 different countries. This is because exams and certificates on MIS need to be recognized in Europe, and in order to do this a team made of specialists from different countries toned to be able to compare educational levels in different centers unbiased. The project target groups of the developed curriculum includes urological residents, surgeons and their trainers across Europe.Activities and methodologyTwo educational programs will be developed for three key MIS procedures (endoscopic stone treatment, laparoscopy and transurethral treatment): (1) a train the trainer program to ensure that sufficient number of well-trained trainers are available to teach residents; and (2) a high-quality, standardized program including the required examination and certification for training of residents (to be provided by the trained trainers). The development of these two programs for each of the different MIS types will be performed in parallel since developed methodologies can be adapted for one and another. During SISE, the developed programs will be implemented and validated by all consortium partners. ResultsTraining materials will be developed for both trainers and students. As such, online training material for endoscopic stone treatment courses (ESTs1, ESRs2a, ESTs3), laparoscopy courses (LUSs1/E-BLUS, LUSs2 and LUSs3) and transurethral treatment course (TUT) will become available by the end of this project for both trainers and students. Also, the courses on this will all be validated during the project ensuring that dissemination to other European hospitals and universities of each of the programs can be established after the project. BenefitsFuture implementation of a standardized curriculum will lead to an increase in skilled trainers and residents, and ultimately to better clinical outcomes with less surgical errors, lower readmission and reoperation rates and an associated decrease in healthcare costs. In addition, cross-over to other surgical disciplines is highly probable and feasible since MIS is widely used in other disciplines such as gynecology and cardiology.

<< Background >>The RLT Academy project aims to launch a multidisciplinary and transnational blended education programme for healthcare professionals on the use of radioligand therapies in cancer care. Radioligand therapy (RLT) is an innovative approach to precision cancer treatment that delivers radiation directly to tumour cells, regardless of where they are in the body, leaving healthy tissues unharmed. One of the greatest strengths of RLT is the concept of theragnostics, which effectively combines diagnosis and treatment within the same therapy. It uses the same vector to localize the disease by PET-scan (diagnosis) and then hit the tumour with radiation capable of breaking the DNA of the target tumour cell (treatment). RLT has a huge potential to transform cancer care as we know it, however, despite its great promise, this treatment option is a long way from being a mainstream cancer therapy in Europe. The lack of permeation of RLTs in cancer care is primarily a consequence of the capacity and knowledge gap that exists among healthcare professionals in the use of this innovative therapy. This gap is the result of several crucial factors. First, RLT is an innovative therapy that has only been in use at a few specialised centres in Europe in the past 20 years. Keeping up the pace with medical innovation is always a challenge. Because there hasn’t been any structured capacity building in this area, healthcare professionals haven’t had the chance yet to acquire the necessary skills to integrate RLTs in patient care. Second, while RLT falls under nuclear medicine, this subfield has been traditionally focused on diagnostics, rather than therapeutics. As a consequence, many nuclear medicine specialists in Europe still do not possess a working knowledge of RLTs and cannot act as champions for this treatment. Third, although RLT is a nuclear medicine solution, its primary application lies in oncology (cancer care). As such, the delivery of RLT requires a strong multidisciplinary approach (i.e. the cooperation between nuclear medicine specialists, oncologists, radiologists, nurses etc.) which is often a challenging task for medical professionals to facilitate. The current reality in Europe (and also globally) is that there are only a small number of healthcare professionals appropriately trained in this treatment approach, which hence remains restricted to a small number of specialized centres. The required multidisciplinary work is rarely implemented in clinical practice. Roles and responsibilities of different members of the multidisciplinary team are not properly defined, or not all necessary specialists are included in tumour boards of non-specialized hospitals. This lack of preparedness is further contrasted by the expected boom of RLT solutions in the future, as this therapy will be the growth driver of nuclear medicine worldwide, becoming the next pillar of cancer care. In light of the above, there is an urgent need to address this knowledge gap through a structured transnational training programme in RLTs – something that is currently missing from the education portfolio of healthcare professionals. A consistent educational initiative at the European level, appropriate, dedicated, and tailored to the relevant professionals within multidisciplinary cancer teams needs to be urgently launched. The need for such an inter-specialty approach in nuclear medicine education for a better cancer care is also strongly advocated by the European Commission’s flagship Beating Cancer Plan initiative as well as by the Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) Action Plan. Such a training programme is a mandatory prerequisite of ensuring cancer patients can truly benefit from this innovative treatment. The potential of this new pillar in cancer care can only be fulfilled if the relevant healthcare communities are prepared for RLT’s integration into patient care.<< Objectives >>The RLT Academy project, through launching a multidisciplinary blended training in RLTs, will aim to achieve the following high-level objectives: Objective 1: Map the knowledge gap in RLTsWhile it is known that there is a considerable knowledge gap in RLTs among healthcare professionals, its exact extent and nature have never been studied before. The project will elevate the understanding of the current RLT education landscape and measure the exact knowledge gap in a qualitative and quantitative manner broken down to specialisations, geographic areas and other relevant factors. A state-of-the-art research on this topic will be published as part of the project that will serve as a benchmark for any further RLT related study and capacity building programme (including the RLT Academy). Objective 2: Bridge the knowledge gap that currently exists among healthcare professionalsThis objective will be primarily achieved through the design, creation and launch of a structured, transnational, and multidisciplinary education programme on the use of RLTs for interested healthcare professionals. This will consciously complement other mostly ad-hoc training initiatives through its unique design. The training programme will be delivered in a blended format, i.e. it will have a strong virtual as well as physical (clinical) training aspect. Through its open and free access, the training programme will fill the current knowledge gap on RLTs and strengthen the multidisciplinary cooperation between oncologists, nuclear medicine specialists and other relevant professionals. The RLT Academy project will provide adapted educational programs to relevant stakeholders on the nature of this novel therapeutic strategy, its biology, pharmacokinetic, biophysics, preclinical and clinical challenges, as well as knowledge on the most up-to-date research programmes, facilitating the transition of RLTs to routine care.Objective 3: Promote the integration of RLTs into mainstream cancer care In the long-term, by launching the RLT training programme to address the currently existing knowledge gap, the RLT Academy project will also greatly contribute to integrate RLTs in mainstream cancer care. As mentioned above, through its innovative approach, RLT has the potential to create a true paradigm shift and become a new pillar of cancer care. Adopting this treatment will transform patient outcomes and contribute to a more successful EU level effort at combatting cancer, but only if it is properly adapted into mainstream cancer care. This cannot be done without first laying the foundations through proper education and training a new generation of healthcare professionals who can integrate RLTs in their ongoing practices. These healthcare professionals, armed with the knowledge attained through completing the RLT Academy programme, will be able to initiate the positive changes in their home countries/institutions necessary for RLT integration and act as champions of this treatment for the benefit of cancer patients. This objective is fundamentally aligned with the European Commission’s initiatives to improve European cancer care, especially through its Beating Cancer Plan, as well as the SAMIRA Action Plan which specifically identifies the Erasmus+ programme as a tool to promote capacity building and training in nuclear medicine to strengthen the fight against cancer in Europe. Realising this synergy, the project will advise policymakers on addressing the complex barriers RLTs face in Europe through a set of policy recommendations. Ultimately, the project’s objectives will greatly contribute to the proper implementation of this paradigm changing solution, which will transform the approach to tackling cancer and profoundly modify the organization of therapeutic care for patients.<< Implementation >>The objectives of the RLT Academy will be achieved through five comprehensive deliverables. In particular, it will realise four main Project Results and over twenty training activities. Project Result 1: scientific study to measure knowledge gap in RLTsThis activity will deliver an in-depth research on the education of RLTs in Europe and conduct a needs analysis for the target audiences of the project. The research study will integrate systematic surveys across European universities and medical training centres with detailed comparison of the respective contents. The study will include the development of a questionnaire to evaluate the real knowledge among health care operators as well as the perceived risk of utilising ionising radiation in medical environments. The consortium will aim to publish the study in a relevant scientific journal. Project Result 2: development of training curricula and material on RLTsThe core part of the RLT Academy Project is the creation of educational pathways on RLTs, comprehensive and versatile for all categories of healthcare professionals who want to gain more knowledge about the treatment. During this phase of the project, consortium partners will design the necessary curricula and develop training courses addressing the needs resulting from the completion of Project Result 1. Different training needs addressing different audiences can be perceived with respect to different levels of training (medical doctors, nurses, technicians, medical physicists), clinical experience (board certified attendings, residents, medical students), and previous exposure to nuclear medicine and RLT (minimal vs. high-level knowledge on RLT). The design will pursue a tiered approach of training including an introductory online course (basic – part 1), an advanced hybrid online and in presence course (advanced – part 2) and a mainly in presence professional course (professional – part 3).Project Result 3: A unique online platform for RLT education: “Virtual RLT Academy” The Consortium will develop a fully-fledged online education platform, where most of the trainings offered within the project will take place. The system will be designed in an interactive way to offer tailored training opportunity to participants, integrating the materials developed during Project Result 2. The Virtual Academy will bring together all the different medical and technical skills, simplify the transfer of knowledge, and thus facilitate the implementation of RLT to countries and regions where this treatment is not yet available. The platform will provide information about: 1) project background and details, 2) RLT education landscape (e.g. heatmap), 3) Virtual RLT Academy (training site), 4) RLT library (scientific knowledge repository).RLT clinical training activitiesThe project will also offer 20 short-term (two-week long) intensive clinical training opportunities and 4 long-term (six-months long) fellowships for interested healthcare professionals who complete the prerequisite online trainings (Virtual RLT Academy). These clinical trainings are essential to properly education stakeholders on the various complex aspects around the use and delivery of RLTs to patients. Project Result 4: Policy recommendations to ensure wider uptake of RLTs in EuropeBuilding on the lessons learned from the project, the consortium will go beyond the educational scope and will provide policy recommendations to EU and national level policymakers on RLTs. Education of healthcare professionals is only one of the key elements of ensuring that countries can provide access to these therapies. The effective uptake of RLTs require also infrastructural developments, regulatory adjustments and the enaction of other relevant policies before wider patient access can be achieved. This can be done by educating policymakers on the value and importance that RLTs will increasingly have in the near future, as a key element of the precision cancer medicine.<< Results >>The key outcomes of the RLT Academy project are closely tied together with its proposed Project Results and high-level objectives. Key outcome 1: mapping the RLT education landscape and the exact knowledge gap of target audiences. The consortium will carry out a research and needs analysis mapping existing RLT trainings and measuring the needs of target audiences. The findings will be crucial to inform the development of training curricula. This research will be published on the project’s online platform, in a scientific journal and disseminated across the relevant medical communities. The research results will also be presented at an online event.Key outcome 2: developing RLT training curricula and creating virtual interactive training courses. Informed by the findings of the research exercise and the existing expertise of the consortium partners, the project will see the development of an exhaustive and customizable training curricula. This outcome will include both the intellectual output of writing the right contents and designing exams and tests in advance, as well as a more practical side of creating and recording of video lectures. The curriculum will be designed in a way that it will recommend three main approaches depending on pre-existing knowledge and background. As such, participants with minimal experience in nuclear medicine and RLTs will be offered a more comprehensive training programme, while people with a more established professional profile in this field will be offered a specialised immersive approach. Key outcome 3: launching the Virtual RLT Academy online education platform. The consortium will design and launch an education platform which will integrate a complete Learning Management System, an online education platform where target groups will be able to create a profile and access a tailored online programme in form of MOOCs (Massive Online Open Courses) and SPOCs (Small Online Personalised Courses) based on their background. The contents will include scientific reading materials, interactive video lectures, tests and exams, and peer-learning interactions. The platform will also include an RLT Library, a repository of the most state-of-the art and relevant information. The Virtual RLT Academy will be unveiled at an online event in September 2023.Key outcome 4: publishing a set of policy recommendations to advise policymakers on how to address barriers around the uptake of RLTs. As the project will bring together some of the most established experts in the medical fields relevant for RLTs, the consortium will be perfectly placed to provide guidance to policymakers with the necessary weight to be heard. The adoption of RLTs in Europe and ultimately proper patient access does not only depend on proper education, it must also address other barriers such as setting up proper healthcare infrastructures, finetuning relevant regulatory contexts and harmonising cooperation between all relevant stakeholders from regional to European levels. The policy recommendations will build on the best practice attained through the project and set out concrete actions for the policymakers to take. The results will be presented at an event in Brussels to maximise impact. Key outcome 5: encouraging adequate skills attainment for healthcare professionals through clinical trainings. A proper training programme in RLTs cannot happen on a strictly virtual basis. As such, the participants will be offered physical training opportunities at select clinical sites where there is an accumulated clinical expertise in the delivery of RLTs to patients. By the conclusion of the programme, the consortium will aim to train at least 44 healthcare professionals and offer additional placements through seeking external financing support. As an ultimate long-term outcome, the RLT Academy seeks to positively influence the adoption of RLTs in Europe and increase the number of patients who can receive this therapy.

The aim of this project was mainly to develop, test and validate the European Association of Urology training program for robotic surgery. Target of the program were trainees who finalizes their residency program and qualified surgeons who are currently working in the field of urology. This is necessary because the quality assessment for robotic surgery training in Europe is not set uniform, which means that requirements for surgeons to execute robotic surgery differ across various countries in Europe or are not defined at all. This is problematic because, as stated by the European Commission, all citizens of Europe need to reap the benefits from safe, effective and innovative medical devices. The quality of the skills of a surgeon on the use of robotic surgery should not vary across countries in Europe.To address the training needs of surgeons and trainees best, three training programs were developed, tested and validated. These training programs are different in entry level, length of duration, expert level and intensity to fully meet the specific needs of surgeons and trainees.1. Basic Robotic Skills Course: basic course which contains an online theoretical course and training on a simulator.2. Advanced Robotic Skills Course: intermediate level, 5-day training course. A theoretical training combined with a simulator training in a dry lab and wet lab.3. EAU Robotic Curriculum: expert level, 6 month training programme. This programme is a modular robotic training in a host centre.The training programmes involve preclinical and clinical components to facilitate the proper adoption and application of robotic surgery. The training program was accredited by the European Accreditation Council for Continuing Medical Education (EACCME) which involves an expert determined, standardized educational process, including a minimum criterion of proficiency.In addition, a large scale pilot study of the three training program is also executed. Of this pilot study, a research paper will be published. A presentation was held to present the project results in June 2018 at the National Societies Meeting in Noordwijk. In total, 145 people were directly targeted by the project. This was based on approximately 70 participants of the pilot study, and a total of 75 attendees of the presentation of the project results. On a national level, this project will increase the level of skills required by surgeons on robotic surgery to ensure good and properly executed robotic surgery procedures by allowing surgeons to learn transnationally. On a European level, this project will lead to a clearly defined training standard for robotic surgery in the field of urology that stimulates transnational learning. The project will increase the quality of education and training of robot surgery in the field of urology, all over Europe. The project was carried out by the forerunners of robotic surgery in the field of urology. The European Association of Urology (NL), ORSI (BE), the University of Saarland (DE) and the Ospedale San Raffaele SRL (IT) (which replaced Humanitas Mirasole SPA during the project because Dr. Guido Guisti's promotion) combined their state of the art knowledge and expertise, to develop these training programs. The partners have a solid track-record on (1) the latest developments in urology and robotic surgery, (2) experience with the use of robotic surgery and (3) extensive experience with modern training technology. Although the Urologic community is the forerunner for surgical robotics innovation, the use of robotic surgery is applied in other fields of medicine as well. For this reason, the results of this project will also be disseminated to other fields of medicine, such as cardiology and neurosurgery. Within the structured training programs, the criteria of the surgeon’s competence before starting with robotic surgery will be sufficiently met to ensure surgical outcomes and patient safety are not compromised during the learning process all across Europe.