GENERAL INFORMATION - DEMOGRAPHICS
Finland has a population of 5.2 million inhabitants and is a member of both the European Union (EU) and the European Board of Urology (EBU). 5 Urological Departments are operating all over the country. There are 110 Urologists (1 urologist per 47,272 inhabitants) and 20 Residents (1 resident per approx. 5 urologists).
NATIONAL UROLOGICAL SOCIETY
Suomen Urologiyhdistys Ry
The whole surgical training was renewed in 1998. Before that it took 8 years to become urologist, and urology was a subspecialty of surgery. There are still some residents on the old scheme. Most of the residents today are on the new scheme. The urological training takes a minimum of six years after graduation. A minimum of 6 months of general practice is required. There is a common trunk (basic surgical training) for the following surgical specialties (minimum 2,5 years): Gastrenterologic surgery, orthopedic and trauma surgery, hand surgery, plastic surgery, heart and thorax surgery, urology, vascular surgery, general surgery and pediatric surgery. The contents of the common trunk are well defined (elective and emergency/trauma procedures). The common trunk can be done at a university hospital (five in Finland) or more often at a central hospital (about 20 in Finland), which is affiliated to a university hospital. At the beginning or during the common trunk the decision for the specialty (see above) is made and a training agreement is signed by the resident and the trainer (head of the urological department/clinic at a university hospital). After the common trunk there is an evaluation.
At the University of Kuopio this includes an oral exam. The textbooks and Journals required are named. The urological residency takes 3 years. This can (not obligatory) include 6 months of training in other specialties relevant to urology (gynecology, organ transplant unit, pediatric surgery etc). This residency is usually done at one university hospital. In some cases up to one year of residency can be obtained at a central hospital (this requires a qualified trainer, usually academic status of associate professor, to be in charge of the training at the central hospital). The practical training includes all aspects of modern urology (except pediatric urology, which is managed by pediatric surgeons in Finland). Theoretical training comprises 60 hours of courses/lectures during common trunk and 100 hours of courses/lectures during residency (for example EAU, AUA, EBU and ICS congresses, national and Scandinavian meetings, urological and surgical meetings at the university hospital held weekly). Of the 100 hours 20 hours should be of administrative nature. Altogether 160 hours of theoretical training. The residents fill a log book/portfolio, which is used to evaluate the progression of training. Every resident also has a personal tutor, with whom there should be at least two evaluative meetings per year. In the end there is a national (same for all five universities) exit-exam.
The exam consists of 5 essay-type questions. The exam is usually taken during the last residential year. The textbooks (Campbell’s Urology, Glenn’s Urologic Surgery, Urodynamics by Mundy, Stephenson and Wein and the Finnish Urologia by Rannikko, Tammela etc) and Journals (J Urol, BJU, European Urology, Urology, Scand J Urol and Nephrol, Urologic Clinics of NA and Journal of Endourology) are named. Three last years of the Journals are required.
Most Finnish urologists work at hospitals owned by communities. There are five university clinics and about 20-30 smaller hospitals with 1-4 urologists. Only few practice privately and some work in private hospitals. All urologists are employed and there are even some vacant jobs. For the time the community owned hospitals have problems providing salaries, working hours, working conditions and time off comparable to the private sector, which has attracted even some of the young urologists. In the next years there will be work for every graduating urologist, the workload will grow together with the population getting older and wanting to have more quality in their senior-years (andropause, ED, incontinence etc.). Urologists in Finland are well trained and up-to-date (thanks to the possibility of attending international and national urological congresses provided partly by pharmaceutical companies). The majority of urologists meet at two annual meetings of the Urological Association discussing research and other issues. Most modern treatment modalities are routinely applied, only urological laparoscopy is just beginning to find its place.
FELLOWSHIP - RESEARCH OPPORTUNTIES
Professor Olof Alfthan, the Primus Motor of Finnish urological research in the past years formed two Research Groups, Finn-Prostata and Finn-Bladder, which both have achieved international recognition. Other Study Groups like Finn-Impo and Finn-IC have also been formed. A great deal of Finnish urologists have participated in multi-institutional studies organized by these groups and have been able to get their Doctorate done. The research work is usually done side by side with urological training/work, and research fellowships are rare. Considering the small amount of urologists in Finland, research is done a lot. Postgraduate training is not organized.