The history of urology can be traced back to before written records and among the discoveries of archaeologists. Bladder stones were found in Egyptian tombs, presumably 7000 years ago. The discovery of urinary stones in archaeology had been well documented and studied, and the symptoms of urinary stones had been described from a very early date. The surgical treatment of urinary stones predates other procedures by a long way, with technical improvements in stone extraction and lithotripsy procedures taking place over a period of more than 2000 years. In the fourth century BC, the extraction of bladder stones was already a specialist task. Lithotripsy is the only medical specialty mentioned in Hippocrates' famous oath of medical virtue. He said, “For bladder stones, I do not operate, but leave it to those who have the skill to do it.” By the fourth or fifth century BC, there was already a decent amount of knowledge about kidney and bladder stones. In the early 18th century, urinalysis began to enter the age of science, and the magnum opus of Chinese urology training dawned in the 1990s.
China's 5000-year history has been marked by endless sparks of wisdom from its ancestors who gave rise to countless inventions and technologies. From Huangdi Neijing, also known as Huangdi's Inner Classic of Medicine, to today's innovations in cloning technology, and from the prosperity of the Qin Empire to the throngs of people at the Museum of Qin Terracotta Warriors and Horses, the Chinese nation has gone through its highs and lows. As Winston Churchill said, “The farther backwards you can look, the farther forward you are likely to see.” Learning from history has brought this nation out of its doldrums. “Never forget the roots, learn from the outside, and be forward-thinking,” academician Yinglu Guo (academician of the Chinese Academy of Engineering and academic leader of Urology and Andrology in China), a 93-year-old urologist, and champion of training scientific urological talents said when talking about the future development of urology in China (Figure 1). He believes that the training of scientific and future-oriented urologists should also follow this principle.
In the Department of Urology, learning from the outside means two major projects, the Talent Project and the General Talent Project, which correspond to two methods, inviting experts in and talents going global. When a US delegation visited China, they told academicians Jieping Wu (academician of the Chinese Academy of Sciences and Chinese Academy of Engineering) and Yingluo Guo about their intent to support the training of Chinese urologists by sending two to three Chinese urologists to study in the United States each year. Wu and Guo were heartened by this offer, as China's paucity of urological talent had always haunted these practitioners. However, as mandated by US law, overseas trainees were limited to basic laboratory research and could not involve clinical study at all. Yet, clinical training was mostly needed for Chinese urologists. At this point, Guo came up with a new idea: organizing training in China and inviting experienced Chinese and foreign experts to lecture together, making it a win-win situation for both sides. This is how the Talent Project was born.
In the 1990s, the Beijing Medical University Urology Training Center was established, and the Talent Project was activated. Guided by the principle of “multilevel, diversified, all-round, and large scale”, the Beijing Medical University Urology Training Center aimed to cultivate hardworking professionals with broad scientific knowledge, excellent skills, creative capability, and a progressive mindset. The training was not only completely free of charge but also provided tuition, teaching materials, accommodation, and food for all trainees, lifting their financial burden so that more doctors had access to this opportunity.
The training involved three stages. First, there was a period of long-term training that involved 1–2 years of off-the-job study in the Department of Urology at the Beijing Medical University First Hospital, with training in clinical and scientific research, management, and other fields of study. The second stage involved thematic training, with two face-to-face sessions every year. Each session lasted 3–4 days and focused on a single theme, which aimed to improve the performance of professional surgeons. Finally, the third stage involved collaboration with China Education Television to provide distance learning for general practitioners in grassroots healthcare institutions that lacked urology expertise. This aimed to popularize urological knowledge across the board. The Talent Project mobilized urologists nationwide through long-term, large-scale, free-of-charge training. The participating urologists have become part of a big family, united and motivated, creating a unique community and atmosphere where they can exchange ideas and discuss problems they encounter.
On June 23, 2002, 30 Chinese urologists participating in the first overseas training course of the Leadership Project officially set off on their journey. For 15 years, from 2002 to 2016, the Leadership Project has held 27 training courses in the United States, Singapore, France, Japan, and other countries or areas, with more than 1000 participants, covering almost all urological directors and surgeons with senior professional titles or above in major hospitals across China. “It allows the younger generation, who are already well-versed urologists, to learn from the best in the world.” Guo said, “unlike those new to the field of urology who may fail to understand anything in the process, these young professionals can gain new insights throughout this experience, which will update their clinical expertise upon return to China. Most importantly, the US lifted their law that prohibited foreigners from entering clinical settings, and our doctors were able to observe directly in the operating rooms or even participate in the surgery.”
In September 2004, participants of the Leadership Project visited the Johns Hopkins Hospital and Johns Hopkins Brady Urological Institute in the United States. This also created an opportunity for American doctors to learn more about Chinese doctors. The Institute's director, Professor Patrick Walsh (a professor of urology at the Johns Hopkins School of Medicine; he is recognized internationally as a pioneer in the diagnosis and treatment of prostate cancer), was amazed at the English proficiency of the Chinese doctors, their level of conscientiousness and commitment, cohesiveness of the team, and depth of the discussions. He exclaimed, “it's a great thing to bring together the best of China's leading urologists. This is something that cannot be done in the United States.” The trainees demonstrated a professional image of young Chinese doctors and scholars, and gained international friendship for Chinese urology.
The Leadership Project is also essential in enhancing the professional ethos and pride of Chinese urologists. Professor Donald Skinner (a Urology Specialist in Los Angeles, CA and has over 59 years of experience in the medical field) from the Department of Urology of the University of Southern California has a license plate, “T. POUCH”, the name of his pioneering continent ileostomy. Professor Mark Solowy (a board-certified urologist and an internationally recognized leader in urologic oncology who has made significant contributions to the understanding and treatment of prostate, bladder and kidney cancer over a 40-year career) from the University of Miami has a license plate reading “URO ONC,” which stands for “Urological Oncology.” In addition, Professor Patrick Walsh from Johns Hopkins University has the department's logo printed on a red tie, which is worn by all urologists at every Thursday morning meeting, making it a traditional “red tie day” for the department. Guo often tells these stories of foreign urologists to the younger Chinese urologists, whose strong sense of professional honor, pride, and collective commitment greatly inspires the Chinese doctors.
Participating in the Leadership Project has broadened the horizons and changed the mindsets of young urologists, who have learned and brought back the most advanced techniques, ideas, and management practices from countries worldwide. They have significantly reduced our weaknesses and inadequacies. It is clear that we still need to make progress. To provide high-quality urological treatment and patient-focused service, we need to improve education and training for every medical student, nurse, and other medically related practitioners in the field of urology to adapt to the latest trend.
“The two revolutions in the life sciences, molecular biology and genomics, have triggered the third revolution, and the seeds of the third revolution in the life sciences have certainly been sown, and in leading labs across the country, they are already beginning to bear fruit.” Susan Hockfield, President of the Massachusetts Institute of Technology, said in April of 2009 in a speech to the American Academy of Arts and Sciences Science and Technology Policy Forum.
The next convergence follows the elucidation of DNA structure in the 1950s and the subsequent fundamental discoveries in molecular and cellular biology. These discoveries created a revolution in the life sciences and drove the development of recombinant DNA technology and the launch of the biotechnology industry. By the mid-1980s, the explosion of data from genomics and proteomics brought about a second revolution, further accelerating life science innovation. These two revolutions in the life sciences have witnessed a quantum leap in the knowledge of biology that has led to an unexpected new partnership between biology, physics, and engineering. Disciplines gain from the connection and emerge with potent new answers. What began as a relationship of convenience has become a flourishing partnership that is now rapidly advancing life science discoveries toward practical uses for society. For example, precision medicine, which refers to the definition of disease at a higher level by genetic and other technologies, can enable more specific targeting of disease subgroups with novel medicines. Also, genome sequencing has significant promise for improving patient care through more accurate treatment targeting and enhanced diagnostic sensitivity. To fully realize this promise, scientific, future-oriented talent training will also incorporate DNA-sequencing technology and analytical methods that have been established for genetic discoveries.
Nowadays, we are witnessing increasingly difficult procedures being performed robotically. In addition to the standardized oncologic surgeries, we will see more complex reconstructions and vascular surgeries performed by robots. Moreover, we shall see a shift in the clinical paradigm in the near future as artificial intelligence technologies find their place in guidelines and decision-making. These kinds of research embody a future-oriented mentality. China will rely on its many urological talents to face the challenges the future brings, including those that surround the future development of robotic surgery and telemedicine. The evolution of technology is on the near horizon, which is why we need to train future-oriented scientific urologists.
2023 The Authors. UroPrecision published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.
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