The developing paradigm of urologic training in the USA

have qualified instructors and an appropriate clinical learning environment. The spectrum of urological patients and procedures must be broad and include the multiple subspecialties of urology. The goal is to train residents to be competent to practice urology independently and without supervision within a 5or 6-year training program. The training program includes an initial year of internship in general surgery and all residents should have completed an M.D. degree or equivalent at an accredited institution. We are in a new era of training that emphasizes professionalism, communication skills and compassion for patients. Residents, attending physicians and related medical coworkers should work in an environment of mutual respect. Such an environment was not necessarily emphasized in the past. Guidelines founded through evidence-based study and a curriculum driven by the AUA University supports a more uniform outline for resident training. Competency-based training is now mandated and involves teaching and monitoring programs in the training of urology in six specified domains. (1) Medical Knowledge (2) Patient Care (3) System-Based Practice (4) Practice-Based Learning and Improvement (5) Interpersonal and Communication Skills and (6) Professionalism. A detailed discussion of these specific competencies is available at ACGME.org. Each resident must be evaluated with progress monitored by a competency committee formed of delegated instructors trained in evaluation. Resident progress and achievement of a competency in specific milestones of their training is documented with hope that the resident progresses toward complete competence by the end of their training. Progress in building a fund of urologic knowledge is monitored by an annual inservice exam, which simulates the experience of an actual board exam for graduates. The American public and government, which support residency training, mandate such Similar to the practice of urology, modern training of urologists has undergone dramatic evolution in the last three decades. The rapid pace of change is such that without continuous learning, the well-trained surgeon of 1990 might be incompetent today. To keep pace with these changes, training programs have embraced systematic learning modules and new technology along with more conventional teaching in the operating room to successfully prepare the next generation of urologists. The best training paradigm does not exist but is in continual evolution. The US paradigm for training and maintenance of skills as it currently exists is discussed so that training programs in other countries may compare and contrast for their best practice and development. Resident training in the USA is regulated and monitored by the Accreditation Council for Graduate Medical Education (ACGME) with each specialty having a Residency Review Committee (RRC), which establishes the requirements for certification of a residency training program. The ACGME is composed of member organizations representing physicians, hospitals and medical colleges for a coordinated program of graduated medical education. The RRC for urology is responsible for the monitoring and continued accreditation of urologic programs. The responsibility of running a urologic training program and the documentation of training and evaluating residents falls under a named Program Director who must be approved by the ACGME and have an appropriate academic portfolio and level of experience. The urology training program must