351 Summary should be used .16 The European Robotic Urological Society developed a curriculum for fellows (CC-ERUS) focused on the performance of robot-assisted radical prostatectomy (RARP).15,16,18,19 This curriculum includes all the aspects of training, from the most basic ones as live case observation and table-side assistance, to the most advanced training facilities as virtual reality (VR), dry and wet lab with the most complex and advanced training models available today. Currently, this curriculum is available for fellows who train in CC-ERUS host centres. The implementation of training curricula for fellows is a step into the right direction, the next step is the implementation of a structured curriculum during the residency program. The current state of RAS training during the urology residency and the impact of the advanced course in RAS for residents are investigated in chapter 4 of the thesis. This chapter shows that most Dutch residents are allowed to perform RAS during their residency, but criteria for starting RAS differ significantly among the teaching hospitals. This shows there is a need for the implementation of a (multi-step) training and certification program in the Dutch urology residency curriculum. The advanced course in RAS could meet this need. The provided training is the advance robotic skills course as described by Mottrie et al.18 Residents who participated in this week long course show a significant increase in surgical skills. The results of this study show almost all the trainees are allowed to perform RAS in their own hospital after the course. Even though the effects of this week long advanced course in RAS on postoperative outcome of patients remains unclear, initial results of the CC-ERUS curriculum show the completion of the ERUS curriculum leads to an improvement in oncological and functional outcome in patients.32,33 In chapter 5, the long-term effects of the structured fellowship in RAS (CC-ERUS fellowship) are investigated. The results of the survey showed that most respondents still perform RAS after the fellowship, which matches results from other research into the impact of RAS fellowships.34,35 A remarkable finding of this study is that a large proportion of respondents is unaware of the oncological (33%) and functional outcomes (66%) of their patients. Thus, participants of RAS fellowships should be coached to review their own results to learn from their past performance and reduce their learning curve. The addition of a portfolio to the curriculum in which the participants record their progress could improve the participants awareness of their patient’s postoperative outcome. The additional costs of training a new surgeons in RAS varies between 95.000 and 1.365.000 dollars depending on the length of the learning curve.7,36 The implementation of a structured training curriculum does not only reduce possible risks for the
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