The QUEST for better marks

The paper by Touma and colleagues in this issue of CUAJ represents a critical element of urology residency training — that of preparing residents for successful completion of the Royal College of Physicians and Surgeons of Canada (RCPSC) certification examination that culminates the five years trainees have progressed through residency, further preparing them for fellowships and ultimately independent practice. Touma et al present data on the first 20 years (1997–2016) of the Queen’s Urology Examination Skills Training (QUEST) program, describing the impact this national preparatory exam has had on the performance of graduating urology residents.1 This work is incredibly timely and valuable, as the RCPSC’s Competence by Design (CBD)2 curriculum initiative has begun its implementation into all postgraduate medical training throughout Canada. The current, traditional, time-based structured urology residency curriculum components, such as didactic lectures, surgical foundations, journal clubs, rounds, participation in scholarly research, simulation sessions, rotation experience, and in-training exams all aim to prepare residents to meet the core CanMEDS competencies. However, with the implementation of CBD, we will see changes to urology curricula, alongside redefined goals and objectives. Via a retrospective analysis of 495 urology candidates’ performance over the first 20 years of QUEST, Touma and colleagues have importantly assessed the current state of knowledge regarding Canadian urology residency programs conducted under the traditional time-based training model, providing potentially advantageous curricula development guidance as CBD is further developed and integrated into Canadian urology programs