The <scp>LANDMARK</scp> project: providing summaries of key papers that have shaped urological practice

Across the field of urology, best practice is underpinned by a rapidly expanding number of landmark papers. Practice-changing papers often provide the best available evidence to justify the use of a particular diagnostic test, medication or surgical intervention as standard of care. However, navigating this literature poses challenges. There has been a rapid expansion of papers published, with the number of papers indexed in Scopus and Web of Science recently increasing from 1.92 to 2.82 million (from 2016 to 2022) [1]. Papers that define our practice often span decades and are constantly challenged, updated or contextualised by new literature. Maintaining an up-to-date clinical knowledge requires succinct knowledge of these key landmark papers. Furthermore, reading and appraising papers is time-consuming, and concise summaries are often needed. To date, there is no freely-available resource has aimed to provide critical reviews of the conventional evidence base across all urological subspecialties and provide key updates on new papers. We recently launched the LANDMARK educational platform (https://landmark.bursturology.com/), which aims to address this need and provide up-to-date appraisals of key papers across all urological subspecialties. This educational platform has a target audience of not only trainees approaching exit examinations such as Fellowship of the Royal College of Surgeons examination for Urology (FRCS [Urol]), Fellow of the European Board of Urology (FEBU) and in-service examinations, but also plans to provide content relevant to practising urologists internationally. Whilst clinical guidelines offer broad recommendations based on the synthesis of evidence and expert opinion, more detailed knowledge of strengths and limitations of the individual studies that drive everyday urological practice is necessary for examination candidates and practising urologists. Delivered through the British Urology Researchers in Surgical Training (BURST) research collaborative, LANDMARK is a trainee-led initiative [2, 3]. This educational online platform is freely available and open access, providing a structured approach to evidence reviews. The website is structured on an extensible open-source Wiki (i.e., a collaboratively edited database), built on the JavaScript runtime environment NodeJS (‘Wiki.js’; current version 2.5.303) [4]. The website architecture is structured into urological subspecialties and broad evidence categories. Any site visitor can search the database, read evidence summaries, contribute to discussion with comments and questions, and submit their own reviews to be published after rapid peer review. Each review contains a digestable format comprising take-home messages, key details on study design, participants, outcomes and limitations. Pages are interactive, with questions to test users’ knowledge and an open comment section to generate peer discussion on each paper. In 2022, the BURST began a consultation process for core papers to include in the resource (Fig. 1). This involved input from subspecialist experts, BURST committee recommendations and recommendations from recent high-performing candidates of the FRCS (Urol) examination in the UK. An educational sub-committee of BURST undertook preliminary review of submissions. Inclusion criteria were peer-reviewed published papers that provide foundational knowledge, generate controversy in areas of unresolved debate, report first descriptions (e.g., techniques or disease characteristics), used important or innovative research methods, and papers that have findings that changed or are likely to change contemporary practice. During the consultation, 210 submissions were received. After removing duplicate submissions or similar papers, 150 papers were selected for review and appraisal. The selected initial papers are among the core papers fulfilling eligibility for inclusion in LANDMARK. However, the current database of LANDMARK papers is not exhaustive, and the platform is intended for future development. Following selection of papers for inclusion, we performed the process of data extraction and critical analysis. A standardised data extraction and critical appraisal form was developed and piloted through committee consensus and then instructions for use were made before distribution. This was completed by the BURST committee and trainees external to the committee. After completion of review forms, a peer review process was performed to check the accuracy and quality of submissions. A Research Electronic Data Capture (REDCap) form was programmed to enable automatic conversion of reviews from survey format into a HTML code for viewing at http://landmark.bursturology.com. The LANDMARK platform hopes to provide an openly accessible, free and easy-to-use educational resource that can be improved on in an iterative manner. A key advantage is the potential to remain updated with new papers. The REDCap form for submissions is now freely accessible on the website and allows users to submit any paper for peer review and publication if deemed eligible for inclusion on the website. There are some limitations of the LANDMARK website, including the fact that the concise nature of reviews precludes in-depth analysis of papers. In addition to this, LANDMARK is not a substitute for reading and appraising papers to gain the essential skills of critical thinking and independent thought. Journal clubs and formal training in critical appraisal can aid development of these skills and enable users to make useful contribution to LANDMARK [5, 6]. The LANDMARK website has recently launched, and contributions from both trainees and consultants are welcome. We would encourage users to help build this resource by completing a review submission on the website for studies they have been involved with or have a special interest in. User engagement with comments and sharing on social media will help increase the user base and make the resource more engaging for all users. We aim to rapidly peer review and update submissions on the LANDMARK website. We also welcome submissions of interest to become a section editor in any sub-specialist area. This involves facilitating the peer review process, inviting evidence reviews and completing reviews to improve the resource for all users. The LANDMARK website aims to become a useful resource in helping clinicians keep up-to-date and provide core knowledge on papers that define our practice. We would like to thank everyone who aided with the process of data extraction, critical appraisal and peer review. None to declare.