Curriculum

PGY 1

The first year of the Urology Residency Program includes six months of rotations in general surgery and six months rotating in clinical urology. Time spent in General Surgery will include exposure to:

• General Surgery
• Transplant Surgery
• Trauma Surgery
• Vascular Surgery
• Colorectal Surgery
• Plastic Surgery
• Minimally-Invasive Surgery

The General Surgery rotations will pay particular attention to teaching surgical skills required for subsequent Urological training. Time spent in the Urology clinic during this year will cover the basics of Urological practice and medical knowledge critical for Urologic treatment.

This year serves as a foundational year on which to build surgical training.

PGY 2

Having successfully completed their first year of urologic training, residents now have greater responsibility. In this year, our residents rotate through three hospitals, each with a 4-month rotation: Einstein Medical Center Philadelphia, , Jefferson Abington, and the Fox Chase Cancer Center. Einstein Medical Center Philadelphia is a four-month

rotation and includes rotating at Einstein Medical Center Elkins Park, a nearby hospital under the direction of Einstein Medical Center Philadelphia. Each hospital provides close interactive supervision so that a urology resident in the earlier stages of training can be given sufficient direct, constant supervision.

During this year, residents will also be exposed to a great deal of Urologic oncology cases – and will gain competency to perform endoscopic cases, office procedures, as well as bedside robotics training.

At Einstein Medical Center Philadelphia, residents play an instrumental role in the clinical care rendered at the Academic Urology clinic. In this clinic, residents see and help manage Urology patients that are from surrounding areas referred for Clinic care to our high volume, tertiary care trauma center. Numerous general urology principles are taught through not only the Academic Clinic but also through the inpatient and emergency room experiences on this campus. Clinical experiences include but are not limited to training in the diagnosis, work-up and management of kidney/bladder stones, erectile dysfunction, BPH, overactive bladder, kidney transplant clearance, urinary tract infections, female stress incontinence, urologic oncology, and urologic trauma. At this training site, the residents participate in one of the largest kidney stone practices in the country. Residents gain valuable experience in the performance of office-based procedures, including in-office vasectomy, TRUS biopsy of prostate, penile injection testing, office cystoscopy, in-office neuro-modulation, and office urodynamics. This rotation has heavy operative experiences in regards to basic skills acquisition in endoscopic Urology (PCNL, TURBT, TURP, Bladder biopsy, Ureteroscopy) and minor surgical procedures (Hydrocele, Circumcision).

At Fox Chase Cancer Center, residents gain an immersive experience in the inpatient, outpatient, and operative management of urologic oncology patients. At this large nationally recognized Urologic Oncology cancer center, residents work with any one of seven urologic oncologists to learn the principles in management of urologic cancer. Such cancers include the diagnosis, management, and work-up of prostate, kidney, testicular, bladder, adrenal, and penile cancers. Residents also participate as critical members of several multi-disciplinary conferences that involve Medical Oncology,

Radiation Oncology, and Pathology to focus on advancing an optimal management strategy for patients diagnosed with a urologic malignancy. Residents gain valuable operative experiences in advanced endoscopic tumor resection as well as in assisting major urologic cancer operations (robotic prostatectomy, robotic/open radical cystectomy, radical/partial robotic/open nephrectomy).

At Abington, residents will work with both fellow-trained and general urologists. They will receive specialized training in Urologic Oncology, Reconstruction, Robotic Surgery, and FPMRS. Additionally, they will run a busy service of general urology in a large suburban teaching hospital.

PGY 3

During the third year of urologic training, residents rotate for four months at Children’s Hospital of Philadelphia and Jefferson Methodist Hospital. They also have a dedicated 4 months for research.

During this year, the resident will have greater responsibility and autonomy while still having constant, direct supervision by more senior residents and the attending faculty.

At Children’s Hospital of Philadelphia, the residents have a highly immersive experience with the largest Pediatric Urology division in the country (12 pediatric urology attendings) and one of the largest international referral centers for pediatric urology in the world. During this rotation, PGY 3 residents are exposed to the entire range of outpatient pediatric urology; they perform all the histories and physical examinations, formulate an initial impression and then outline a diagnostic plan. They assist with outpatient procedures at surgical centers and will have the opportunity to assist in office circumcisions and urodynamics/videourodynamics. Residents also take emergency room call in order to gain experience evaluating, recognizing, and managing pediatric urologic emergencies. Finally, residents perform under the guidance of a supervising attending physician complicated pediatric procedures (including, but not limited to hypospadias, ureteral reimplantation, and pyeloplasty). The resident has exposure to the full preoperative, intraoperative and postoperative experience, so as not to be considered a “trailing” resident. There is total continuity of care. The resident’s operative experience during this rotation is greatly enhanced and augmented, witnessing the full spectrum of pediatric urologic procedures/surgeries.

At Methodist, residents will work with both fellow-trained and general urologists. They will receive specialized training in Urologic Oncology, Endourology, Reconstruction, Robotic Surgery, and FPMRS. Additionally, they will run a service of general urology in a large urban teaching hospital.

There are four months of dedicated research time during the PGY3 year to advance residents’ knowledge and practice of the scholarly approach to evidence-based patient care. This research is to be performed under the guidance of the chief resident. During this time the resident is expected to be leading multiple research projects, with at least 1 project being mentored by an Einstein core faculty member. These projects may be continuation of previous work or can be completely new projects. Research is encouraged to be submitted to the Philadelphia Urologic Society Resident Essay Competition, the AUA Annual Meeting, the Mid-Atlantic AUA Annual Meeting, or another conference of the resident’s choosing. Funding for attending the conferences is available through both Einstein GME and the Urology Department.

PGY 4

In this year, residents will rotate for four months each at Einstein Medical Center Philadelphia, Thomas Jefferson University Hospital and the Fox Chase Cancer Center.

The resident has much greater independence as well as administrative and organizational responsibility beginning this year of training.

At Einstein Medical Center Philadelphia, residents play a supervisory role in the clinical care rendered at the Academic Urology clinic. In this clinic, residents see and help manage Urology patients that are from surrounding areas referred for Clinic care to our high volume, tertiary care trauma center. Numerous general urology principles are mastered at this level along with supervisory responsibilities through not only the Academic Clinic but also through the inpatient and emergency room experiences on this campus. Clinical experiences include but are not limited to training in the diagnosis, work-up and management of kidney/bladder stones, erectile dysfunction, BPH, overactive bladder, kidney transplant clearance, urinary tract infections, female stress incontinence, urologic oncology and urologic trauma. At this training site, the residents help lead management efforts in one of the largest kidney stone practices in the country. During this rotation, residents are able to independently perform office-based procedures, including in-office vasectomy, TRUS biopsy of prostate, penile injection testing, office cystoscopy, in-office neuro-modulation and office urodynamics. This rotation offers immersion into major cancer surgery performed in an indigent care patient population. Operative involvement in major reconstructive and oncologic procedures is gained through this experience in anticipation of taking a supervisory effort as a PGY5 resident the upcoming year.

At Fox Chase Cancer Center, the PGY 4 resident works with seven full-time urologic oncology surgeons. There is a large amount of major cancer surgery done here by the resident, and consequently there is a major increase in his/her experience performing laparoscopic/robotic surgeries, including robotic radical prostatectomies, radical cystectomies, and radical and partial nephrectomies. Many of these procedures are performed with robotic assistance – although there is also an incredible number of major abdominal open operations that give the residents excellent grasp and familiarity with open surgery. Due to the large institutional databases already in place, this experience also serves as a reservoir for many clinical research papers for the residents. There is also a major increase in oncologic knowledge base and management of seriously ill patients with other significant co-morbidities. Fox Chase Cancer Center employs a mentorship model of teaching where the residents are afforded the opportunity to engage in block rotations with a given faculty mentor in a one-on-one experience. This opportunity allows the residents to not only learn directly from each faculty mentor for a given period of time but also ensures that their educational experience is not diluted through the incorporation of fellows. Simply put, fellows have not impacted the surgical involvement of our residents or training program. Additionally, the incorporation of one-on-one experiences allows for fair case distribution between all learners present on this rotation. The distribution of surgical cases and clinical experience, therefore, is strictly maintained between faculty mentor and resident.

At Thomas Jefferson University Hospital, residents will receive specialized training by fellowship trained faculty in Urologic Oncology, Robotic Surgery, Reconstruction, FPMRS, Neurourology, and Endourology. They will work primarily in the operating room to hone their skills in these areas and progressively set themselves up for their chief resident experiences.

By the time residents finish this training year, they have accumulated a large amount of knowledge and surgical skills in preparation for their chief resident year. While there is always constant supervision in all aspects of the resident training program, it is in this year that there is more apparent independence and graded responsibility in preparation for the role as a chief resident. Residents have now mastered many laparoscopic cases, pediatric cases, robotic cases, and general urology cases. They have gained considerable experience in presenting cases, participating in conferences, journal clubs, presenting data and studies at local, regional and national meetings, and running a service. They are given more responsibility as seen fit by the faculty on a continual basis of interaction and assessment. Continuity of care is implemented through joint rounds with the covering resident and daily interactions with the responsible, supervising attending.

PGY 5

The increased, graded responsibility of the resident’s fourth year prepares him/her for the last training year as chief resident. For this year, the residents rotate for four months at Einstein Medical Center Philadelphia, four months at Jefferson Abington, and four months at Fox Chase Cancer Center.

At Fox Chase Cancer Center, the chief resident will act as co-chief alongside the Temple chief underneath the two Fox Chase Cancer Center Urologic Oncology Fellows. Building on the skills learned during the PGY 4 year, the chief resident continues to hone their laparoscopic/robotic surgery skills, including robotic radical prostatectomies, radical cystectomies, and radical and partial nephrectomies. Fox Chase Cancer Center employs a mentorship model of teaching where the residents are afforded the opportunity to engage in block rotations with a given faculty mentor in a one-on-one experience. This opportunity allows the residents to not only learn directly from each faculty mentor for a given period of time but also ensures that their educational experience is not diluted through the incorporation of fellows. Simply put, fellows have not impacted the surgical involvement of our residents or training program. Additionally, the incorporation of one-on-one experiences allows for fair case distribution between all learners present on this rotation. The distribution of surgical cases and clinical experience, therefore, is strictly maintained between faculty mentor and resident.

At Einstein Medical Center Philadelphia the chief resident will oversee all aspects of the administrative and clinical training program, with active participation of the Residency Program Director. During this final year of training, the chief resident will have heightened responsibilities regarding the supervision of the outpatient and inpatient service, determining when elective patients are to be admitted, organizing a functioning operating schedule, and allocating and delegating resident responsibilities to maintain a high quality service. They are sometimes faced with administrative challenges which they must make every effort to resolve before seeking assistance from the faculty. Although the attending has full responsibility for the patient, all within the program view the chief resident as junior faculty. They also have an increased obligation to educate medical students rotating on the service.

At Abington, chief residents will have a surgically-heavy experience working with both fellow-trained and general urologists. They will receive specialized training in Urologic Oncology, Reconstruction, Robotic Surgery, and FPMRS. Additionally, they will run a busy service of general urology in a large suburban teaching hospital.

There is constant feedback on a daily basis between faculty and the chief resident based on information obtained during rounds, meetings, and conferences. The chief resident discusses any urgent issue or complication with the faculty immediately, and assumes responsibility, under the guidance of the faculty, in managing these cases and providing follow-up care. These cases will then be discussed during M&M conference, which will allow the resident to reflect and enhance on their experience. This final year of training serves to put the chief resident in the “driver’s seat”. Everything is still supervised, and the faculty still oversees the surgery. However, the goal and objective of the chief resident year now becomes evident, and that he/she must perform surgery in an independent, competent, moral and ethical manner before they can graduate from the program.