Urology Residency

Urology residents complete the PG I year totally under the auspices of the Department of Surgery at Thomas Jefferson University, rotating through both general and subspecialty rotations.

The second postgraduate year of training is considered a pre-urology year. During this year, the resident spends six months of training in general surgery, with another six months spent as the C service resident in the Department of Urology, to start the transition process into Urology from General Surgery. The TJUH C service emphasizes the treatment of voiding dysfunction, incontinence, pelvic floor prolapse, and neuro-urology, but also includes a significant exposure to erectile dysfunction and infertility and general urology. The treatment of incontinence and neurogenic lower urinary tract dysfunction often involves complex urinary tract reconstruction procedures, urinary diversion, and bladder augmentation. Techniques in management of erectile dysfunction are learned with the use of invasive and noninvasive diagnostic testing, medical and surgical management. Insight as to the nature and role of novel techniques such as intracavernosal injection therapy, semen retrieval and preservation, intracytoplasmic sperm injection, vacuum-assisted erection, and penile prosthesis surgery is included.

The third postgraduate year of urologic training marks a full transition to the urology residency program. The first four months of training are obtained at the Wilmington VA Hospital. The VA setting is quite conducive to introducing the basics of clinical urology. With instruction by an attending staff, familiarity is obtained with both transurethral procedures, such as cystoscopy, and open urologic surgery. Expertise is developed in obtaining a thorough urologic history and performing physical examination.

The VA rotation is an initial introduction into establishing the graduate medical trainee as the total care provider for the patient. By the end of this four-month block, the PG3 urology resident has developed skill in preoperative evaluation, care, and postoperative treatment. This introduction to urology allows the development of the expertise required to care for patients in a tertiary setting such as Thomas Jefferson University Hospital during the remainder of urologic training.

The next two months are spent training at the Nemours Children’s Hospital, Delaware. The experience of the urologic service at the Nemours Children’s Hospital, Delaware, is also considered extensive for the training of the urologic resident. The department at the institute has three urologists, Drs. Figueroa, Barthold and Gonzalez. As only one urologic resident rotates at this institution at a time, the resident retains exclusivity in the evaluation and treatment evaluation and treatment of pediatric patients with disease processes as simple as hypospadias to as complex as the extrophy-epispadias complex. This one-on-one type of educational experience is truly unique in learning physical examination.

The amount of case experience and education that our residents receive far exceeds what could be expected when several other residents and fellows may be on the same service, such as is found at other pediatric health care institutions. The resident participates in both inpatient and outpatient care, evaluating and treating both private and clinic patients. Commonly, at the time of an office visit, the resident may schedule a patient for surgery, and participate not only in the surgical procedure but also postoperative care, extending to outpatient office visits, ensuring the continuity of care and a thorough educational experience.

A pediatric urologic conference held weekly at the Nemours Children’s Hospital, Delaware, permits the active presentation, review, and discussion of interesting cases. Often, significant pediatric cases are presented by the pediatric urology resident and discussed in a Grand Rounds setting at Thomas Jefferson University Hospital.

The last six months of the third year of urologic training is devoted to an introduction to urologic research. Although six months is not adequate to fully formulate, develop, and conduct a research project to its completion, it has proven to be adequate to initiate at least one basic science project and complete several clinical research paper submissions for publication. During this time, it is our intent that the resident becomes interested in one basic science research effort, and participates in this project as much as possible. Continued participation in the project will usually continue throughout the completion of residency training.

Certain clinical investigative effort regarding the review and compilation of data, such as case histories, enables the development of clinical manuscripts suitable for submission to major journals for publication. Although somewhat restricted to maximize the research effort, residents during the lab rotation are allotted night call to aid the other residents with some clinical responsibilities during this period.

The fourth postgraduate training year is divided into two equal six-month rotations on the A and B. The A service combines both private and clinic patient care, including both inpatient and outpatient treatment experiences. The urology resident is exposed to primary urologic care, including the initial patient evaluation, diagnostic testing, therapeutic modalities, and patient care follow-up. The resident experiences a gradual increase in the intensity and complexity of patient care tasks and responsibilities throughout this year.

Specifically, the resident is responsible as the primary care provider for clinic patients. The decision and arrangements for hospital admission, surgery, and therapy are primarily the resident's responsibility, although management will be discussed by senior staff members. After the patient is discharged, the resident is responsible for outpatient follow-up care.

The residents are supervised by the physicians on the A service, which emphasizes urologic oncology but also contains general and minimally invasive urologic therapy. In the operating room, this resident serves as an assistant to the chief resident on major cases, such as radical cystectomy and radical prostatectomy, and as surgeon on less complex cases. An increasing proportion of extirpative surgical procedures are being performed using hand-assisted laparoscopy, including adrenalectomy, nephrectomy, and nephroureterectomy.

The other six months of the PG4 year is spent on the urology B service, which provides a very solid background in calculus disease therapy including ESWL and urologic endoscopy, especially complex procedures such as percutaneous nephroscopy, and flexible ureteroscopy with laser therapy. The responsibilities on the B service are similar to the A service.

During this year, the resident participates in the initial evaluation of the patient and learns to arrange for admission, consultations, in-hospital acute care, participate in surgery, and postoperative follow-up care. After a patient's discharge, the resident further appreciates the consequences of the intervention provided to the patient through outpatient visits with a specific attending supervising. During these office hours, clinic patients are mixed in with the private patients so the resident maintains his own outpatient responsibilities. This continuity of patient care forms a rich, rewarding framework for a sound foundation in urologic training.

This, the first year as a senior resident in urology, will be broken into three rotations, to include four months at A.I. duPont, two months at Wilmington V.A. and six months at Bryn Mawr Hospital. The rotations for A.I. duPont and Wilmington V.A. are described above in the PG3 year in great detail, and should be referred to for the curriculum. It is the identical training as during the PG3 year, but is simply split over the PG3 and PG5 years so as to act as a refresher course later in the residency program. This allows a full six months at the V.A. and du Pont over the four urology years.

As mentioned above, the remaining six months of this year are spent at Bryn Mawr Hospital. Here the resident is responsible for inpatient and outpatient, clinic and private urology patient care. This is a large service where the resident develops considerable experience with a rather heavy patient load.

The resident is fully responsible for all patients under the supervision of six attending urologists. During the rotation, the resident's responsibilities in surgical, preoperative, and postoperative cares are steadily increased. He is responsible for follow-up of these patients in the private office hours.

This has proven to be a very valuable experience for the residents. It is during this time that he develops an appreciation for the private practice of community urology.

This, the chief year of urology residency training is divided into six months as chief urologic resident of the A service and six months as chief urologic resident on the B/C service. The resident is totally responsible for all urologic patients, selecting any and all urology care in which he would like to participate. The chief resident is responsible for a significant volume of both private and clinic patients. The chief resident is also responsible for directing patient management by the residents on the A, B, and C services. During this chief year, the resident further develops his sense of responsibility and surgical skills required to function independently after residency has been completed.