The goals of the PGY-1 year of training are for the resident to (a) gain broad knowledge of surgical principles, (b) learn skills of pre-operative evaluation, peri-operative care, and management of surgical patients, (c) learn basic surgical techniques including suture tying, wound care, and acute and emergency resuscitation of surgical patients. The rotations will incorporate 13 separate four-week blocks and will include 7 urology rotations, 4 core general surgery rotations (Acute General Surgery, Surgical Oncology, Surgical Intensive Care Unit, and Surgical Night Float), and 2 non-general surgery rotations (plastics and urogynecology).
Urology Rotations (7 blocks):
During these rotations, there will be flexible scheduling between VCU and the VA with primary assignment to the VA to promote acquisition of clinic skills as well as office-based cystoscopy with interventions, prostate biopsy, vasectomy, circumcision, percutaneous suprapubic catheter placement, and minor operative procedures in the OR. The PGY-1 resident may assist as a consult “triage” in coordination with the senior Consult Supervising Resident. The PGY-1 will also present during didactics, indication conferences, and journal clubs and will assist in the completion of weekly pre-operative lists and daily sign-out/transition lists.
Non-Urology Surgical Rotations:
- Surgical Oncology* (1 month)
- Acute General Surgery* (1 month)
- Night Float* (1 month)
- Surgical/Trauma ICU* (1 month)
- Plastic Surgery (1 month)
- Urogynecology (1 month)
The goal of the PGY-2 year is to begin the experiential process in the diagnosis, treatment, and surgical management of urological diseases. This critical and formative year consists of twelve months of clinical urology experience under direct supervision of the Urology faculty. During this year, residents complete alternating two-month rotation blocks at the VCU Medical Center and the Hunter Holmes McGuire VA Medical Center. The purpose of this two-month rotation block is to provide exposure to different senior and chief residents who may have diverse teaching, leadership, and administrative styles. However, there will, by necessity, be some imbalance in resident-to-resident exposure. In addition, PGY-2 residents are trained in endoscopy, basic surgical techniques, and outpatient diagnostic procedures. Specific roles and responsibilities of the PGY-2 resident include:
Responsibilities at both VCU/VAMC
- Management of floor patients with responsibility to write daily progress notes
- Double scrubbing with senior residents on endoscopic, intro, and advanced cases
- First call for floor coverage (supervised)
- Management of daily and weekend sign-outs
- Providing assistance in completion of weekly pre-operative case lists
- Providing assistance in preoperative patient preparation
Responsibilities at VCU only:
- Attending afternoon clinic coverage
Responsibilities at VAMC only:
- Primary management of clinic procedures including cystoscopy, prostate biopsy, bladder Botox, bladder biopsy, SP tubes, and SCI clinic procedures with expectation to perform at least 50% of scheduled procedures.
VCUHS and Clinics Rotations: This PGY-2 rotation involves in-patient and out-patient services as a part of a urology resident team under the supervision of the chief resident and urology faculty. The daily structure of the rotation is designed to allow the resident to spend A.M. hours double scrubbing on cases with senior residents, managing floor patients, or triaging consults for presentation and review with the senior Consult Supervising Resident. The resident will then spend P.M. hours working under the direct supervision of urology faculty in the Nelson Urology out-patient clinic. He/she gradually learns and masters outpatient patient evaluations including thorough history and physical examination and preoperative assessments. He/she is also introduced to outpatient procedures and minor and endoscopic cases in the operating room. The resident is expected to gradually gain experience in cystoscopy with interventions, urodynamics, transrectal needle biopsy of prostate, diagnostic imaging studies, and minor open surgeries. The large volume of new and returning patients in the clinic provides ample resources for the resident to learn urologic data collection, primarily history and physical examination, interpretation of diagnostic tests including imaging and laboratory studies, synthesis/analysis of patient data, and decision making in the diagnosis and management of patients under the guidance of the supervising faculty. He/she acquires also skills in peri-operative evaluation and clinical communication.
McGuire VA Medical Center: The expectations and approach are the same for this rotation.
At the McGuire VA rotation, the resident is a part of the urology team which covers both the outpatient and inpatient services, as well as the consult service. Therefore, the PGY-2 resident acquires knowledge and skills in peri-operative evaluation and management as well as care of urologic in-patients. The resident is expected to learn clinic procedures including cystoscopy with interventions (stent removal, bladder biopsy, botox injection, prostate biopsy, and suprapubic tube placement early in the rotation and will also participate in O.R. procedures.
The major emphasis of the PGY-3 year is academic achievement as well as refinement of clinical decision-making, endoscopic, and surgical skills. During this year, residents complete a six- month rotation in Pediatric Urology at VCU Medical Center. An additional six-months is devoted to scholarly basic science and clinical resident research.
Research Rotation: Each resident is required to be academically and scholarly productive during his/her residency training at VCU. Therefore, in preparation for these six months of research, the resident is required to meet with Dr. Klausner (director of research rotation) to discuss topics at least 3 months prior to the start of the rotation. During the research rotation, the resident will be guided and supervised by Dr. Klausner or other designated faculty research mentors with the expectation that he/she will produce or contribute to a publishable manuscript(s) during his/her training. In addition, he/she is expected to submit least one abstract every year.
The research resident (a) participates in the call schedule; (b) may need to cover for the vacationing resident; and (c) will help in organizing research conferences. The research resident is expected to present progress of his/her research at didactic conference or grand rounds. The resident is also expected to attend the mandatory AUA’s Fundamentals in Urology course in June of each year. During the research rotation, the resident is expected to work in the lab approximately 4 days/week with approximately 1 day/week assigned to clinical duties. Due to the need for significant coordination with collaborators, co-investigators, and outside resources, the research resident is expected to arrange clinical duties as far in advance as possible. “Pulling” for non-emergent clinical situations with minimal notice will not be permitted. All requests to cover clinical duties should be approved directly by the program director.
Pediatric Rotation: The pediatric resident is expected to continue the experimental learning and application of data collection, data analysis/interpretation of imaging studies, laboratory tests, and consultative recommendations in the decision making in the management of pediatric urologic patients. Surgical experience and autonomy will advance at an individualized pace as directed by the pediatric faculty. The resident remains, always, under the supervision of both the urology faculty and the chief resident. The pediatric resident is considered a sub-unit of the larger VCU urology team, and is therefore expected to contribute to the adult service when pediatric clinical work is completed. The pediatric resident must report daily to the chief resident for this purpose. To help with coordination between the pediatric and adult VCU services, the pediatric resident must complete a pediatric pre-operative case list with pertinent details for the upcoming week which will be reviewed with the chief resident and distributed to the faculty. Specific roles and responsibilities of the pediatrics rotation include:
- Monthly submission of resident call schedule, excluding chief call
- Maintaining resident vacation schedule in conjunction with residency coordinator
- Attend GU Tumor Board Conference
- Completion of weekly pediatric pre-operative case list
- Contributing to the VCU adult service on completion of pediatric clinical work
During this year, residents complete alternating 3-month rotation blocks at the VCU Medical Center and the Hunter Holmes McGuire VA Medical Center.
VCU and VA Rotations: During this rotation, the resident (a) assists the chief resident in overseeing the care of in-patients and all major adult operations; (b) teaches junior level residents and medical students; and (c) is responsible for in-patient consults under the supervision of the designated attending urologist. He/she must present complicated consults to the chief resident.
Specific responsibilities include:
- Preoperative case preparation including documentation of history and physical exam, informed consent, and required orders for antibiotics, blood products, etc,
- Serving as the Consult Supervising Resident and managing the consult service
- Reviewing consults with the consult “triage” junior residents with the responsibility to directly examine and document all consults (other than simple catheter placements/changes)
- Double scrubbing with junior residents to provide instruction on the performance of introductory and endoscopic cases
- Assumption of the role of “acting Chief” during vacations, conferences, travel, etc
- Assisting the chief resident in overseeing the care of in-patients and in the OR
- Teaching, supervision, and oversight of junior residents and rotating students
PGY-5 | CHIEF RESIDENT IN UROLOGY
The major emphasis of the PGY-5 chief resident year of urologic training is mastery of surgical skills and clinical decision-making through operative experience and teaching. During this year, residents spend alternating six-month rotations as the chief resident at VCU Medical Center and the Hunter Holmes McGuire VA Medical Center. He/she is expected to demonstrate strong administrative and leadership abilities, productivity in scholarship/research, serve as a role-model in teaching of junior residents and medical student, and demonstrate excellent clinical skills. He/she supervises the consult service run by the senior residents. The chief resident is expected to teach junior level residents and the medical students, and help to enrich the medical student’s experience during his/her rotation on Urology.
Specific responsibilities include:
- Patient Management: Direct management of in-patients and oversight of the Consult and Pediatric services with ultimate responsibility for all services
- Supervision: Direct supervision and oversight of residents and rotating students in the clinics, wards, and operating rooms
- Faculty Liaison: Function as an advisory mediator and faculty liaison for any junior resident concerns, critiques, or comments regarding any aspect of the program
- Teaching: Engage in on-going education both formally and informally of residents and rotating students during rounds, cases, and other teaching opportunities
- Feedback: Provide informal feedback to junior residents and rotating students and serve as a liaison to the PD regarding required duties as well as expected skills and functions
- Arrangement of weekly calendar listing expected cases with assignment of residents (at least 1 week in advance) with written notification to the faculty and surgical scheduler.
- Provide written notification to program director, residency coordinator, site directors, and surgical scheduling coordinator regarding leave and foreseen resident staffing issues.
- Presentation/management of monthly Q&A, pathology, and radiology conferences.
- Assignment and oversight of administrative responsibilities including preop list creation and presentations for indications conference.
- Organization of chief call schedule and management/oversight of overall schedules with notification of all elective leave (by juniors) at least 1 month in advance, if possible.