Department of urology

Resident Responsibilities

The Department of Urology is actively involved in all phases of adult and pediatric urology and currently performs more than 1,000 major operative procedures each year. We have a multidisciplinary prostate cancer center, which will be housed in the newly expanded Hollings Cancer Center. Our program incorporates the Medical University of South Carolina Hospital, MUSC Children's Hospital, Charleston Memorial Hospital, and the Veteran's Administration Medical Center in Charleston, South Carolina.

Resident Responsibilities
The urology residency program is structured to provide the resident with a strong background in all aspects pertinent to urological surgery. Two positions are made available per year.

Training Structure
PGY-1 General Surgery
PGY-2 Uro-1
PGY-3 Uro-2
PGY-4 Uro-3
PGY-5 Uro-4

The Medical University Hospital (MUH) will be covered by a first, second, and chief resident daily (except for vacations and meetings). The junior residents will direct adult patient care under the supervision of the chief resident and the attendings. The surgical intern will be assigned to the MUH and the senior and junior medical students will be assigned to the MUH or the Veteran’s Administration Hospital (VAH). At the VAH, ward rounds will be at the discretion of the chief resident, and with concurrence of the attending staff. The VAH service is covered by a chief resident and a second or third year urology resident.

At the MUSC Children’s Hospital, one urology resident will be in charge of pediatric patient care under the supervision of the attending pediatric urologist. The pediatric urology resident covers the Children’s Hospital urology patients, consults, and assists in clinic with the attending. The resident is typically in the OR on this service two to three days a week.

Admission histories and physical examinations should be completed in a timely fashion (no later than 24 hours from the patient’s admission). The intern and junior residents will share responsibility for completing all evaluations and discussing them with the proper attending physician.

The chief residents must be informed (by the junior residents) of all consultations directed to urology, all adverse changes in the course of a patient, emergency admissions, actions contrary to the welfare of the Department (confrontations with ancillary and/or support staff, etc.) and will report these to the appropriate attending (clinical matters) or the chairman (Departmental matters) as they occur. They will respond to hospital consultations and notify the proper attending physician. They will notify each attending of any patient admitted to his service (at the time of admission) and will present a plan of action (to be discussed with the attending). All admissions must be discussed with the proper attending prior to admission.

Residents will not allow a patient to be anesthetized without the express knowledge and consent of the attending physician. No case in this system will be done without the attending actively involved. We will adhere to the elbow-to-elbow doctrine that meets HCFA standards. It is expected that residents will be fully knowledgeable about patients on whom they are operating, as well as the procedure(s) contemplated. Failure to be so informed may result in censure by the attending including exclusion from the operative case. Any untoward event (including complication, drug reaction, change in patient course, misunderstanding with attendings, residents, nurses, ancillary personnel or staff) will be brought to the attention of the attending immediately. No operative case will be terminated until the situation is clarified and discussed with the attending. Only the attending will make the decision as to disposition. Any deviation from this policy may result in immediate dismissal from the program. All residents will show sensitivity to patients and family needs. Patient information is not to be discussed in public. All residents will maintain cordial decorum with all hospital personnel as well as with each other, and resolution of differences of opinion will be carried out in a straightforward and reasonable fashion. If personal differences cannot be resolved between individuals, they will be brought to the chairman. Residents will be judged fairly on performance and inherent in this concept is that judgment must be evaluated and treatment courses critiqued. This must be carried out in a positive fashion so maximum learning experience is achieved.

Residents are to be in the OR 15 minutes prior to scheduled start time to assist in patients' positioning and to ensure that all cases start on time. Operative dictations must be done on the day of the procedure. It is advisable that these be done immediately after the procedure. The resident should confirm with the attending physician before the end of each case who is responsible for dictations. Attending physicians must be listed first and their presence in the OR properly documented. Discharge summaries must be done within 24 hours of the patient’s discharge and are the responsibility of the junior residents and intern on service. They are not to be done by medical students.

Call Schedule
The chief resident assigned to the MUH rotation will be responsible for making a monthly call schedule. These will be due to the residency director by the 15th of the preceding month. The Department allows for call to be taken from home as long as patient care is not compromised. The residency director reserves the right to institute “in-house” call should there be any indication that patient care has been compromised. Call for the junior resident varies from 6-7 weeknight calls and 1-2 weekend block calls. The junior residents have from 2-3 weekends off a month. The intern takes rotating within this framework and also shares with weekend block call. Outside after hours calls are directed to either the junior resident or the chief resident. All physician calls will be directed to the attending physician on call. The on-call attending will be designated as the physician of the day and will be responsible for all consults on that day. Adult attending call schedules will run from Friday through the next Friday. The pediatric urology attending covers all pediatric consults. In his absence, the on-call attending will cover pediatric call.

Research Activities
There is no dedicated research time. However, there are ample opportunities to get involved with basic and clinical research. Each resident is expected to publish at least one paper and to make a presentation at a major urological conference during the course of their residency.

Educational Activities
Formal ward rounds and weekly specialty conferences, including grand rounds, basic science lectures, Campbell’s Conference, Morbidity and Mortality Conference, and Pre-Operative Conference are the mainstays of the didactic training. A monthly journal club in conjunction with local, private urologists is held to discuss current publications.

PGY-1
This year is designed to introduce the trainee to the broad field of surgery. Rotations are provided in general surgery, transplant surgery, pediatric surgery, cardiothoracic surgery, gastrointestinal surgery, surgical oncology, urology, and critical care. Rotations are performed at the Medical University Hospital, the Children’s Hospital, and the VA Hospital. A minimum of five months is spent
on the general surgical services. In each of these areas, the PGY-1 trainee is given responsibility commensurate with his/her interest and ability. He may have the opportunity to perform operations under the direct supervision of chief residents and attending surgeons.

Primary emphasis is placed on the evaluation of the surgical inpatient and outpatient. The trainee works as a junior ward officer where all aspects of preoperative and postoperative care are stressed.

The PGY-1 is also responsible for much of the administrative aspects of patient care, including ensuring timely completion of histories and physical examinations, and progress notes whether completed by the students or other members of the team. The trainee assures that all aspects of care are addressed by communicating them in the doctor's orders and assuring that these orders have been accomplished.

Together with other junior residents on the service, the PGY-1 is responsible for the dictation of accurate and concise discharge summaries. When the PGY-1 is the primary operating surgeon, he is responsible for dictation of the operative note immediately following the procedure. By the end of the PGY-1 year, the intern is comfortable with ward clinical problems, basic critical care, and ATLS and ACLS protocol.

PGY-2
This is the first of four dedicated urology post-graduate years. The resident will become familiar with office-based urology, including the initial evaluation of adult and pediatric urologic patients, performance of office-based procedures, including, but not limited to cystoscopy, transrectal ultrasound and prostate biopsy, vasectomy, and urodynamic studies. He or she will learn how to work-up common urological problems encountered in hospital consultations and will learn how to deal with urological emergencies.

The resident will develop an understanding of socio-economic issues related to medicine, including the practice of delivering cost-effective medical care. He or she will develop an understanding of the ethics of the medical and urologic profession and will become an active participant in conference discussions and journal club presentations.

PGY-3
By the end of the PGY-3 year, the resident will be able to evaluate all urologic patients under his care, and organize a plan of management acceptable to the chief resident and attending physician. This plan will include total assessment of the patient, evaluation and interpretation of all pertinent accompanying information, determination of appropriate diagnostic studies, and providing a rationale for therapy.

The resident will develop an understanding of adult and pediatric anatomy and physiology as it relates to urologic patients and learn the medical and surgical management of adult and pediatric patient. The resident will understand basic urologic disease including uro-oncology, benign diseases of the prostate, voiding dysfunction, chronic and acute renal failure, male infertility, and erectile dysfunction, as well as, become proficient in common pediatric urologic conditions, including hydronephrosis, vesicoureteral reflux, posterior urethral valve disease, bladder pathophysiology, and pediatric malignancies.

The resident will become proficient in office based urology, including the initial evaluation of adult and pediatric urologic patients, performance of office based procedures, including, but not limited to cystoscopy, transrectal ultrasound and prostate biopsy, vasectomy, and urodynamic studies. He or she will be responsible for moderating pre-operative conference.

The resident will become proficient in minor operative urology, including endourologic procedures, open surgical procedures, pediatric surgical procedures, and lithotripsy and will learn the details of major urologic operative procedures by active participation in cases as time allows.The resident will develop an understanding of pre-operative assessment of patients and post-operative management of surgical
patients. He or she should at this point be actively involved in an independent research endeavor within the department.

PGY-4
By the end of the PGY-4 year, the resident will be able to evaluate all urologic patients under his care, and organize a plan of management acceptable to the chief resident and attending physician. This plan will include total assessment of the patient, evaluation and interpretation of all pertinent accompanying information, determination of appropriate diagnostic studies, and providing a rationale for therapy. The resident will further his understanding of adult and pediatric anatomy and physiology as it relates to urologic patients. The resident will serve as the administrative chief of the pediatric service during his time on that service. The resident will understand complex urologic disease including uro-oncology, benign diseases of the prostate, voiding dysfunction, chronic and acute renal failure, male infertility, and erectile dysfunction.

The resident will be comfortable with office-based urology. He or she will also finalize the process of learning all medical and surgical urology as it relates to the pediatric population. The resident will remain an active participant in conference discussions and journal club presentation and will continue the process of learning operative urology, including endourologic procedures, more complex open surgical procedures, and lithotripsy. The resident will learn the details of major urologic operative procedures by active participation in cases as time allows. The resident will have an understanding of pre-operative assessment of patients and post-operative management of surgical patients.

By the end of the PGY-4 year, the resident will have completed an independent research endeavor and prepare for presentation at a major academic meeting.

PGY-5
The chief residents will prepare the service report presentations, lead grand rounds and other didactic functions, oversee all patient care, review preoperative evaluations, schedule patients for hospital admission and surgery, control hospital beds, and assign operative cases. In essence, administrative functions will be entirely assumed by the chief residents. The chief will meet independently with the
junior floor residents each morning and make rounds on all patients.

The PGY-5 year will be devoted to mastering medical and surgical Urology and developing administrative skills necessary for the performance of high quality urology, either in an academic or private practice situation. The resident will serve as administrative chief of the respective institution and serve as a junior faculty under the guidance of the faculty. The resident will organize the residency program under the guidance of the residency director and take initiative with the didactic schedule and ensuring that all conferences are attended. The resident will master the understanding of adult anatomy and physiology as it relates to urologic patients and finalize his understanding of urologic disease, including uro-oncology, benign diseases of the prostate, voiding dysfunction, chronic and acute renal failure, male infertility, and erectile dysfunction.

The resident will master office-based urology, including the initial evaluation of adult urologic patients, performance of office based procedures, including, but not limited to cystoscopy, transrectal ultrasound and prostate biopsy, vasectomy, and urodynamic studies. The resident will become proficient in operative adult urology including preoperative and postoperative management and discussion of alternative therapies with surgical patients. The resident will lead most conference discussions and journal club presentations, including actively participating in the development of conference schedules.

The resident will finalize the process of learning operative urology and learn the details of major urologic operative procedures by active participation in all major cases.

 Clinical Specialties

  • Urologic Oncology - diagnosis and treatment of all types of genito-urinary cancers
  • Sexual Dysfunction and Infertility - diagnosis and treatment of male sexual dysfunction and infertility
  • Minimally-Invasive and Laparascopic Surgery - breadth of endoscopic and less invasive procedures performed
  • Urinary Incontinence and Female Urology - diagnosis and treatment of bladder dysfunction
  • Pediatric Urology - diagnosis and treatment of genito-urinary disorders in children
  • Video Urodynamics

Medical Students
Several MUSC medical students rotate through the Department of Urology every 2 weeks. One week is  spent at MUH and the other at the VA Hospital. Students are encouraged to follow patients postoperatively, spend one-on-one time with attendings in clinic, and scrub for the OR. All of our residents are active participants in medical student teaching. Morning rounds with the Chief Resident, junior resident, intern, and students, although informal, are a rich learning experience. Residents discuss basic but important clinical topics with students regularly. The Department of Urology encourages students from other institutions to visit for an externship. There are also ample opportunities for students to become involved in research.