The Urology Surgery Residency Training Program follows the Residency Review Committee (RRC) guidelines of the Accreditation Council for Graduate Medical Education (ACGME):
- Home call during all 12 rotations
- 80 hours of work or less is required in the hospital per week
- Residents receive at least one weekend day per week with no clinical responsibility (no rounds/beeper off)
Urologic Surgery residents rotate through the core program in General Surgery. This offers graded responsibility with the primary emphasis on pre- and postoperative patient care. During this year, the residents have a 12-week rotation in genitourinary surgery and eight five-week rotations that include a night float system and one night of in-house call per week. They rotate through the Intensive Care Unit (ICU), general surgery, cardiothoracic surgery, the transplant service, pediatrics and selected sub-specialty surgical services. This set of rotations enables the PGY-1 resident to obtain the following goals:
- Develop skill in obtaining medical histories and performing physical examinations
- Learn all aspects of routine pre- and post-operative management of surgical patients
- Learn management of acutely ill patients in the ICU, including cardiopulmonary resuscitation, management of ventilators, endotracheal intubation, placement and management of tubes and access lines
- Learn how to care for patients in the Emergency Room, including the general management of trauma
- Learn the principles of transplantation and vascular surgery
- Learn basic surgical techniques
During the first year of the Urology Training Program, residents rotate in four-month blocks at Barnes-Jewish Hospital South, St. Louis Children’s Hospital and the St. Louis VA Medical Center.
While at Barnes-Jewish South, the URO-1 resident works closely with the chief resident and the URO-2 resident. He or she is responsible for learning basic inpatient and outpatient urological care as well as minor urological procedures including circumcision, orchiectomy, cystoscopy, retrograde pyelography and bladder biopsy. In addition, the resident receives training in the insertion of Foley urethral catheters, insertion of suprapubic tubes, use of urethral dilators and performance of flexible cystoscopy in the Emergency Room and intensive care units. While on the Barnes-Jewish South rotation, the URO-1 resident is on home call every fourth night.
At Children’s Hospital, the URO-1 resident works with a URO-3 resident. The URO-1 resident is responsible for inpatient urological care as well as seeing patients in the outpatient area with the attending physicians. The resident is exposed to common urological procedures performed in children such as circumcision, orchiopexy, cystoscopy and more straightforward hypospadias repair. While at Children’s Hospital, the URO-1 resident takes call from home every other week.
At the VA Medical Center, the URO-1 resident works with URO-3 resident and a URO-4 resident (chief resident). The URO-1 resident is responsible for learning inpatient and outpatient urological care. The URO-1 resident’s operative training includes all minor cases such as circumcision, orchiectomy, cystoscopy, catheter manipulation, urethral dilation and office-based procedures such as prostatic ultrasonography and biopsy. The resident takes call from home every other week.
The URO-2 year consists of four-month rotations on Barnes-Jewish Hospital South, Barnes-Jewish Hospital North and Barnes-Jewish West County Hospital.
The Barnes-Jewish South URO-2 Ward resident has responsibilities for general inpatient care and participates with the Ward chief resident in managing Ward cases in the clinic, operating room, hospital inpatient floors and consults. Additionally, he or she has responsibilities as needed in the Emergency Room and has an obligation to the Ward Clinic, which is held weekly on Friday. While at Barnes-Jewish South, the URO-2 resident is on home call every fifth night.
The Barnes-Jewish North URO-2 resident is responsible for all aspects of general inpatient care and specifically is expected to master skills appropriate to open urological surgery and endoscopic surgery. Special emphasis is placed on infertility during this rotation because of its proximity to the reproductive endocrinology center. The resident is also responsible for consults in the hospital and in the Emergency Room, and the resident is exposed to private practice urologists who admit patients to Barnes-Jewish North. The URO-2 resident at BJH-North is on home call every fifth night.
The Barnes-Jewish West County URO-2 resident has an opportunity to learn general and female urology in the office evaluating patients, in the urodynamics laboratory and in the operating room. Additionally, he or she has responsibilities as needed in the Emergency Room and consults in the hospital as well as an obligation to the Ward Clinic, which is held weekly on Friday. The URO-2 resident participates in call obligations at BJH-West County.
During the URO-3 year, the residents spend four months at the VA Medical Center, St. Louis Children’s Hospital and Barnes-Jewish Hospital South (endourology/laparoscopic rotation).
While at the VA, the URO-3 resident enhances skills in evaluating patients in the clinical setting as well as developing operative skills with more sophisticated endourology and endoscopic procedures such as transurethral resection of the prostate, ureteroscopy, percutaneous stone manipulation and other upper tract endoscopic procedures. The URO-3 resident is also exposed to laparoscopy at the VA Medical Center. He or she is also responsible for consults and Emergency Room coverage. Call at the VA Medical Center is from home on an every-other-week basis.
At Children’s Hospital, the URO-3 resident participates in more sophisticated open surgical and endoscopic procedures. The URO-3 resident participates in a clinic three times per week to gain exposure to the process of evaluating children in an outpatient setting, selection of children for surgical procedures and postoperative follow-up. There is also a pediatric urodynamics clinic conducted by Drs. Paul Austin and Doug Coplen where children with functional or neuropathic voiding dysfunction are evaluated on an ambulatory basis. The URO-3 resident is also responsible for covering the Emergency Room and inhouse consults. Call at Children’s Hospital is from home every other week of the rotation.
The Barnes-Jewish South Endourology URO-3 resident is responsible for covering the endourological surgeons who are performing laparoscopic endourologic procedures as well as lithotripsy. This resident also has clinic time with the endourology attendings. The Barnes-Jewish South Endourology URO-3 resident is responsible for home call every sixth night.
Chief resident rotations are four months in length at Barnes-Jewish Hospital South, the VA Medical Center and Barnes-Jewish Hospital North. All URO-4 chief residents are on call from home (second call) as back up to more junior residents. The goals of these rotations are to allow the resident to master all aspects of urological care.
The Barnes-Jewish North resident is responsible for running the public patient clinic and, with appropriate supervision from the attending, to select and perform surgery on patients. For this purpose, each attending sets aside one OR day per month into which the URO-4 may schedule a subspecialty-appropriate operation. A similar degree of autonomy is available for the URO-4 chief resident at the VA. The URO-4 resident at Barnes-Jewish South, in addition to his or her responsibilities to oversee the running of the service, refines his or her skill with open surgery and directs consults on inpatients. The URO-4 resident at Barnes-Jewish South also coordinates the schedules of the residents as the administrative chief resident.
The residents at each hospital have graded responsibility for care of the patients. In general, decision-making is encouraged by residents at all levels with an expectation that residents will discuss their decision-making with more senior and chief residents and, ultimately, the responsible faculty member. Continuity of care is implemented by allowing residents on eight of the rotations (URO-1: SLCH and VA; URO-2: BJH-N; URO-3: VA, BJH-S and SLCH; URO-4: BJH-N and VA) to see and evaluate patients in the urological outpatient offices preoperatively, in the hospital or operating room (if surgery is to be performed), and postoperatively, as well.
At Barnes-Jewish South and Barnes-Jewish North, allied personnel, such as nurse practitioners and surgical assistants, are available and under the supervision of the administrative chief resident and program director to perform certain histories and physicals, and to assist at surgery, as needed.