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Department of
Urology |
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Rotations: First year residents (URO-1) spend four months on
the University rotation and 8 months at the VA Hospital . Both of these rotations provide resident
exposure to a large volume of non-private patients. Both of these rotations have adequate
facilities for in-patient and out-patient care. During both of these rotations first year
urology residents learn, under supervision, the proper assessment of urologic
out-patients with particular attention to preoperative assessment. They are responsible for the evaluation and
subsequent admission history and physical for those patients requiring hospitalization. They also see these patients for
postoperative management in conjunction with the chief resident. During the hospitalization, the first year
resident is responsible, under supervision, for the routine hospital care,
arrangements for diagnostic studies, and preparation for the operating
room. During this year, the residents
are initiated into the fundamentals of transurethral prostatic resection
under the personal supervision of the faculty. During October and November of
the first urology year, residents are assigned to the freshmen medical
students anatomy class; a six week period during which time the students are
dissecting the abdomen, pelvis and perineum.
This six week assignment consists of three, four hour sessions per
week; one hour of lecture followed by three hours of dissection. The residents attend the lectures and then
serve as instructors, each with four medical students per cadaver. This basic science instruction, although
time consuming, has proven to be very helpful as the residents progress to
the more senior years. Second
year (URO-2) urology residents are assigned to three four month rotations:
the LeBonheur Children's Hospital rotation, Methodist rotation, and the
University rotation. The Children's
Hospital rotation is under the direction of Dr. H. Norman Noe, the training
director for that institution and the Program Director for a fellowship in
Pediatric Urology. For most of our
residents, this rotation represents the first direct exposure to pediatric
patients since their pediatric experience as a medical student. Therefore, a significant amount of time is
devoted to provide the residents with an understanding of the fundamentals of
pediatric care. In conjunction with a
Uro-4 urology resident, a pediatric fellow and the two full time pediatric
urologists in our division, the second year urology resident is exposed to
the pre and post-operative care of pediatric urologic patients as well as the
care of hospitalized pediatric urologic patients, most of which undergo
diagnostic or therapeutic surgical procedures. The second year urology resident, under
supervision, is responsible for patient care in the LeBonheur Hospital
outpatient urologic clinic, the Children's Special Services Clinic, and the Myelomeningocele
Clinic. The resident is also
responsible for the evaluation and management of hospitalized patients, under
the supervision of the urological staff as noted above. An additional four
month rotation to the University is provided for the second year urology
resident. During this rotation, the
resident assumes additional responsibilities and continues to participate in
the out-patient clinics and in the care of hospitalized patients. Training in transurethral prostatic surgery
continues during this rotation and in most cases progresses to a level at
which the operative procedure can be totally completed within a prescribed amount
of time. The resident is given the
opportunity to perform open surgical procedures such as, but not limited to,
ureterolithotomy, simple open prostatectomies, pelvic lymph node dissections,
and other procedures of similar difficulty.
He/she is given the opportunity for additional decision making; for
example, pre and postoperative care.
In all cases, the resident remains under faculty supervision. Third year urology residents (URO-3)
spend four months each at the University, Methodist Hospital and the Veterans
Administration Medical Center-Spinal Cord Injury Urology Unit. During these rotations, the resident functions
as a chief resident. Responsibilities therefore, are greater in that the
resident reports directly to the training directors of the respective
institutions. Urology residents
assigned to this rotation are responsible for the University Urology Service;
a service representing three types of patients; (1) private patients of the
voluntary urology faculty who agree to admit to this service and allow
resident participation in the medical and surgical management of their
patients; (2) private patients of the full-time UT urology faculty; (3) non-private patients are seen in the
hospital clinic by the resident, supervised by the training director, and
subsequently hospitalized to the non-private service. Postoperative care of these surgical
patients is performed in the non-private hospital clinic by the resident
under supervision by the training director.
On average, the University service has 10 patients; 5 private and 5
non-private. This is an opportunity
for the resident to observe and participate in the in-patient care and surgery
of private patients of various faculty members. In so doing, the resident is under the
direct supervision of the individual urologic practitioners (all of whom have
faculty appointments) as well as the training director. Supervision of the resident on non-private
patients, both out-patient and in-patient, is accomplished by the training
director. Methodist Hospital is
likewise a large private hospital in which the residents have a four month
rotation. The resident is assigned
responsibility for certain in-patients by the faculty. In addition, Methodist
Hospital maintains a non-private service with an average urologic census of
between 2 and 4 patients. There is
also a weekly out-patient urologic non-private clinic which is staffed by the
resident under the supervision of the training director. The resident is responsible for the
pre-operative assessment, hospitalization and post-operative care of these
non-private patients. Supervision of
these activities is performed by the program director. Methodist Hospital is also affiliated with
the University of Tennessee, Memphis and is a training site for many UT
Memphis residency programs; including General Surgery.
Fourth
year urology residents (URO-4) are chief residents for four months each at
University, Veterans Administration Hospital and LeBonheur Children's
Hospital. All three of these rotations
represent standard chief residencies.
At University, the chief resident is responsible for organization of
the service both out-patient and in-patient.
It is the chief residents responsibility, under the supervision of the
training director, to assign duties to the first and second year urology
residents, to organize the surgical schedule, to prepare for daily afternoon
rounds with the training director, to maintain a liaison with other relevant
services, and to provide consultation when necessary to the trauma
center. The chief resident at the
Veterans Administration Hospital is likewise expected to organize the service
and assign junior resident functions with the goal of an efficient management
of the in-patient and out-patient services.
The chief resident is under the direct supervision of the relevant
training director during this four month rotation. He/she is not responsible for, but
maintains a close liaison with, the third year urology resident in the Spinal
Cord injury Urology Stone Center. The
final four month rotation of the fourth urology year is at LeBonheur
Children's Hospital as chief resident.
In this position, the resident is responsible for organization of the
pediatric urology service with supervision from the pediatric fellow and the
pediatric training director and is responsible for organization and staffing
of the pediatric clinics and for the preoperative and postoperative care of
these patients. Operative procedures
are performed under the supervision of the pediatric training director, and
data complied to date indicating that a satisfactory surgical experience is
occurring. |
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