Pre-Urology (Intern) Year
We require that all of our pre-urology residents perform their PGY1 general surgical training at Vanderbilt. The first year of the general surgery residency program is designed for 12 one-month rotations. The rotations occur at Vanderbilt Hospital, the Veterans Affairs Hospital, and at St. Thomas Hospital, which is a private hospital in Nashville with a busy surgical program. The resident rotations are selected through consultation between the Urology program director, Dr. Peter Clark, and Dr. John Tarpley, program director for General Surgery. Feedback from our residents has indicated that the most valuable experience occurs on the General Surgery rotation both at St. Thomas and Vanderbilt, Pediatric Surgery, Vascular Surgery, SICU, and the Emergency Room. Therefore, these rotations are included for all residents. Additional months are selected from Cardiothoracic Surgery, GI/Laparoscopy, Urology, and other surgical subspecialties.
Each resident at this level spends two six-week rotations at the Department of Veterans Affairs Hospital, the Pediatric Urology service at Vanderbilt, Vanderbilt University Hospital and the Urology Outpatient Clinic. The year is designed to give the resident exposure to all aspects of Urology at a junior level so that the individual can obtain a broad base for graded and increased responsibility and learning in subsequent years. On the Vanderbilt service, the emphasis is primarily on operative experience and inpatient care but the resident sees all patients preoperatively and has the opportunity to see many of them when they return to the clinic for postoperative care. On each rotation, the resident is matched with a senior level resident. The Urology 1 resident becomes proficient at cystoscopy, transrectal ultrasound and prostate biopsy, renal and bladder ultrasound, and other commonly performed clinic procedures. He or she participates as the primary surgeon on many of the more minor surgical procedures. The design of the Urology 1 year exposes the resident to the basics of care in the clinic and outpatient setting as well as the operating room and hospital for both adult and pediatric patients.
Urology 2 year consists of four separate three-month rotations.
The resident is assigned to Meharry Metropolitan General Hospital for three months. During this time, the resident has primary responsibility for the Urology service, both inpatient and outpatient. The resident gains some independence through this rotation and is exposed to a patient population which is somewhat different from that seen during other parts of the training program.
There is a three-month rotation in The Vanderbilt Medical Center. During this time, the resident continues to advance his/her surgical skills.
Three months of the Urology 2 year are devoted to basic research with ongoing clinical responsibilities. During this time, the resident does have clinical responsibility for coverage, attending clinical conferences, and assisting in some of the clinics. The resident also participates in a basic research project. We have five full-time Ph.D.s in the Department of Urologic Surgery who are involved in a variety of cutting-edge basic research projects. We have an endowment that specifically supports the resident research. The residents are exposed to the principles and practice of basic research and actually have been able to complete basic research studies that have resulted in both presentations and publications on a regular basis at national meetings.
The final three month-rotation is the Endostone Disease Rotation. This involves both inpatient and outpatient responsibilities under the guidance of Dr. Nicole Miller.
The Urology 3 year consists of three-month rotations on advanced laparoscopy, pediatric urology, female pelvic medicine and reconstructive surgery, as well as a rotation at St. Thomas Midtown Hospital.
This rotation is a three-month rotation focused on refining and expanding the residents' skills in advanced laparoscopy, with or without the use of robotic assistance. The emphasis is on the management of diseases amenable to minimally invasive surgery, including benign upper urinary tract stricture disease, stone disease, renal cancer and prostate malignancies.
We have five full-time Pediatric Urologists and an extremely busy pediatric service. During the three months, the resident has excellent exposure to all aspects of pediatric urology. He gets to participate in a large number of surgical procedures and there is also a strong teaching program in the clinic.
Female Pelvic Medicine and Reconstructive Surgery
This is a three-month rotation focused on female pelvic medicine and reconstructive urology. The emphasis is on benign diseases of the lower urinary tract, including voiding disfunction, female pelvic prolapse, stricture disease, neurogenic bladder, impotence, and peyronie's disease. Skill sets include not only outpatient and intra-operative training, but also performance and evaluation of urodynamics.
St. Thomas Midtown Hospital
The other three months are spent at St. Thomas Midtown Hospital, a large private hospital in Nashville with a busy Urology service. The attendings with which the resident works are all clinical faculty members at Vanderbilt and have trained at a variety of institutions. Thus, the resident gets exposed to different approaches to Urology and to private practice Urology.
The chief resident year consists of four separate three-month rotations at either the Veterans Affairs Hospital or Vanderbilt University Medical Center. On each of these rotations, the chief resident is paired with junior residents. Thus, there is a definite progression of graded responsibility throughout the residency program.
The nine months of the chief resident year spent at Vanderbilt Medical Center are probably the busiest during our residency. By this time in the program, the resident has had a large amount of experience with both operative and nonoperative Urology. The resident perfects his operative skills during these eight months with an extremely heavy surgical load. Although the chief resident at Vanderbilt spends a large amount of time in the operating room, he is also responsible for the entire service. This includes pre and postoperative care as well as consultation and coverage of the emergency room. The chief resident coordinates the service and directs the junior residents and intern in managing the service. The chief resident sees preoperatively all patients in whose surgery he or she participates, including completion of their preoperative workup and review of pertinent pathology and imaging studies. He or she then follows these patients throughout their hospitalization and has the opportunity to see many of them in the clinic for their return visits since this is immediately adjacent to the operating area.
At the Veterans Affairs Hospital, the chief resident is also responsible for the urology service and directs the junior residents. The residents at the VA Hospital staff the outpatient clinic as well as the inpatient service. Operative volume, though not as busy as at Vanderbilt, is heavy and there is broad variety of cases to be performed. The busy outpatient service serves is run entirely by the chief and junior resident on the VA rotation.