PGY-4

THE CHILDREN'S HOSPITAL

The Children’s Hospital is an extremely busy, tertiary care referral center for the Rocky Mountain area pediatric population. The Urology Service there is an exceedingly active operation.

Function of the Resident

The resident essentially acts as a complete and equal member of the team at The Children’s Hospital. He/she is directly responsible for patient care, surgical coverage, evaluation of outpatients in the Urology Clinic, Dry Time Clinic, Spinal Defects Clinic, and the emergency evaluation of children in the Emergency Department or Medical Surgical Specialties Clinic as necessary.

Since the residents rotate at The Children’s Hospital on a six-month stint, he/she will be expected to write at least one case report in the first three month period and one paper suitable for peer review publication during the second half.

Teaching Responsibilities

The resident is to function both as teacher and pupil at The Children’s Hospital. As he/she is directly involved with the patients and nurses, the teaching mission is clearly present. The presence of rotating medical students, general surgery residents, pediatric residents, family practice residents and child health associate students also lends to teaching opportunities for the resident. Involvement with the nurses on the ward should include teaching with close interaction as well.

Administrative Responsibilities

The resident will be responsible for keeping statistics for M&Ms up-to-date. He/she will also be responsible for organizing a monthly Radiology/Pathology Conference.

Operative Responsibilities

The resident must read up on all cases and be prepared for all surgeries. It is suggested that the resident have read completely Kelalis and King as well as the Pediatric Urology chapters in either Gillenwater or Campbell’s. Other reading assignments will be given while at The Children’s Hospital by the faculty.

Call Coverage

Call coverage for The Children's Hospital and the Denver Health Medical Center is shared between the PGY-4 resident assigned to The Children's Hospital and the two PGY-5 residents. Residents will take first call at The Children's Hospital as well as second call at the Denver Health Medical Center every third weeknight. The resident will take the same call every fourth weekend.

The PGY-4 resident rotating on research does not cover weeknight call but does cover call one weekend per month.

Conferences

The resident is expected to attend all Grand Round and Textbook Review and Basic Science conferences. He/she is expected to have read the appropriate reading assignments in preparation for the conference. For Journal Club, the resident should be able to critically evaluate the purpose, data and significance of the published manuscript. The conferences to be attended are:

• Monthly Pediatric Urology-Radiology Conference
• Textbook and Basic Science Review Conference
• Grand Rounds Conferences

Summary

The Children’s Hospital resident will finish with a caseload in the 98th percentile or higher of similar residents in this country. Hence, despite a very intense, sometimes stressful rotation, there is reward at the end. The demands are great as is evidenced by this synopsis, but clearly an interested resident will learn a tremendous amount about Pediatric Urology and advance his/her technical skills dramatically.

RESEARCH ROTATION

This six-month rotation is set aside for the urology resident to learn investigative urology. Each resident may decide if he/she would rather pursue a clinical project or gain hands-on experience in one of the Urology laboratories. To be most productive in the basic science laboratory, it is preferred that the resident continue laboratory work that has already begun.

Two months prior to this rotation, the resident must submit to the Residency Program Director a Research Plan outlining the work to be done. At the end of the rotation, the resident is expected to have accumulated enough data to present an abstract at a major scientific meeting. Also, the work should result in at least one publication in a peer-reviewed journal.

During the research rotation the resident will spend one day per week performing Extracorporeal Shock Wave Lithotripsy cases at the Kidney Stone Center. The resident will also prepare for and lead the monthly Urinary Stone Treatment Conference.

The resident on the research rotation does not take weekday call but does cover call one weekend per month with the other PGY-4 and PGY-5 residents. 

PGY-5 Year

UNIVERSITY OF COLORADO HOSPITAL

Outpatient Clinics / Emergency Room / Consults

The resident will be responsible for regularly attending the outpatient clinic to work with the individual attending when not in the operating room. At the end of the rotation, the resident should be competent to:

• Perform a complete urologic history and physical examination necessary in the pre-operative setting, understand and have a working knowledge of a cost-effective pre-operative work-up and the complications associated with all urologic procedures.
• Perform a focused urologic history and physical examination in the clinic setting. Based on the information received, the resident should be able to articulate a differential diagnosis and order the appropriate lab tests or diagnostic procedures.
• Be able to perform a vasectomy, as well as discuss the complications and appropriate follow-up.
• Perform competent consultations in the emergency room and in-patient settings. The resident should be proficient in urethral catheterization, suprapubic tube placement and accessing the difficult urethra.

Operating Room

The overall goal during the 5th year rotation is to become comfortable as the primary urologic surgeon. He/she should be prepared for every case and, prior to the case, know and understand all of the major steps required to perform any procedure. In addition, he/she should be able to discuss all surgical options and complications and their management. The resident is also expected to learn how to first assist during major open procedures. At the end of rotation, the resident should be competent to:

• Gain experience in robotic surgery
• Perform all endoscopic surgery as the primary surgeon. This includes TURP, TURBT, DVIU, ureteroscopy and stent placement.
• Act as the primary surgeon, or the first assistant, during radical prostatectomy, nephrectomy, nephro-ureterectomy and cystectomy with diversion.
• Perform percutaneous nephrolithotomy.
• Perform all scrotal surgery as well as radical orchiectomy.
• Perform female vaginal and retropubic anti-incontinence procedures.

Conferences

The resident is expected to attend all Grand Rounds and Textbook Review and Basic Science conferences. He/she is expected to have read the appropriate reading assignments in preparation for the conference. For Journal Club, the resident should be able to critically evaluate the purpose, data and significance of the published manuscript. The conferences to be attended are:

• Monthly Pediatric Urology-Radiology Conference
• Textbook and Basic Science Review Conference
• Grand Rounds Conferences

Denver Health Medical Center (DHMC)

This rotation for the intermediate urology resident provides a unique opportunity for him/her to learn the management of urologic trauma, and to develop clinical decision making skills. The rotation is demanding in that the resident is expected to initially address a clinical urologic problem somewhat independently. Urology attendings are available to help the resident analyze the problem thoroughly, discuss the differential diagnosis, and develop a rational therapeutic plan for the patient. The urology resident must communicate with the urology attendings about in-patient consultations and in-house urology patients.

Outpatient Clinics / Emergency Room / Consults

The resident is responsible for initial urologic consultation solicited from the Emergency Room, and other outpatient clinics or in-patient medical services. At the end of the rotation, the resident should be competent to:

• Perform a complete urologic history and physical examination. Based on this information, the resident should be able to order appropriate diagnostic procedures in a cost-effective manner.
• Have a working knowledge of the necessary pre-operative work-up and post-operative management of the urologic patient.
• Discuss the differential diagnosis of all urologic problems and develop a rational therapeutic plan for the patient.

Operating Room

The overall goal during this rotation is for the resident to perform all major and minor open urologic surgeries and endourologic procedures. At the end of rotation, the resident should be competent to:

• Perform percutaneous endourologic procedures such as renal access and nephrolithotomy
• Perform uretero-renoscopy with lithotripsy
• Perform all penile and scrotal surgery including circumcision, vasectomy and varicocelectomy
• Perform a simple or radical nephrectomy and radical orchiectomy
• Perform endoscopic procedures on the bladder, prostate and urethra
• Perform a radical prostatectomy and radical cystectomy with incontinent or continent urinary diversion
• Repair traumatic urologic injuries
• Assist and perform minimally invasive abdominal surgical procedures

Conferences

The resident is expected to attend all Grand Round and Textbook Review and Basic Science Discussion conferences. He/she is expected to have read the appropriate reading assignments in preparation for the conference. For Journal Club, the resident should be able to critically evaluate the purpose, data and significance of the published manuscript. The conferences to be attended are:

• Monthly Pediatric Urology-Radiology Conference
• Textbook and Basic Science Review Conference
• Grand Rounds Conferences

In addition to the above University related conferences, the resident is expected to attend the following DHMC conferences:

• Tumor conference when urology cases are presented and reviewed
• Weekly Mortality & Morbidity Conference

Attendance at DHMC Surgical ICU rounds is also recommended.

Teaching

The resident is expected to teach clinical urology to all interns and medical students rotating on the Urology Service.

Call Coverage

Call coverage for The Children's Hospital and the Denver Health Medical Center is shared between the PGY-4 resident assigned to The Children's Hospital and the two PGY-5 residents. Residents will take first call at The Children's Hospital as well as second call at the Denver Health Medical Center every third weeknight. The residents will take the same call every fourth weekend with the PGY-4 resident on research taking one weekend.

PGY-6 Year

UNIVERSITY OF COLORADO HOSPITAL AND VETERANS ADMINISTRATION MEDICAL CENTER

The PGY-6 rotation at the University of Colorado Denver is the Administrative Resident in Urology. The Chief Resident assumes responsibility for coordinating resident activities, in all its aspects in cooperation with the Residency Program Director. Responsibilities include organizing the conferences, scheduling surgery for all of the faculty, teaching the other residents and medical students both didactic and surgical technique and passing on his/her experience to the junior residents.

Outpatient Clinics / Emergency Room / Consults

At the Veterans Administration, the chief resident is responsible for running all outpatient clinics. At both hospitals, the chief resident is also responsible for timely in-patient and emergency room consultations. On completion of his/her training, the chief resident should be able to practice urology in its entirety in a skillful, humane and efficient fashion and, at the end of his/her training, should be competent to:

• Perform a complete urologic history and physical examination. Based on this information, the resident should be able to order appropriate diagnostic procedures in a cost-effective manner and recommend therapy.
• Have an intimate knowledge of the necessary pre-operative management of all urologic problems.

Operating Room

Upon completion of the PGY-6 training year, the resident should be able to do complicated major urologic surgeries competently. He/she should be able to:

• Gain experience with robotic surgery
• Perform retroperitoneal and pelvic lymph node dissections
• Perform radical prostatectomy, radical cystectomy and diversion procedures, both continent and incontinent
• Perform a radical nephrectomy with removal of vena cava tumor thrombus
• Perform a percutaneous nephrolithotomy
• Perform incontinence operations, both suspensions and slings
• Perform microscopic surgical procedures; i.e., vasovasostomy
• Perform endoscopic surgery procedures such as TURP, ureteroscopy, laser lithotripsy, etc.)
• Perform minimally invasive abdominal surgical procedures

Conferences

The PGY-6 is expected to organize and attend all conferences. He/she is expected to have read the appropriate reading assignments for the Book Club. For Journal Club, the resident will direct the meeting and make article assignments. He/she should be able to critically evaluate the purpose, data, and significance of the published manuscript. The conferences for organization and attendance are:

• Monthly Pediatric Urology-Radiology Conference
• Textbook Review and Basic Science Conference
• Grand Rounds Conferences

Teaching

The PGY-6 is expected to teach the junior residents, interns and medical students on the Urology service both administrative and didactic as well as clinical skills.

Call Coverage

The PGY-6 takes call covering the University of Colorado Hospital and the Veterans Administration Medical Center. PGY-6 call consists of two weeknights per month (Monday-Thursday) and one weekend per month. Call coverage is shared with the PGY-3s rotating at the University of Colorado Hospital and the Veterans Administration Medical Center.

Pre-Urology (General Surgery Years)

PGY-1 Year

The objectives of the surgical internship are to achieve a wide experience in the broad field of surgery, experience in pre-operative evaluation and post-operative care of all classes of surgical patients and to begin the development of technical surgical skills.  The essentials of pre-operative and post-operative care include the recognition and treatment of surgical complications, fluid and electrolyte balance, wound care, and nutritional support.  During this year the intern rotates on a monthly basis with General Surgery, Vascular, Orthopaedics, Night Float, and Urology (typically 3 months with Urology during the year).  The intern does supervised surgical procedures, gains expertise in vascular access, and other invasive procedures; e.g., tube thoracostomy, diagnostic peritoneal lavage, etc.  The intern does admission work-ups, writes pre and postoperative orders, progress notes and hospital discharge summaries. Call varies at each institution with some utlizing a night float system and others using a traditional in-house every 4-6 night system.

Hospitals

• University of Colorado Hospital
• The Children's Hospital
• Denver Health Medical Center
• Veterans Affairs Medical Center

PGY-2 Year

The PGY-2 year is broken down into two distinct parts. Residents rotate on three-month blocks alternating between General Surgery and Pediatric Urology. The total of six months on the Pediatric Urology Service is a unique experience that allows residents to gain early exposure to Urology and have a significant operative experience. The six months of General Surgery is subdivided into onoe month rotations on a variety of general surgical specialities. These vary by year but can include: General, Cardiac, Vascular, Trauma/Intensive Care, and Transplant services.  

Hospitals

• The Children's Hospital
• University of Colorado Hospital
• Denver Health Medical Center

Pediatric Urology (6 months)

• Primary resident surgeon on 250+ operative cases with attendings.
• Assistance with Pediatric Urology clinic.
• Opportunity to operate with attendings at the Children's Hospital outpatient surgery centers within the greater Denver area.
• In-house call coverage at night (average every 4-6 nights) for the Pediatric Surgery service (Pediatric Urology call is covered by the PGY-4s and 5s).

General Surgery (6 months)

• Mid-level resident responsibilities on a variety of General Surgery and sub-speciality services (Cardiac, Vascular, Trauma/Intensive Care, and Transplant) 
• Consult coverage for General Surgery and Trauma
• In-house consult call averaging every 4-5 nights

APPLICANT INFORMATION

Applications must be submitted through the Electronic Residency Application Service (ERAS). Paper applications are not accepted.  The application deadline is October 1st.  Applications must be complete by this date to be considered.

The following items must be included with all ERAS applications:

• Personal statement
• Curriculum vitae
• Transcript from medical school
• Letter from the Dean of the School of Medicine
• National test scores
• Three letters of recommendation from faculty members

Please note: Residents in our program must be a U.S. citizen, lawful permanent resident, refugee, asylee, or possess the appropriate documentation to allow Resident to legally train at the University of Colorado School of Medicine.

A complete description of the AUA Matching Program is available at the American Urological Association website at: http://www.auanet.org/content/residency/residency-match.cfm.

An informational packet for applicants who will be interviewing with our training program is available by clicking here.

If you have any questions or need additional information, please contact:

Beth Musser
Residency Program Coordinator
Division of Urology
University of Colorado School of Medicine
12631 E. 17th Ave, M/S C-319
Aurora, Colorado 80045
beth.musser@ucdenver.edu