Year : 2009 | Volume
: 25 | Issue : 2 | Page : 225--227
Urologic education and training: A global perspective diary of a urologist as a trainee: My Johns Hopkins experience
Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI-482 02, USA
Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI-482 02
|How to cite this article:|
Rogers C. Urologic education and training: A global perspective diary of a urologist as a trainee: My Johns Hopkins experience.Indian J Urol 2009;25:225-227
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Rogers C. Urologic education and training: A global perspective diary of a urologist as a trainee: My Johns Hopkins experience. Indian J Urol [serial online] 2009 [cited 2021 Apr 21 ];25:225-227
Available from: https://www.indianjurol.com/text.asp?2009/25/2/225/52927
My experience as a urology resident at Johns Hopkins has had a profound influence upon me. I would like to reflect on specific aspects of my residency training and the tools I gained from these experiences that have helped me in beginning my urology career.
Interview/Why I Chose
When I was a medical student at Stanford, I decided I wanted to pursue a residency in Urology. I interviewed, and was impressed by, the many excellent training programs available. However, for me, my interview and interaction with Dr. Patrick C. Walsh, the then Chairman of the Brady Urological Institute at the Johns Hopkins Hospital, stood out from the others and left a great impression upon me. Dr. Walsh made it clear that his goal was to train academic urologists who would be leaders in the field. His vision and enthusiasm were contagious. He convinced me that his residency had the resources that would help me succeed, including research experience, clinical volume, mentorship, education, and opportunities for increasing responsibility and leadership. Near his office was a wall with pictures of all former residents of the Brady, the vast majority of whom had gone into academics and were leaders in the field. Within the last 20 years, virtually all resident graduates had assumed faculty positions in major academic centers and many of them had gone on to become chairmen within their institution. I wanted to join this rich tradition and I was fortunate to be accepted into the program. I attended a welcome reception for the incoming residents and new faculty where I was given my Brady tie and a book on the history of the Brady. I felt like I had become a part of this rich history.
General Surgery / Pre - Urology
My training started with two years of General Surgery. During my intern year, I learned how to take care of surgical patients. I performed a variety of smaller surgeries and participated in larger surgeries. Although these were not urology procedures, I felt the techniques I was learning would help me be a better surgeon. I learned how to manage complex ICU patients. I also had a rotation in urology in which I was the intern taking care of the floor patients and assisting in surgeries. I was able to scrub in on radical prostatectomy cases with Dr. Walsh, as a second assistant to the junior resident. I particularly enjoyed my second year of General Surgery, as there was more autonomy in taking care of patients and in performing more complex surgeries. After the completion of my General Surgery training, the urology program changed to include only one year of General Surgery. Sometimes my colleagues said it was too bad that I had to do the extra year of General Surgery. I do not feel short-changed at all. I loved my second year of General Surgery and I feel that it contributed significantly to my development as a surgeon.
There was a strong emphasis on basic research during my residency and we were taught that this is fundamental to the advancement of our field. Dr. Walsh emphasized that discovery is the most important mission and that you make important discoveries by working on important problems. The environment at Hopkins was conducive to such cutting-edge research as many important discoveries had been made there, including nerve-sparing radical prostatectomy, laparoscopic donor nephrectomy, hereditary prostate cancer, and the role of nitric oxide in penile erections.
I was able to have a one year focused research experience during my residency working on a project of my own choice. We were encouraged to participate in a basic science experience and I consider my research year to be an important part of my training. It gave me time away from the daily pressures of patient care to critically think about scientific questions in order to come up with solutions to the problems. At the beginning of my research year, I met Dr. Donald Coffey, the Director of Research at the Brady Urological Institute at that time. We had a very interesting conversation in which he explored in-depth my background, interests, experience, and goals. He helped me to formulate some ideas for research projects that were in line with my interests and goals. He introduced me to faculty who were working in areas of my interest and I met with them to help me to choose which laboratory I would work in during my research year. There were many faculty members participating in urology research, including urologists, medical oncologists, and radiation oncologists. Ultimately, I chose to work in the laboratory of Dr. William G. Nelson, MD, PhD, Department of Medical Oncology and Urology working in collaboration with Dr. Christian Pavlovich as the urology faculty. My project involved prostate cancer detection by molecular urinalysis using protein and DNA biomarkers. Although I did not have an extensive basic science research background, there were many knowledgeable people in the lab, including postdoctoral students, technicians, and medical students, who were a tremendous resource to me when I needed help in carrying out experiments. Dr. Nelson was also a tremendous mentor and helped me interpret my data, make proper conclusions, and design subsequent necessary experiments. Dr. Walsh made this entire research experience possible by facilitating the necessary funding and emphasizing its importance. At one point in my research year, I approached him about my interest in another project related to kidney cancer research. He asked me to look into the details regarding cost and logistics and then gave me his full support and encouragement to pursue the project along with some advice as to how to go about it. His commitment to research made a very positive impression on me.
I also had the opportunity to participate in clinical research projects during my residency. I was able to write clinical papers with prominent faculty including Dr. Walsh and Dr. Partin regarding clinical outcomes after prostatectomy. From this experience, I had the opportunity to work with statistical software and learn how to utilize statistical analysis to help solve problems and to improve the quality of papers. I was fortunate to be in an environment in which there were faculty trained in statistical analysis, who could help me gain these skills. I also enrolled in a statistics course during my research year, which was also helpful.
The clinical experience at Hopkins was busy. Dr. Walsh had set it up that way, keeping the number of residents in the program small enough so that we would have sufficient clinical volume to gain the experience we needed. The training consisted of a graduated series of experiences and responsibilities intended to culminate in full training as an academic urologist. This progression began with the opportunity to work with Dr. Walsh as a Junior Urology Resident, assisting him while he performed the radical prostatectomy operation, until the operative steps and perioperative management became second nature. I was grateful to receive this opportunity to work with him at the earliest point of my urology training, to help build a solid foundation for the rest of my training. As I progressed in my training and did more of these steps of the operation with other attendings, I tried to emulate Dr. Walsh's technique. The busy clinical volume at Hopkins was helpful, in that I was able to log a variety of different cases that enhanced my training and skills.
In addition to open surgery, we also received training in minimally invasive surgery. Initially, as a junior resident I was allowed to mobilize the bowel during laparoscopic kidney cases under close supervision by Dr. Kavoussi or Dr. Jarret and the fellow. As my skill improved, I was allowed to do more. During my research year, we had the opportunity to perform laparoscopic kidney surgeries in the animal laboratory so that we would become more facile with the more critical steps before performing them on patients. We were fortunate to have an animal laboratory available to practice these skills. Our department also purchased the laparoscopic training equipment that I was able to use to improve my laparoscopic suturing skills.
Our clinical rotations included an outpatient clinic experience, where we were able to shadow different attendings as an apprentice to learn how to interact with patients and manage a busy clinic. We were also able to perform the office-based procedures, such as prostate biopsies and cystoscopies. Other clinical rotations included experiences on the adult urology service, pediatrics, endourology, nephrology and radiology electives, and rotations at our affiliate hospital. Quality patient care was strongly emphasized during our training. We were taught to care for patient and be dedicated to them.
Education was strongly emphasized throughout our training and we had several conferences each week that helped us learn urology. The residents would hold weekly morning teaching sessions designed to cover all potential topics to help us prepare for our in-service examinations. We would go through test questions in an interactive format with faculty supervision and review concepts that were not clear. We had a weekly pediatrics conference organized by the Chief Resident, with supervision from the pediatric urology faculty, where we learned the basics of pediatric urology in a case-oriented format. We had monthly tumor board meetings in which we would present patients with complex oncologic issues to the radiology, medical oncology, and pathology staff, to learn about the multi-disciplinary aspects of patient care in urologic oncology and the trials and principles guiding our current management of these patients. We had a monthly journal club in which we would be assigned a list of recent urology articles on various topics selected by the faculty. We would have to know all of the articles well enough to summarize and critically analyse each paper, as we could be randomly called upon to present any article.
I was given opportunities to review papers for urologic journals and to write papers with various faculty that helped me gain a much deeper knowledge about these topics and helped me learn how to write a paper.
We were expected to give talks for grand rounds. There was a rotation set up in which all residents took turns giving a grand rounds talk on a selected topic that was supervised by an attending staff and based on a clinical vignette followed by an in-depth talk on the subject. Dr. Walsh encouraged us to have talks prepared at all times so that we were ready to go at any time, like 'planes on a runway'. These talks were expected to be well researched and polished. We also had opportunities to present our research in posters and abstracts at various urological meetings. We would often perform these presentations to the staff prior to attending the meeting so that we could get suggestions as to how to improve our presentation skills.
The culmination of my residency experience was my six months as 'ACS', which stands for Assistant Chief of Service. During this time, I had a staff appointment, I ran my own clinic, managed inpatient and ER consultants, and staffed surgeries on these patients, all with oversight from the more senior urology staff. The autonomy I was given stretched me and helped me to learn how to manage patients. I appreciated the oversight from the faculty. Each month I would present to the faculty cases that I had performed, as well as my upcoming cases. It was an opportunity to explain my management plan and to benefit from the experience of the full-time faculty.
As I progressed in my training, I was given more leadership and administrative responsibilities. I had the opportunity to run a particular service as a Chief Resident and to be in charge of all services as the ACS. My administrative responsibilities included organizing and overseeing conferences such as grand rounds, the resident conference, the pediatric conference, and the morbidity and mortality conference. I assisted in planning topics and inviting speakers. I also had the opportunity to help host visiting professors who would come to visit from other institutions and drive them to various functions. It was exciting to have this personal interaction with leaders in urology. One of these visiting professors was Dr. Mani Menon from Henry Ford Hospital. Although, I got lost driving him to the dinner, he still eventually gave me a job!
Throughout my training, I was fortunate to have mentors who were leaders in the field of urology and who took the time to teach and influence me. Dr. Walsh would routinely sit down with me and go over my performance evaluations with me, telling me clearly what I was doing well and things that I could improve. I learned from faculty members, who were successful clinicians and surgeons, as well as research scientists.
I am grateful for the opportunities and mentorship that I received during my residency training. I am also grateful that I had resources available to me in my training to help me succeed, including research experience, clinical volume, mentorship, education, and opportunities for increasing responsibility and leadership. I am proud to have my picture included with the former residents of the Brady Urological Institute and to carry forth the ideals that I was taught there.