Indian Journal of Urology
: 2009  |  Volume : 25  |  Issue : 2  |  Page : 257--258

Diary of a urologist as a trainee in USA

Ashutosh Tewari, Rajiv Yadav 
 Department of Urology, Weill Medical College of Cornell University, New York, New York, USA

Correspondence Address:
Ashutosh Tewari
Department of Urology, Weill Medical College of Cornell University, 525 E 68th St., New York, New York

How to cite this article:
Tewari A, Yadav R. Diary of a urologist as a trainee in USA.Indian J Urol 2009;25:257-258

How to cite this URL:
Tewari A, Yadav R. Diary of a urologist as a trainee in USA. Indian J Urol [serial online] 2009 [cited 2021 Apr 12 ];25:257-258
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I became a general surgeon from Ganesh Shankar Vidhyarthi Medical College (GVSM) Uttar Pradesh, India, in 1988. This was followed by entry into the M.Ch program at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS). Looking back 21 years later, I feel fortunate to have had such a wide range of experiences ranging from working in some of the best institutes in the developing world with limited financial resources to working in some of the most renowned institutions in the United Kingdom and America.

It would not only be difficult, but also inappropriate to compare the places where I received my training. Each place was unique in its own sense and every juncture gave me new challenges and opportunities. And, of course, how can I forget the role of my mentors in helping shape my career. I must say that while places where I worked played an important role, the people I had the opportunity to work with had an even greater impact upon me.

At the time I decided to pursue a career in the specialty, urology had not yet achieved its status as a subspecialty in India and was still under the shadow of general surgery. There were only a few institutions imparting postgraduate training courses in urology, primarily due to limited numbers of trained teaching faculty. SGPGIMS was one of the few places with a dedicated urology program. SGPGIMS possessed all the characteristics of a good teaching center with the right mix of financial resources, a well-read and motivated faculty, program directors with a vision to advance the department, and bright student colleagues.

My entry into SGPGI was indeed the turning point in my career. This is where I first met Dr. Bhandari, to whom I owe a great deal. He literally shaped my career. He was the example all of the students tried to follow. Under his mentorship, I not only learned to work hard but also to think like a scientist. He taught us the basic qualities that a good researcher possesses: the ability to analyze a problem, think critically, formulate hypotheses, and consider solutions that are not always limited by traditionally established practices. We learned to constantly challenge ourselves and take things to the next level. Overall, it was a humbling experience where I realized that despite my extensive training and knowledge of diseases, I was left unable to cure the patients on many occasions. Blame it on the extent of disease or the limitations of treatment but the challenge stimulated me to think outside the box.

After completing my M.Ch, I went to the United Kingdom to work in one of the leading transplant programs. In contrast to India, in the United Kingdom the resources and technology were abundant. In spite of the luxury of so many advanced resources and medicines, still there was so much to learn. Transplant patients are fragile and have very little reserve to sustain any error in judgment. It is sometimes easy to overlook the important details when distracted by the presence of gadgets. I learned to appreciate how important attention to details can be within the practice of medicine; I was trained to give meticulous attention during surgery to minor details about signs and symptoms. The most important realization for me was that learning does not stop at completion of residency but rather is a continuous, life-long process.

I came to the United States in 1994. For the first time in my career, I was surrounded by the top minds of urologic oncology who taught me to look at each case in a different way and impart treatment customized to the patient's situation. My years in the research center at the University of California San Francisco (UCSF) were illuminating. The environment was always charged with excitement and the challenges motivated us to work harder and harder. It was there that I found the importance of team effort. As a team member, each would contribute his/her strengths and work toward a common goal. During these years, I admired and tried to learn to be a team leader from Dr. Narayan. He would challenge the team to work toward a concept but at the same time provide solutions when team members could not figure out the problem and faced difficulties.

My time at Henry Ford was another crucial juncture in my professional life. At Henry Ford, I suddenly found myself in the middle of a whirlwind of futuristic technology with a potential to challenge the paradigm. I was among the fortunate ones who worked with Dr. Mani Menon during the initial application of robotic surgery in urology. I also involved myself in the management and analyses of large databases, writing grants, and doing outcome research in prostate cancer. Dr. Menon really gave me the opportunity to improve and apply the skills that I had gathered over the years. It ultimately helped me to establish myself as an academic scientist in robotic surgery. His guidance and mentorship was more than any student could hope for. My career would not be the same without the experience of working with Dr. Menon.

After gathering all this experience at such varied places, institutions, and with some of urology's most distinguished mentors, I can easily come to the conclusion that the Indian medical education system is at par with any system in the world. It just needs more mentors like the ones I had the opportunity to work with. However, there is always a scope for improvement.

In my opinion, more opportunities to both the faculty and residents, for independent thinking and interaction with international programs, will be a good start. Specifically, more academically minded professors at major teaching institutions should take the lead in developing international collaborative programs with regular exchange of visitors and electronic transmission of academic programs. In this age of high speed internet and computer technology, live transmission of scientific meetings and programs is essentially effortless.

It also becomes important now that we focus and provide answers to problems that are unique to the Indian subcontinent. An early exposure to basic research in the areas which are of particular interest to the Indian situation like genitourinary tuberculosis, filariasis, STD, tobacco-related cancers, etc. is desirable. None of this is possible until we conduct studies specific to our needs and generate data which pertains to India specific problems. For example, we recently analyzed the pathologic characteristic of prostate cancer in PSA screened Asian Indian patients who underwent robotic radical prostatectomy at our institute. We found that compared to white men they not only have a higher percentage of cancer in each biopsy core but also a lower percentage of pathologically organ-confined cancer on final pathology, higher incidence of primary gleason 4 and a higher incidence of seminal vesicle invasion (12.9 vs. 3.4%).

In the long run, it is crucial to appropriately train our future leaders in the field. In my opinion, personalized mentorship is crucial in the formative days. Residency programs should not only include training in general urology to give them an overall idea of the field, but specific interests and talent should also be identified and promoted in the later years of the training program or fellowship. As a developing nation, we definitely need a huge workforce of general urologists working in community settings, but we cannot ignore the need for good tertiary care centers to support them. It is high time for us to have institutes with facilities to treat specific diseases and provide the right training environment. Various fellowship training programs, such as minimally invasive urology, female urology, pediatric urology, etc. should be standardized and regulated by a national society of urologists. Tight regulation and constant monitoring is a must to maintain the desired standards and make timely changes.