The URO-1 resident is expected to learn the basics of the urologic workup with an emphasis on endoscopy. The resident spends their time with:
The residents spend six months at University of Maryland Medical Center (UMMC) and six months at the Veterans Administration Medical Center at Baltimore (VA). The rotations are broken up into at three-month intervals. Care is taken in the rotation assignments to provide each resident equal exposure to the different chief residents. Initially during the URO-1 year, the emphasis is on learning endoscopy and urological patient care.
At both the UMMC and the VA, essentially all cystoscopies are first performed by the URO-1 resident. The URO-1 residents also perform:
Needle biopsies of the prostate
Simple urodynamic workups
Transrectal prostatic ultrasound
As the year progresses, the URO-1 resident will gain responsibility depending on his/her ability. Open surgery for the URO-1 resident includes all circumcisions, scrotal cases, pelvic lymphadenectomies, and open prostatectomies. The resident assists on radical surgery cases, as well as laparoscopic and endourologic cases.
By the half-way mark of the year, the URO-1 resident will perform parts of major procedures. By the 3/4 mark, the URO-1 resident performs the start of TURP's under supervision at the VA. All TUR cases are done under video monitoring for better teaching and patient safety.
The URO-2 resident spends part of the year in the urology research laboratory, which will be described later; the remainder is spent covering the resident clinics at the UMMC and the VA. For six months, the URO-2 resident rotates on the pediatric urology service at the Johns Hopkins Hospital.
In addition to the UMMC resident, the service has one Johns Hopkins Hospital senior resident and one junior resident. The Johns Hopkins attendings closely control the education on this service. They first allow assistance on simple cases, progressing to performing the simple cases with their own assisting, and then progressing to assisting on complex pediatric cases.
The URO-3 resident spends six months at the Baltimore Washington Medical Center. While at the Baltimore Washington Medical Center, the URO-3 resident operates with the private hospital attendings and operates a small indigent service with one attending each month. The experience is broad, encompassing everything from simple endoscopy cases to radical surgery.
There is also an emphasis on endourology and laparoscopy at the Baltimore Washington Medical Center. The URO-3 resident assumes some administrative responsibility and performs most of the TURP's and medium-size cases with the attendings present. The URO-3 resident covers as the chief resident for those times when the URO-4 residents are at national meetings and/or while they are attending job interviews.
The URO-4 resident is the chief resident at UMMC and the VA, and is responsible for the operation of the service. The rotations are for six months consecutively at each location. The URO-4 resident performs all the major surgeries and teaches lesser procedures to the resident level below. The chief resident is administratively responsible for operating the outpatient clinic, inpatient service, operating room and performs all major consultations.
On most private practice cases, the URO-4 resident performs the surgery with the assistance of the attending. The URO-4 residents are responsible for the content of the weekly Urology Grand Rounds and the Radiology Conference. As the URO-4 resident progresses through the year, he/she will gain more operative leeway. All attendings closely observe every move early in the year, but give the URO-4 resident more independence later in the year. Early in the year, radical prostatectomies are closely supervised. By the midpoint, attendings stay in the room only for radical prostatectomies. By late in the URO-4 year, it is expected that the resident can safely perform all but the most exotic procedures unattended.