Residents Experience the Breadth and Depth of the Urology Field Through Unique Training Programs
Residents in the University of Rochester Medical Center’s Urology program gain invaluable clinical and research experience through the department’s unique training curricula. The focus is to find the best ways to educate the next generation of urologists.
“Our training programs start with recruiting a broad range of candidates, with most of our faculty participating in the recruitment process,” said URMC Department of Urology Chair Jean Joseph, MD. “Our residents benefit from a comprehensive, immersive experience composed of training in every aspect of urology, operating-room experience, the ability to work with a mentor, and the flexibility to conduct research.”
A new path
While most urology programs are completed in five years, URMC’s Urology program includes a sixth year during which residents can conduct research and have more time to develop their careers. For many, the research year has taken them on a path they did not expect to focus on — to pursue an academic career encompassing research.
When choosing a residency program, Laena Hines, MD, was interested in whether she would come out of it as a good surgeon. “My top priority was becoming a competent surgeon,” Hines said. “When I interviewed with the chief resident, he talked about the range of surgical autonomy I would have. I had no doubt that training at URMC Urology would make me the strongest surgeon I could be.” The level of surgical volume is special, and, Hines added, it stands true for research as well.
“I wouldn't have committed to pursuing fellowship had it not been for having the time during my research year to reflect on my career,” she said. “During the research year, I was able to drive my own destiny and to fulfill a passion project.”
Hines’ passion project involves patients who develop post-operative incontinence. She had an idea to help patients to conduct their pelvic-floor physical therapy, an integral aspect of recovery for patients who have prostate surgery but one that can be time-consuming and difficult to sustain. She pondered whether sending text messages to patients reminding them to do their Kegel exercises would make a difference.
This question has turned into a pilot study evaluating 120 patients who had a radical prostatectomy or a HoLEP procedure.
In addition to the research autonomy, Hines values URMC Urology’s supportive environment where everyone is treated as a colleague.
“When I was a medical student at another institution, my perception of surgeons was that they were unapproachable,” Hines said. “After being in this program, I quickly found out that the contrary is true. I feel comfortable asking any question in the operating room, and I would not be nervous about calling any of the faculty in the middle of the night for help.”
From surgical variation to a research focus
When deciding where to pursue his residency, Stephen Hassig, MD, MBA, was not focused on finding a research powerhouse but on whether he could conduct a range of surgeries and have a high case volume.
In the end, he chose URMC’s Urology program because of the extra year dedicated to research. “That I could come up with projects on my own – work that I was excited about – made the decision for me,” he said.
“The six-year program is one of a few that offer a dedicated research year, allowing residents to pursue more complicated research questions. This program helped me realize that I wanted to conduct research as part of my career.”
One of Hassig’s research projects focuses on addressing infections after ureteroscopy, which can lead to serious illness in about 6% of patients, resulting in intensive-care requirements or even death. He is exploring whether antibiotics in irrigation fluid during ureteroscopy can improve outcomes by not only killing bacteria but also reducing bacterial product burden within the kidney.
Currently in the lab stage and using simulated 3D-printed kidney models, the next phase will involve simulating the procedure in a live-animal model, with the goal of then moving to patient trials.
Hassig also greatly appreciates the resources provided through the program. Program resources support his work through research mentorship, access to a rich network of collaborators, funding to pursue the animal protocol, and enabling him to travel to international meetings and present his research, which is uncommon for residents.
Boosting procedure confidence in the lab
The models Hassig utilizes are created in URMC’s SURGE (Surgical Simulation and Genitourinary Engineering Lab), which creates high-fidelity surgical and procedural phantoms that mimic high-risk situations. The lab gives residents and fellows the ability to rehearse procedures before doing actual surgeries.
According to Thomas Osinski, MD, SURGE Lab Principal Investigator, the lab helps boost residents' and fellows’ confidence in specific procedures and allows surgeons to learn revolutionary new skills such as robotic surgery or minimally invasive procedures.
“The SURGE lab gives residents and fellows the opportunity to work with biomedical engineers to figure out how to model, to learn about the research process, and to hone their robotic skills in a safe environment so they can become more comfortable before performing actual procedures on patients. It also gives attending surgeons more confidence that a resident has a basic understanding of performing a procedure safely and accurately.”
Osinski noted that plans are underway to bring simulations to the next level by building on the current hydrogel polymers used in models to create physiologic platforms that can mimic human diseases.
A highly selective process
The combination of expert training and research autonomy makes URMC’s Department of Urology a highly selective program. Typically, there are approximately 350 applications for 40 interviews and three available spots.
“There are so many great applicants hoping to be urologists, and we believe we have one of the best programs in the country,” said Hani H. Rashid, MD, Program Director for the Urology Resident Program. “We train future urologists in a healthy, conducive environment. Whether they want to be an academic superstar or a surgeon with the skills to do any type of urologic procedure, we provide the structure and the tools to make it happen.”
URMC’s program is highly regarded because it affords the opportunity to train complete urologists – in all the major urology subspecialties.
“We are at the top of many candidates’ lists because we emphasize mentoring, subspecialty training and independence in a collegial environment,” Rashid added. “We focus on wellness as that helps with training, such as our night-float program in which junior residents might cover 1 to 2 months a year at night, and then in the remaining months, they go home after work and get much-needed rest and stay fresh without clinical responsibilities.”
Sub-internship scholarships
URMC also offers a sub-internship scholarship award program to expose the urology discipline to more students with diverse backgrounds. Offered to fourth-year medical students from across the country interested in pursuing a surgical/urological career, the program pairs students with a faculty member for clinical mentoring and with a resident mentor. They also are exposed to research opportunities during their month-long rotation. Selected students receive a stipend to assist them with their travel and housing expenses – costs that add up for students as they visit universities they are considering for their residencies.
Preparing the next generation
URMC’s Urology team is intentional in finding the best ways to teach residents to prepare them to be the best-possible urologists and to be competitive in the field. Ultimately, the goals are to train urologists who will find cures for today’s urological diseases and to help care for the growing population of people who need urologic care.
“Research is at the core of our training and our institution, from basic science and education to improving health outcomes and the quality of patient care,” Joseph added. “It is what sets us apart, and we believe it is essential for preparing the next generation of urologists for the field.”