NYP-CORNELL UROLOGY DEPARTMENT OVERVIEW RESIDENT TRAINING

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NYP-CORNELL UROLOGYDEPARTMENT OVERVIEWRESIDENT
TRAINING

• Puneet Masson, M.D.
• New York Presbyterian HospitalWeill Cornell
  Medical College
• Department of Urology
• September 11th, 2009

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MEDICAL TRAINING

• May I always act so as to preserve the finest
  traditions of my calling and may I long
  experience the joy of healing those who seek my
  help.
• -- Hippocratic Oath

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TRAINING PATHWAY

• University at least Bachelor of Arts from
  accredited institution
• Medical School at least 4 years in accredited
  allopathic or osteopathic program
• Residency at least 5 years in accredited program
• Fellowship (accredited or unaccredited) ?
  academia vs. private practice
• CME and board re-certification

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TRAINING PATHWAY

• University
• No required major but pre-medical core training
  essential (e.g. Biology, Organic Chemistry,
  Physics)
• Requisite Medical College Admissions Test (MCAT)
  to assess problem solving, critical thinking, and
  writing skills in addition to knowledge of basic
  science concepts and principles

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TRAINING PATHWAY

• Medical School
• 37-52 of all applicants accepted
• Combination programs available MD, MD/PhD,
  MD/MPH, MD/JD, MD/MBA, etc.
• Opportunity to take additional time for research
• United States Medical Licensing Exam (USMLE)
  Steps I and II

Source American Association of Medical Colleges
(AAMC)
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NATIONAL UROLOGY TRAINING

• Approved urologic residency training program 5
  years of clinical postgraduate education (42,
  41, 51)
• 12 months in general surgery
• 36 months in clinical urology
• 12 months in general surgery, urology or research
• Final 12 months as a chief resident in urology
• Periodic review by the Residency Review Committee
  (RRC) for Urology under AMA
• role of the RRC protect the interest of the
  resident by insuring that the educational
  expectations implicit in the training program
  will be met

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NATIONAL UROLOGY TRAINING

• 114 non-military accredited US urology programs
  in 2007
• 2006 109 programs with 235 positions offered,
  235 positions filled
• 350 applicants, 115 (32.8) unmatched

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RESIDENCY SELECTION

• the Match
• Very competitive resident matching process
• 4th year medical students apply, usually only top
  students
• Rigorous interview process
• Both residents and programs rank their
  preferences
• Everyone finds out one month later at the same
  time
• Typically 66 of students applying in Urology get
  a position

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RESIDENCY TRAINING

• 5 and 6 year programs for Urology
• Comparison to other fields Anesthesia (4 years),
  OBGYN (4 years), Cardiology (6 years), General
  Surgery (5-7 years)
• Main difference one year of research
• Cornell Urology is a 6 year program
• 1.3 years of general surgery
• 3.7 years of clinical urology
• 1 year of research (basic science and clinical)

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NATIONAL UROLOGY TRAINING

• Fellowships 1 to 2.5 years
• Urologic oncology
• Female urology/voiding dysfunction
• Pediatric urology
• Infertility/erectile dysfunction
• Laparoscopy/endourology

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NATIONAL UROLOGY TRAINING

• Board certification under the aegis of the
  American Board of Urology (ABU)
• qualifying written examination within three years
  after completing approved residency
• second certifying examination within five years
  after successful completion of written
  examination pathology, uroradiology, and oral
  examination
• 80 pass rate for written board examination
• 80 pass rate for certifying examination
• 10-year period for recertification

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UROLOGY CAREER PATHS

• Private practice urology
• Majority of US urology
• Solo vs. group practice
• Academic urology
• Usually affiliated with university and/or medical
  school (tertiary care centers)
• Research and tenure-track positions
• Tendency for larger and more difficult/complex
  cases

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NEW YORK
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JAMES DIAMOND BRADY
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NEW YORK PRESBYTERIANHOSPITAL/ CORNELL MED CTR
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NEW YORK PRESBYTERIANHOSPITAL/ CORNELL MED CTR
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MEMORIAL SLOAN KETTERING CANCER CENTER
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OUR PHILOSOPHY
To provide unequalled urologic care in a
compassionate setting
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OUR MISSION STATEMENT
To make significant contributions to the field
of urology through research and training of
future urologic specialists.
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UROLOGY PROGRAM STRUCTURE

• 3 residents per class
• 1.3 years of General Surgery at NYPH
• 4.7 years of Urology
• 12 months of research
• Residency rotations
• New York Presbyterian Hospital
• Memorial Sloan Kettering Cancer Center
• Goal to train the physician-scientist leaders of
  tomorrow

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Urology
General Surgery
PGY-1
PGY-2
PGY-4
PGY-5
PGY-6
PGY-3
New York-Presbyterian Hospital General Surgery
Program at Cornell
MSKCC Chief/ Fellow
Pediatrics
Gold/ Cysto Clinic
Gold Chief
Research
Silver / Consults
Urology
Silver Chief
MSKCC
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PGY1 PGY2 YEARS

• General surgery
• General Surgery
• Critical Care
• Trauma
• Cardiothoracic
• Transplant
• Urology
• 1 month during PGY-1 year
• 9 months during PGY-2 year (50 at Cornell, 50
  at Memorial Sloan Kettering Cancer Center)

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PGY1 PGY2 YEARS

• Urology Training
• Basic inguinal and scrotal surgery
  (hydrocelectomy, inguinal hernia repair)
• Circumcision
• Microsurgical varicocelectomy
• Microsurgical epididymal sperm extraction
• Microsurgical testicular sperm extraction
• Microsurgical testicular biopsy
• Penile prosthesis placement
• 2nd assistant on major oncological cases

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PGY-3 YEAR

• Urology Clinic
• 1 2 days a week of outpatient urology
• Endourology
• Basic cystoscopy
• Laser and traditional transurethral resection of
  prostate tissues (TURP, Laser TURP)
• Transurethral resection of bladder tumor (TURBT)
• Urodynamics
• Ureteroscopy, laser lithotripsy, biopsy
• Extracorporeal shock wave lithotripsy (ESWL)
• Percutaneous nephrolithotripsy (PCNL)

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PGY-4 YEAR

• Research
• 1 year of protected research
• Opportunity to do basic or clinical research
• Opportunity to perform research at outside
  institutions
• Current 4th years
• 2 residents in male infertility, andrology
• 1 resident in urologic oncology

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PGY-5 YEAR

• Pediatric experience
• Penile surgery (Circumcisions, Hypospadias
  repairs)
• Scrotal surgery (Orchiopexy, Hydrocelectomies)
• Inguinal surgery (Varicocelectomy, Hernia
  repairs)
• Renal surgery (Pyeloplasty)
• Urinary diversions (Bladder neck closures,
  Mitrofanoff procedures, appendicovesicostomy)
• Sexual ambiguity/CAH procedures (Clitoroplasty)
• Pediatric cystoscopy

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PGY-5/6 YEAR

• Major open procedures
• Radical retropubic prostatectomy (RRP)
• Cystectomy with creation of ileal conduit,
  Indiana pouch, neobladder
• Orchiectomy
• Retroperitoneal lymph node dissection (RPLND)
• Partial and radical nephrectomy
• IVC Thrombectomy
• Ureteral reimplantation

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PGY-5/6 YEAR

• Minimally invasive surgery
• Robotic prostatectomy
• Robotic cystectomy
• Robotic pyeloplasty
• Laparoscopic radical and partial nephrectomy
• Laparoscopic adrenalectomy
• Single incision laparoscopic surgery (SILS)

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PGY-5/6 YEAR

• Female Urology / Voiding Dysfunction
• Cystocele repairs
• Rectocele repairs
• Pubovaginal slings (autologous, synthetic)
• Male slings
• Placement of artificial urinary sphincters (AUS)
• Advanced Male Infertility, Microsurgery
• Microsurgical vasovasotomy
• Microsurgical vasoepididymostomy

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DAILY ACTIVITIES

• 530am - Round on patients in the wards.
• 645am - Meet at breakfast table to go over the
  list of patients with the chief resident.
• 730am to 6-10 pm
• Operating Room
• Clinic
• Floor / Emergency Room
• Evening rounds
• 80 Hour Work Week

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CORNELL AREAS OF EXPERTISE

• Urologic Oncology
• Voiding Dysfunction
• Female Urology
• Endourology
• Pediatric Urology
• Male Infertility
• Microsurgery
• Sexual Dysfunction
• Minimally Invasive Surgery

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ANNUAL CLINICAL ACTIVITY

• Discharges 1,400
• Total procedures 10,500
• Ambulatory/office 6,627
• Main OR 1,904
• Cysto suite 1,480
• 3,904 in-hospital
• Outpatient visits 30,000
• Clinic experience 2,000 visits

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MINIMALLY INVASIVE SURGERY
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SINGLE INCISION LAPAROSCOPIC SURGERY
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ROBOTIC PROSTATECTOMY
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LASER PROSTATECTOMY
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MALE INFERTILITY MICROSURGERY
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CORNELL UROLOGY
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NEW YORK CITY (NYC) SKYLINE
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NYC EMPIRE STATE BUILDING
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NYC STATUE OF LIBERTY
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NYC CENTRAL PARK
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NYC METROPOLITAN MUSEUM
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NYC TIMES SQUARE
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THANK YOU!