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Residency

Answers to questions posted for the Residents Committee:

Question:
What resources have people found most helpful in studying for the in-service? As a pgy-2/uro-1, campbell's doesn't seem practical for this year's exam...

Answer from Mathew Cameron Raynor,M.D.:
Everyone has different methods of studying. Some residents use summaries from high-yield Campbell's chapters and some use AUA updates. As a Uro-1, I found that the high-yield Campbell's chapters were beneficial. I would also highly recommend studying old SASP questions as some of these questions re-appear on exams and you can get used to how the questions are asked.

Answer from Douglas Edward Sutherland MD:
I would not be surprised if you saw material taken out of the new CWU on your test. It will have been in print for 10 months prior to the exam, which should be enough time to work it in. If you are still in contact with the chief residents who are sitting for the boards in 3 weeks, the AUA just put out the first study guide for the boards. It is long (800 pgs), but seems to be the best collection of high yield material yet. Otherwise, I recommend reading CWU cover to cover once and make notes for yourself to study prior to the inservice. Alternatively, just use the study guide to review each chapter, then read up in CWU as needed.

Question:
What do you all think about home call? Right now, the only rule seems to be that you can't work more than 320 hrs in any 4 week period. Otherwise, if you're up all night in the hospital irrigating someone's bladder, you're still working all day the next day. Is the ACGME looking into this at all?

Answer from Mathew Cameron Raynor,M.D.:
Home call can be hit or miss. As for duty hours, the ACGME states that time spent in the hospital in direct patient while on home call counts toward the 80-hour work week averaged over four weeks. To avoid conflicts with the rule, we will sometimes allow the "post-call" resident to come in late or leave early the next day if they were busy all night. This also allows for the 10 hour rest period between shifts.

Answer from Douglas Edward Sutherland MD:
I am sure the ACGME is monitoring the home call situation, but more importantly, your program director must monitor the call volume b/c official changes made by the ACGME happen slowly. For a given program, there are usually several different options available (cross-covering, etc) to make it reasonable for everybody. It is harder for programs with one resident/yr. Also, consider this: once out in the real world, outside of academic programs with residents available to do the dirty night work, you are living the life of the average PP urologist! Even the frequency of your call may stay the same if you join a small group! It is unlikely that the ACGME will move to make the resident's experience substantially easier than that in private practice, unfortunately.

Answer from Matthew Mark Lux,M.D.:
My understanding is that for the home call, the 10 hours between calls does not matter. Therefore it is perfectly ok for you to be brow-beaten on call, as low as you don't do more than 80/week averaged over a month. All other rules apply only to in house call.

Question:
I am studying for the inservice and would like to know where to obtain the AUA study guide mentioned in this reply to another question. Thanks! the AUA just put out the first study guide for the boards. It is long (800 pgs), but seems to be the best collection of high yield material yet.

Answer from Douglas Edward Sutherland MD:
The review I was referring to is bundled into the materials given to the attendees of the annual AUA Board Review course in Dallas. To my knowledge, you cannot buy this yet, which is why you should stay in contact with your x-chief resident who is probably studying from it now for the boards.

Answer from Matthew Mark Lux,M.D.:
There is a urology board review book, apptly named Urology Board Review published by McGraw Hill. About 500+ pages that is a question based format. I've not heard about the 800 page review book. Can you tell me more about it and where to find it?

Question:
I am a pgy1-gen surg intern. Looking forward to starting GU next year. Any words of wisdom from anyone on how to handle in-service prep, studying, journals, deciding on fellowships, etc. How have you handled the rigors of urology training thus far, and what advice do you have for the newbies? Thank you.

Answer from Justin Matthew Green,M.D.:
In addition to what Craig says, I would start your studying now as if you were preparing for the boards. That way when you are finally studying for the boards you aren't looking at completely new material (different books, ect.). I also found that doing SASP's with upper levels helped me the most, since they will have more experience and can explain things to you about the questions. Justin Good Luck, the inservice is a pain.

Answer from Craig Alan Nicholson,M.D.:
As far as studying goes, I think consistency is best. Make a study plan and, as much as possible, stick to it. I found the SESAP questions and AUA updates to be invaluable. Also the Pocket Guide to Urology by Jeff Wieder was something I could keep in my bag and read through and turned out to be very helpful for inservice and board preparation. Definitely talk to the more senior residents in your program as they may have additional suggestions and some of the materials may already be available in your program.

Question:
I'm a third-year medical student and I want to work with a urologist for a year internationally on a volunteer basis. Any ideas?

Answer from Douglas Edward Sutherland MD:
When I was a 3rd year, the AUA was near my medical school that year. We had several international docs visit my school, and mostly all of them were interested in having US med students visit them. If you do not find what you are looking for with the volunteering lead, try getting a copy of the AUA directory and looking for a MD in the country you are trying to reach. Call them up directly. You never know, they may be able to help you.

Answer from Craig Alan Nicholson,M.D.:
I would start by contacting International Volunteers in Urology. You can find information at http://www.ivumed.org/. Although I am not sure what opportunities they have for medical students--I know they sponsor a scholarship for Urology residents and I believe they are always in need of volunteers.

Question:
I am trying to find out if there is different coding for a prostatectomy performed w/ a robot...my doc's have just started use this and nothing I can find says anything about robot... Thanks in advance Julie Smith

Answer from Jonathan Charles Routh,M.D.:
The ACGME coding website unfortunately hasn't kept up with technology on this one. To the best of my knowledge, there is no code specifically for a da Vinci-assisted radical prostatectomy. The closest one that I'm aware of is 55866 ("Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing"), and that's the one that I use when I code a da Vinci RP.

Question:
Dear collageous I am a urology resident in Iran that i am a member of AUA, we have a urology residency comitee in our country, please tell me about your activity and your residenty training program in USA. Can i register in your match? Sincerely yours, Dr Ali Akbar Kramai(00763406)

Answer from Matthew Mark Lux,M.D.:
If you have passed step I and II, and have graduated from an accredited medical school, you should be able to register in our match.

Question:
Can you please comment on the ethical issues associated with infant circumcision? Several patients have expressed to me their disappointment with the appearance of their penis due to scarring, and in one case there is erectile dysfunction. I am concerned about the risk of harm to the patient outweighing some possible future medical benefits. For reference, Patel HI, Moriarty KP, Brisson PA, Feins NR. Genitourinary injuries in the newborn. J Pediatr Surg 2001;36(1):235-9. Thank you for your consideration.

Answer from Jonathan Charles Routh,M.D.:
Infant circumcision is a controversial issue, in this country as in others. The AAP policy statement on infant circumcision (PEDIATRICS Vol. 103 No. 3 March 1999, pp. 686-693 or www.aap.org/policy/re9850.html) is a very good resource. If you're looking for differing viewpoints, a quick Google search of the word "circumcision" will pull up a variety of sites and opinions. In regards to your patients' concerns with their appearance or function, part of doing surgery is recognizing the potential complications and risks associated with the procedure you intend to do, and educating your patients appropriately as to those risks so that they can make an informed decision about their (or their infant son's) health care. As with any other surgical procedure, circumcision is not guaranteed to be free of complications. However, it should be noted that very, very few circumcisions do result in a complication.

Question:
What resources have people found most helpful in studying for the oral board exam?

Answer from Jonathan Charles Routh,M.D.:
As a current chief resident, I'm still looking forward to the written boards, not yet the orals. However, in talking with previous graduates from my program, the common themes of studying for the inservice are still true: read the last 5 years of AUA updates, the Wieder textbook, and the SASP questions. In addition, I have heard very favorable reviews of the AUA review course syllabus. Hope this helps, and good luck!

Answer from Douglas Edward Sutherland MD:
I am pretty sure that Choe's Urology Oral Board Self-examination is still manditory reading for the orals...not so much for the content (I have read a few cases and some of the info seems out of date), but more to get into the habit of answering questions in that fashion. I agree, the AUA Board Review book (given out for the Dallas course) is very good, but Wieder would also be a good topic review. And dont forget to read the recent AUA guidelines (found on the auanet.org website), which are higher yield than the updates.

Question:
Could you be more specific about Wieder textbook

Answer from Douglas Edward Sutherland MD:
"pocket guide to urology" Jeff Wieder, MD. pocketguidetourology.com: 3rd edition due out later this year.

Question:
Hi; I am a 53 year old urologist in the UK who would like to become BE/BC to work in the private field after relocating to the USA. I have a letter from the ABU that I need 2.5 years of residency to become Board eligible. I have been trying to apply for residency openings for almost 2 years. The closest I got was an invitation for interview only once and I could not make it to the interview. Any suggestions?

Answer from Nikhil Lalit Shah DO,MPH:
Tough question to answer. While your experience would be beneficial, it may hinder you from obtaining a position. I would give strong consideration to contacting program directors directly. Many larger academic programs may be willing/able to create a position for you that includes ambulatory practice coverage, surgery and clinical research for 2.5 - 3 years. These are not published positions and not easily available. Application for residency positions via the usual routes will be difficult, if not impossible, as you have already experienced. Some suggestions are Bob Bahnson, MD at Ohio State, Jim Peabody, MD at Henry Ford in Detroit, and Phillip Nasrallah, MD at Northeast Ohio. Good Luck.

Question:
where can I find the lecture that was supposed to be posted on this website (from the resident's forum last week)?

Answer from Jonathan Charles Routh,M.D.:
A CD-ROM of the included powerpoint slides was given to all registered attendees at the meeting; in addition, there was additional material available from one speaker which will be emailed out to registered attendees. This should be forthcoming in the next week or so. Thanks for your interest!

Question:
I still haven't received the lecture that was supposed to be posted from the resident's forum at the AUA. Has it been sent out to our emails yet or is it posted somewhere? Thanks

Answer from Jonathan Charles Routh,M.D.:
It has not yet been sent out, but will either be posted to the Resident Committee website or emailed out to registered participants in the near future. Please keep checking back in to the website for updates.

Question:
Hello i am a Canadian urology resident looking to do a fellowship in the USA. Do you know whish states require the USMLE and wish one accept the canadian equivalent (MCCQE) ??

Answer from Geoffrey Thomas Gotto,M.D.:
I guess it's my responsibility to answer this question as the only Canadian on the AUA Residents Committee. I also happen to be going to Memorial Sloan-Kettering in New York for a fellowship starting in July. I guess the easy answer to your question is "It depends." Certain states require the USMLE (like California) and certain fellowship programs require the USMLE regardless of the state because the want you to have a specific type of visa, the H1b. The J1 "educational" visa does not specifically require the USMLE. The best thing to do is figure out what fellowships you're interested in, ask them what kind of visa they require, and then look into whether the state licensing board requires the USMLE. Make sense?

Question:
Hi, Is it possible to match directly into a urology program if one has already done general surgery in the UK? FMGs need to obtain ECFMG certification before entering the match. From what I understand of the AUA match, it is done 2 years in advance, ie apply fall 2007 to start a program in June 2009. Is this always the case or can one apply and get in the following year, eg fall 2008 to start June 2009? If this is possible, how does one go about it. If it isn't possible to start the following year, are there any suggestions of how best to spend the year. Thanks for your help.

Answer from Craig Alan Nicholson,M.D.:
In order to sit for the American Board of Urology board exams an applicant must graduate from an accredited urology program that includes general surgical training. Further information on the process and requirements for the ABU can be found at http://www.abu.org/CertBook2007.pdf. You do match for the next year but urology program by requirement include general surgical training. Additional information on the match can be found at the AUA website at http://www.auanet.org/residents/resmatch.cfm or other private "unofficial" sites such as urologymatch.com.

Question:
I would like to know how many of the programs in the US and PR are training residents in female pelvic surgery. I would like to know how many cases are being done in the different programs, and their percentile rankings. I am a chief resident in Urology in a program that does a large volume of female pelvic surgery. How many of these cases are being lost to gyn? How would I go about trying to find out this information? Please advise. Sincerely, Jennifer Hill rebhill27@live.com

Answer from Desri Lashley-Rogers, M.D.:
Hi Jennifer, I'm not sure who readily you are going to get the information without either asking the ACGME -- not sure they will tell you, but they might -- or individually soliciting the info from program directors -- probably more likely to give you info, but it may be far from 100% response rate. The ACGME will have the most extensive database, since they are the clearinghouse for everybody's op logs. Which cases are you interested in exactly? Assessing how much gyn is doing is going to be much more challenging, and my sense is there will be a great deal of variability from institution to institution. If you don't get this info from the ACGME, have you considered creating a survey and distributing it to program directors, and asking them to give you an idea of how many cases are being down now versus in the past, what percent are done by GYN etc . . . You will need to control for location (university versus community hospitals), whether there is a female/pelvic floor faculty member etc . . . . . From: Peter L. Steinberg, M.D.

Question:
I am scheduled to take part II of the ABU certifying exam this February. I know that in the past there has been a mock boards review course specifically for the oral exam. (I think it took place in Dallas the few days leading up to the test) Do you know if this course still exists, and if so where I can find more information? Thanks

Answer from Jonathan Charles Routh,M.D.:
Due to the economic downturn, several urology courses have recently been cut back or cancelled. I don't know if the ABU Part II review course is still available. It might be worthwhile to contact the ABU directly (www.abu.org) to see if their staff have heard anything. Also, you might want to contact graduates from your residency program who have recently taken the exam to get more specific contact information for the course director, etc, then try to contact him/her directly.

Question:
I am a FMG and I am interested in investing a year in a Research fellowship or a prelim in General surgery. Which one would you recommend and why? Does the prelim year put you at a better position for unexpected PGY2 vacancies?

Answer from Janelle A. Fox MD:
PGY-2 slots in Urology, especially at programs you'd otherwise consider your first choice, are few and far between. I'd advise you to do the Research, strengthen your resume, and participate in the regular match. FMGs are always at a disadvantage but in my opinion even moreso when trying to match into a PGY-2 vacancy.

Answer from Jonathan Charles Routh,M.D.:
Both have the potential for significant benefits. As for which is better for you, the short answer is that it depends on where you're planning on doing your prelim year or research fellowship and where you want to do your residency. You will want to talk to current prelims/research fellows to find out about the program's track record of placing people in residency spots, what their policy is for giving you time for interviews, etc. Also, if you want to stay in a particular area or go to a specific program, you may want to talk to the program director to see what they would prefer for you to do.

Question:
Which is better for applying to a Urology Residency, Clinical or Basic research and why?

Answer from Janelle A. Fox MD:
In general, any project that is actually influencial for clinical decision making. Clinical research is easier for your interviewers to relate to and question you on, just make sure it's something feasible to finish by the end of med school and well-designed.

Answer from Ingride Richardson,M.D.:
Any research that you can do is beneficial, but of course if you have participated in urological research interviewers might be more assured of your interest in Urology. As for clinical or basic science, I don't think it matters there. Whatever you do, you must show that you had significant involvment in the research, and were not just pipetting or filling slots in a database. Be sure to have an intimate knowledge of the subject that you are researching.

Question:
To whom it may concern: I was wondering if there are any Urology ORal board review courses out there, or is Choe's textbook the extent of material available for oral board review study?

Answer from Abraham A. Hakimi, MD:
The AUA sponsors an board review for both the qualifying an recertification exam which can be found at: http://www.auanet.org/content/courses/arc011/?acid=6331040723|NE21Off194&WT.mc_id=NetNews3444

Answer from Janelle A. Fox MD:
For the Written boards, the annual board review course is useful. For Oral boards, some of our staff have used Choe's as you mentioned plus prior years AUA updates and a board review course put on by U Pitt. You would contact them the year you are planning to take the Oral boards.

Question:
iam a urology resident from saudi arabia, i am willing to apply for a fellowship programme in USA ,what are the requirments ?,any ideas ? does it help if i till u that i am sponcered?

Answer from Justin Matthew Green,M.D.:
I really have no experience in this matter, my only recommendation is that you contact the fellowship directors in whichever field you are interested in. I would also find someone who was in a similar situation and ask them about their experience. I hope this helps. Justin

Question:
Has anybody who has been trained in Urology outside United states ,gained any credit for the training they recieved,by waiving the training years.if yes what is the procedure.

Answer from Jonathan Charles Routh,M.D.:
Certification by the American Board of Urology requires completion of an accredited US or Canadian residency. You may find it helpful to contact the AUA (www.auanet.org) or the ABU (www.abu.org) directly in order to address the particular details of your individual situation.

Question:
I am urologist from India, we are looking into guidelines for residents regarding the minimal numbers for each procedure to be board certified in General Urology. Which is the best source for the same. ASTS and American college of surgeons definitely defines numbers to be done for procedures.

Answer from Jessica T. Casey,M.D.:
http://www.acgme.org/acgmeweb/tabid/152/ProgramandInstitutionalGuidelines/SurgicalAccreditation/Urology.aspx The ACGME lists out minimal numbers. Please see this website.

Question:
Is it legal for a program to add a year of fellowship/research after the match? The program was a 5-year program before the match but became a 6-year program after the match.

Answer from Jonathan Charles Routh,M.D.:
Usually when a program is changing its length, there isn't any secrecy involved - it's typically a very open process. If you really feel like you've fallen for a bait-and-switch, though, it might be worthwhile to contact the RRC with the specifics of your situation to find out what options you have available.

Question:
I apologize in advance if this is the incorrect format for posting this. I am a Clinical Assistant Professor at the University of Toledo and have been in Private Practice for 17 years. I recently gave 2 1 hour lectures on Basic Coding and Billing to the Urology resident at UT and it was very well received. I covered everything from CPT and ICD9 codes to E&M codes and appropriate documentation. I provided them with some useful summary cards to carry around with them. My question is: any interest in having a similar presentation at next years' AUA Residents Forum? I could forward my Power point talk for your review. Greg Haselhuhn, MD ghaselhuhn@bex.net

Answer from Jessica T. Casey,M.D.:
The best person to email is the Chair of the Commmittee - Israel Nosnik. inosnik@gmail.com




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