Resident Responsibilities

The Department of Urology is actively involved in all phases of care for adult and pediatric urology and currently performs around 3,000 operative procedures each year, with over 25,000 outpatient appointments in Urology at MUSC Health. The urology residency program is structured to provide the resident with a strong background in all aspects pertinent to urological surgery. Our program incorporates the University Hospital, Shawn Jenkins Children's Hospital, an outpatient pediatric surgery center, three outpatient clinics, and the Ralph H. Johnson VA Medical Center in Charleston, South Carolina. We have a multidisciplinary urologic cancer program, which is housed in the Hollings Cancer Center, a National Cancer Institute-designated cancer center.

Three positions are made available per year.

Training Structure

PGY-1 URO 1
PGY-2 URO 2
PGY-3 URO 3
PGY-4 URO 4
PGY-5 URO 5

The University Hospital will be covered by five residents daily (except for vacations and meetings). The junior residents will direct adult patient care under the supervision of the chief resident and the attendings. The senior resident will direct the inpatient consult service. The surgical intern will be assigned to MUSC inpatient service and the senior and junior medical students will be assigned to University Hospital OR’s, outpatient clinics, Shawn Jenkins Children's Hospital, or the Veterans Administration Hospital (VA). At the VA, ward rounds occur daily with the four assigned residents.
At the Shawn Jenkins Children’s Hospital, the senior urology resident will be in charge of pediatric patient care under the supervision of the attending pediatric urologist. The pediatric urology resident covers the Children’s Hospital urology patients, consults, and assists in clinic with the attending. The resident is typically in the OR on this service three days a week and in clinic two days a week.

Regardless of service location, admission histories and physical examinations should be completed in a timely fashion (within 24 hours from the patient’s admission). The intern and junior residents will share responsibility for completing all evaluations and discussing them with the proper attending physician. Residents are to meet all patients in pre-op holding and to be in the OR 15 minutes prior to scheduled start time to assist in patient positioning and to ensure that all cases start on time. Operative dictations must be done on the day of the procedure. It is advisable that these be done immediately after the procedure. The resident should confirm with the attending physician before the end of each case who is responsible for dictations. Discharge summaries must be done within 24 hours of the patient’s discharge and are the responsibility of the junior residents and intern on service.

The chief residents must be informed (by the junior residents) of all consultations directed to urology, all adverse changes in the course of a patient, all emergency admissions and will report these to the appropriate attending as they occur. The consult team will respond to hospital consultations and notify the proper attending physician. They will notify each attending of any patient admitted to their service (at the time of admission) and will present a plan of action (to be discussed with the attending). All admissions must be discussed with the proper attending prior to admission.

All residents will show sensitivity to patients and family needs. Patient information is not to be discussed in public. All residents will maintain cordial decorum with all hospital personnel as well as with each other, and resolution of differences of opinion will be carried out in a straightforward and reasonable fashion. If personal differences cannot be resolved between individuals, they will be brought to the chairman. Residents will be judged fairly on performance and inherent in this concept is that judgment must be evaluated, and treatment courses critiqued. This must be carried out in an honest fashion so maximum learning experience is achieved. 

Call Schedule

One chief and one junior resident assigned to the MUSC rotation will be responsible for making a monthly call schedule. The Department allows for call to be taken from home as long as patient care is not compromised. The residency director reserves the right to institute “in-house” call should there be any indication that patient care has been compromised. Call for the junior resident varies from 6 to 7 weeknight calls and 1 to 2 weekend block calls. The junior residents have from 2 to 3 weekends off a month. The intern takes rotating calls within this framework and also shares with weekend block call. Outside after-hours calls are directed to either the junior resident or the chief resident. All physician calls will be directed to the attending physician on call. The on-call attending will be designated as the physician of the day and will be responsible for all consults on that day. Adult attending call schedules will run from Friday through the next Friday. The pediatric urology attending covers all pediatric consults during weekday work hours. In his absence, the on-call attending will cover pediatric call.

Research Activities

Residents are expected to complete scholarly activity each year, either in research, patient safety or quality improvement. There is no dedicated research time. However, there are ample opportunities to be involved with basic and clinical research. Each resident is expected to publish at least one paper and to make a presentation at a major urological conference during the course of their residency. A program goal is for each resident to present at a regional or national conference annually.

Educational Activities

Formal ward rounds and weekly specialty conferences, including Grand Rounds, Campbell’s Conference, Morbidity and Mortality Conference, Wednesday Attending Didactics and VAMC Pre-Operative Conference are the mainstays of the didactic training. The two-year rolling curriculum includes the Core Curriculum from the AUA, and should be covered at least twice during a resident’s time in the program. A monthly Journal Club in conjunction with community urologists is held to discuss current publications. Residents are expected to attend the genitourinary multidisciplinary tumor board.

PGY-1

This year is designed to introduce the trainee to the broad field of surgery including general surgery and urologic surgical experiences. Rotations are provided in general surgery, transplant surgery, pediatric surgery, gastrointestinal surgery, surgical oncology, urology, and critical care. Rotations are performed at the University Hospital, the Shawn Jenkins Children’s Hospital, and the VA Hospital. A total of six months is spent on the general surgical services, and six months on Urology. In each of these areas, the PGY-1 trainee is given responsibility commensurate with their interest and ability. They may have the opportunity to perform operations under the direct supervision of chief residents and attending surgeons.

Primary emphasis is placed on the evaluation of the surgical inpatient and outpatient. The trainee works as a junior ward officer where all aspects of preoperative and postoperative care are stressed.
The PGY-1 is also responsible for much of the administrative aspects of patient care, including ensuring timely completion of histories and physical examinations, and progress notes whether completed by the students or other members of the team. The trainee assures that all aspects of care are addressed by communicating them in the doctor's orders and assuring that these orders have been accomplished.

Together with other junior residents on the service, the PGY-1 is responsible for the dictation of accurate and concise discharge summaries. By the end of the PGY-1 year, the intern is comfortable with ward clinical problems, basic critical care, and BLS and ACLS protocol. 

PGY-2

This is the first of four dedicated urology postgraduate years. The resident will become familiar with office-based urology, including the initial evaluation of adult and pediatric urologic patients, performance of office-based procedures, including, but not limited to cystoscopy, transrectal ultrasound and prostate biopsy, vasectomy, and urodynamic studies. The PGY-2 will learn how to work-up common urological problems encountered in hospital consultations and will learn how to deal with urological emergencies. This resident typically assists in major open, laparoscopic, and robotic surgeries.

The resident will develop an understanding of socio-economic issues related to medicine, including the practice of delivering cost-effective medical care. They will develop an understanding of the ethics of the medical and urologic profession and will become an active participant in conference discussions and journal club presentations. 

PGY-3

By the end of the PGY-3 year, the resident will be able to evaluate all urologic patients under his care and organize a plan of management acceptable to the chief resident and attending physician. This plan will include total assessment of the patient, evaluation and interpretation of all pertinent accompanying information, determination of appropriate diagnostic studies, and providing a rationale for therapy.

The resident will develop an understanding of adult and pediatric anatomy and physiology as it relates to urologic patients and learn the medical and surgical management of adult and pediatric patient. The resident will understand basic urologic disease including uro-oncology, benign diseases of the prostate, voiding dysfunction, urologic trauma and reconstruction, pelvic floor disorders, chronic and acute renal failure, male infertility and erectile dysfunction, as well as become proficient in common pediatric urologic conditions, including hydronephrosis, vesicoureteral reflux, posterior urethral valve disease, bladder pathophysiology, and pediatric malignancies.

The resident will become proficient in office-based urology, including the initial evaluation of adult and pediatric urologic patients, performance of office based procedures, including, but not limited to cystoscopy, transrectal ultrasound and prostate biopsy, vasectomy, and urodynamic studies.

The resident will become proficient in minor operative urology, including endourologic procedures, open surgical procedures, pediatric surgical procedures, and lithotripsy and will learn the details of major urologic operative procedures by active participation in cases as time allows. The resident will develop an understanding of pre-operative assessment of patients and post-operative management of surgical patients. They should at this point be actively involved in an independent research endeavor within the department. 

PGY-4

By the end of the PGY-4 year, the resident will be able to evaluate all urologic patients under their care and organize a plan of management acceptable to the chief resident and attending physician. This plan will include total assessment of the patient, evaluation and interpretation of all pertinent accompanying information, determination of appropriate diagnostic studies, and providing a rationale for therapy. The resident will further their understanding of adult and pediatric anatomy and physiology as it relates to urologic patients. The resident will serve as the administrative chief of the pediatric service during their time on that service. The resident will understand complex urologic disease including uro-oncology, benign diseases of the prostate, voiding dysfunction, urologic trauma and reconstruction, pelvic floor disorders, chronic and acute renal failure, male infertility and erectile dysfunction. The PGY-4 will participate in a transplant surgery rotation for 4 months.

The resident will be comfortable with office-based urology. They will also finalize the process of learning all medical and surgical urology as it relates to the pediatric population. The resident will remain an active participant in conference discussions and journal club presentation and will continue the process of learning operative urology, including endourologic procedures, more complex open surgical procedures, and lithotripsy. The resident will learn the details of major urologic operative procedures by active participation in cases as time allows. The resident will have an understanding of pre-operative assessment of patients and post-operative management of surgical patients.

By the end of the PGY-4 year, the resident will have completed an independent research endeavor and prepare for presentation at a major academic meeting. 

PGY-5

The chief residents will prepare the service report presentations, lead grand rounds and other didactic functions, oversee all patient care, review preoperative evaluations, schedule patients for hospital admission and surgery, control hospital beds, and assign operative cases. In essence, administrative functions will be entirely assumed by the chief residents. The chief will meet independently with the junior floor residents each morning and make rounds on all patients.

The PGY-5 year will be devoted to mastering medical and surgical Urology and developing administrative skills necessary for the performance of high quality urology, either in an academic or private practice situation. The resident will serve as administrative chief of the respective institution and serve as a junior faculty under the guidance of the faculty. The resident will organize the residency program under the guidance of the residency director and take initiative with the didactic schedule and ensuring that all conferences are attended. The resident will master the understanding of adult anatomy and physiology as it relates to urologic patients and finalize his understanding of urologic disease, including uro-oncology, benign diseases of the prostate, voiding dysfunction, urologic trauma and reconstruction, pelvic floor disorders, chronic and acute renal failure, male infertility and erectile dysfunction.

The resident will master office-based urology, including the initial evaluation of adult urologic patients, performance of office-based procedures, including, but not limited to cystoscopy, transrectal ultrasound and prostate biopsy, vasectomy, and urodynamic studies. The resident will become proficient in operative adult urology including preoperative and postoperative management and discussion of alternative therapies with surgical patients. The resident will lead most conference discussions and journal club presentations, including actively participating in the development of conference schedules.

The resident will finalize the process of learning operative urology and learn the details of major urologic operative procedures by active participation in all major cases. 

Clinical Specialties

  • Urologic Oncology – diagnosis and treatment of all types of genito-urinary cancers
  • Andrology – medical and surgical treatment of erectile dysfunction, Peyronie's disease, hypogonadism, and male infertility
  • Minimally-Invasive Surgery – principles of endoscopic, laparoscopic, and robotic procedures
  • Female Pelvic Medicine and Urogenital Reconstruction – diagnosis and treatment of pelvic floor and lower urinary tract disorders and reconstruction of the genitourinary tract
  • Pediatric Urology – diagnosis and treatment of genitourinary disorders in children
  • Voiding Dysfunction and Video Urodynamics – diagnosis and treatment of lower urinary tract dysfunction
  • Urinary Stone Disease – metabolic and surgical treatment of urolithiasis

Resident Teaching of Medical Students

Third and fourth year MUSC medical students and visiting students rotate through the Department of Urology each year. The resident team is expected to be active participants in medical student teaching. Students are encouraged to follow patients postoperatively and round with the resident team, spend one-on-one time with attendings in clinic, and scrub for the OR. Morning rounds with the Chief Resident, junior resident, intern, and students, although informal, are a rich learning experience where resident to student teaching will be the focus. The Department of Urology encourages students from other institutions to visit for an externship. There are also ample opportunities for students to become involved in research and residents can facilitate student research.