USC Urology

INTERNSHIP (PGY 1 year):
Goals:

• Learn general perioperative management of adult surgical patients, including fluid management, intensive care, basic evaluation of the acute abdomen, evaluation of trauma patients, basic wound care, line placement, and suturing.  

13 4-week rotations including general surgery, surgical subspecialties and 3 months of urology.  The schedule is determined by the program director of the Department of Surgery. Interns are assigned one month of vacation.  

UROLOGY 1 (PGY 2 year):
LAC+USC Urology USC I - 4 months
LAC+USC Urology USC III - 4 months
Childrens Hospital - 4 months

Goals:

• Learn basic adult urology outpatient and inpatient management, including diagnostic and treatment approaches for the common urologic diseases.
• Learn basic pediatric urology, including peri-operative patient management, outpatient diagnosis and treatment of common pediatric urologic problems, and begin learning basic surgical techniques in this population.

This year begins to lay the groundwork of basic urologic knowledge and techniques. At LAC+USC Medical Center the resident has major responsibility for pre- and post-operative patient management as well as operative management of simpler cases, all under the direct supervision of the Chief Resident and faculty. Cases include all aspects of general adult urology, including stone disease, BPH, infections, trauma, female urology and oncology.  In addition, the resident will receive extensive outpatient experience in the busy clinics, including considerable experience with outpatient cystoscopic and radiologic procedures. Faculty include Dr. Charles Best, Matt Dunn, Eila Skinner, Gary Lieskovsky, Mihir Desai and Monish Aron.

At Childrens Hospital the resident gets introduced to pediatric urology, begins to learn perioperative patient management, outpatient diagnosis and treatment of common pediatric urology problems, and begins learning basic surgical techniques in this patient population. The residents work under the supervision of four full-time pediatric urologists (Drs. Brian Hardy, Roger DeFilippo, Chester Koh, and Andy Chang) on a very busy inpatient and outpatient service. Cases vary from routine orchidopexies to complex reconstructive surgeries, oncology and renal transplant.  

UROLOGY 2:
LAC+USC Urology USC II/Peds - 4 months
Norris Cancer Center - 4 months
Rancho Los Amigos Hospital - 4 months

Goals:

• Increase the resident’s confidence in medical and surgical management of the most common inpatient and outpatient urologic problems in the adult and child.
• Learn basic urologic oncology and the peri-operative management of complex surgical patients, and establish the basic technical skills for subsequent surgical learning.
• Gain an understanding of the urologic management of patients with spinal cord injury and other neuro-urologic problems.

In this year the resident spends an additional 4 months at LAC+ USC Medical Center assuming responsibility for patient management decisions for more complex cases. In addition the USC II service also covers the pediatric urology service, with one clinic and one operating room day per week, and provides consultation services to the obstetrics and gynecology services at that hospital.  

The Norris Hospital is a busy comprehensive cancer center with a large urology service with 10-20 inpatients and 15-20 major procedures per week. The junior resident has primary responsibility for perioperative patient management of these patients with the assistance and supervision of the chief resident, faculty fellow and attending staff. Faculty practicing at Norris include Drs. Eila Skinner, Gary Lieskovsky, Stuart Boyd, Matt Dunn, and Anne Schuckman. The junior resident scrubs daily with the faculty as first or second assistant on major open oncology surgeries, learning the basic skills of dissection which will form the basis of his/her approach to open surgical procedures.

The Rancho Los Amigos Hospital is a large public rehabilitation hospital with a busy spinal cord injury rehabilitation center. The urology service is under the direction of Dr. David Ginsberg. The resident on this rotation will focus on all aspects of neurourology, including learning the diagnostic and medical management of the urinary tract in the face of neurologic damage, the performance and interpretation of videourodynamics, and the use of surgical reconstruction techniques in this patient population. He/she will get experience in the busy outpatient clinic as well as following inpatients during their initial rehabilitation. The resident will also be exposed to a variety of other chronic neurologic and non-neurologic illnesses that impact the urinary tract.  

UROLOGY 3:
University Hospital - 6 months
Childrens Hospital LA - 4 months
St. Vincents Hospital (Transplant) - 2 months
                        
Goals:

• Become adept at management of general urologic problems in the inpatient setting and learn the role of the urologist as a consultant
• Learn the medical and surgical management of complex kidney stones and female voiding dysfunction and pelvic floor relaxation.
• Become comfortable with the evaluation and medical and surgical management of common pediatric urologic problems.
• Gain an understanding of the basic medical and surgical management of the renal transplant patient.  
• Become adept at using endoscopic and robotic/laparoscopic techniques in the surgical approach to common benign and malignant urologic problems.

This year focuses on the urologist as a hospital consultant with three rotations in academic and community private hospitals, as well as another pediatric rotation.  

At University Hospital the urology service focuses on laparoscopic and robotic surgeries, stones and female urology. The resident covers both the inpatient service as well as the affiliated Doheny outpatient surgical center, and also provides consultative services to a variety of other specialties within the hospital, working closely with the full-time attending staff in the Department. Full time faculty practicing primarily at UH include Dr. Inderbir Gill, Mihir Desai, Monish Aron and David Ginsberg.

On the resident’s second rotation at Children’s Hospital he or she acts as the chief on the service, taking on more complex surgeries and functioning more independently in making patient management decisions.

St. Vincent’s Hospital is a private community hospital that is the home of one of the largest urologist-run kidney and kidney-pancreas transplant programs on the west coast. The resident on this rotation gets an introduction to the surgical and medical management of kidney transplant patients and also participates in a variety of general urologic cases with the attending staff.  

UROLOGY 4:
LAC+USC Medical Center, USC I&III - 4 months
LAC+USC Medical Center, USC II/peds - 4 months
Norris Cancer Center  - 4 months

Goals:

• Become an independent urologist managing the complete array of general adult and pediatric urologic problems.
• Become comfortable with independent patient management of all urologic malignancies.  
• Learn to independently perform basic urologic cancer surgeries and manage common complications.

This year is the culmination of the resident’s training, preparing him/her to function independently as a urologist in the community or in academic practice. At the LAC+ USC Medical Center the Chief Resident functions as the primary supervisor for the juniors, with responsibility for all decisions made on the service in consultation with the attending staff. All surgical procedures are performed at this level except for the most complex, and the Chief Resident also serves as one of the primary teachers of surgical technique as well as clinical judgment for the junior resident. When on the USC II service the Chief Resident is also responsible for the pediatric urology service.

At the Norris Hospital the Chief Resident scrubs daily with the urologic oncology faculty, having an opportunity to refine his/her skills doing complex oncologic and reconstructive procedures. The cases include all aspects of urologic oncology including laparoscopic and open surgery, along with reconstructive and prosthetic surgery for the treatment of incontinence and impotence. The resident at this level also acts as an advisor and teacher for the junior resident on the service.