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Education in Urology. The American Perspective

Education in Urology. The American Perspective. J.Edson Pontes M.D. Professor Urologic Oncology WSU/KCI. American Medicine. Historical Background. Medical Schools in the USA proliferated in the 19th Century with little quality control.

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Education in Urology. The American Perspective

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  1. Education in Urology.The American Perspective J.Edson Pontes M.D. Professor Urologic Oncology WSU/KCI

  2. American Medicine.Historical Background • Medical Schools in the USA proliferated in the 19th Century with little quality control. • In 1908 the AMA created the CME and recruited Abraham Flexner to survey all 155 Medical Schools in the Country, and make specific recommendations. • This has became know as the Flexner report with profound changes in Medical Education in the USA.

  3. The Flexner report. Recommended changes. • Used the Johns Hopkins University as model. • Admission to Medical School to require a high school education and 2 years of College .At the time only 16/155 Medical Schools met these requirements. • Proprietary Schools should be closed or incorporated into Universities.

  4. Consequences of Changes • Flexner suggested to decrease the number of Medical Schools to 31 in the USA. • Decrease the number of graduates from 4400 to 2000. • Between 1910 and 1935 >half of all Medical Schools in the USA were either closed or merged into Universities.

  5. ACGME Recommendations for present training in Urology • One or 2 years of General Surgery- minimal of 3 months in general surgery ,critical care vascular surgery and trauma. • A minimum of 4 years of Urology. Residents must serve a minimum of 12 months as chief resident. • Resident’s expertise to include: management of patients with complex urological problems, advanced procedures and a high level of responsibility and independence.

  6. Sponsoring Institutions • Must assume ultimate responsibility. • Program Director: single program director, approved by GME and submitted to ACGME. • The program director should be in that position for a minimum of 6 years.

  7. Qualifications for a program director • Urological Expertise and Administration experience. • Board Certification. • Medical licensure. • Documented clinical and scholarly expertise in Urology.

  8. Duties of Program Director • Oversees and assures quality. • Selection of program faculty. • Monitor resident’s supervision • Provides residents with biannual evaluation and progress. • Monitor resident’s duty hours to mitigate excessive fatigue, etc…

  9. Didactic conferences • Combined morbidity and mortality conferences. • Urological Imaging conferences. • Urologic Pathology • Journal Club.

  10. Core Domains.Adult Urology • General Urology-TUR, TRUS/Biopsy, scrotal, inguinal surgery, urodynamics- minimal 200 cases. • Endo urology and stone disease: ESWL,PCN procedures, ureteroscopy: minimal 100 cases. • Laparoscopy: minimum 20 cases. • Reconstruction: minimum 60 cases. • Oncology: minimum 100 cases.

  11. Core DomainPediatric Urology • Minor: endoscopy, hydrocele, hernia repair, orchiopexy: minimum 30 cases. • Major: hypospadia, ureter: minimum 15 cases.

  12. The Future • Medical Schools and medical training are undergoing significant changes. • In Urology we have seeing a shift from open surgery to minimally invasive procedures, with surgery being only a player among different disciplines. • In the near future, the training of a Urologist needs to adapt to the new realities of other procedures until now being done by radiologists etc..

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