Endourology Post-basic Training Program Clínica San Camilo

Justification of Endourology Specialization

Urology, as all the medical specialties, has been organized into different sub specialties. This vectorizing has caused an enormous development on diagnosis methods and therapeutic procedures. Among the sub specialties mentioned, there is Endourology.

From its emergence at the end of the 1970´s and beginning of the 1980´s, Endourology has progressed on its field in order to solve cases of increasing complexity with minimally invasive procedures, becoming –at present– the gold standard to solve most urinary stone cases and towards the treatment of other diseases, such as upper track urinary cancers.

Training and the correct handling of this kind of procedures is essential for a better patients assistance. However, a low number of hospitals –as the Clínica San Camilo– currently count with a vast casuistry and the technology needed.

The Endourology Fellowship program was created by Professor Norberto Bernardo in year 2014 and has 10 former fellows so far.

The wide volume of information and the need of a training on specific procedures are the reasons why Endourology training cannot be completed during the Basic Urology Internal Medical Residency, thus a specific training to complete the academic training is required. That is why there are numerous Fellowship Programs worldwide.

The Urology Service at the Clínica San Camilo develops daily a prominent clinical and surgical activity in a private hospital environment. Each week, approximately 300 patients are tended on outpatient clinics, and around 1000 surgeries are performed annually.

In the teaching activity, staff doctors participate delivering classes on subjects related to the specialty for students of Urology at the Medicine Career from the University of Buenos Aires and of the Specialty Training in Urology.

Endourology Training Objectives

General Objectives

Upon completing the training program, the fellow will be able to:

• Have the knowledge, and the clinical and theoretical experience to provide a comprehensive assistance of those pathologies that require an endourologic approach or extracorporeal lithotripsy for their resolution, and of the stone disease in general.
• Interpret image studies related to the pathology, such as ultrasonography, computed tomography, MRI, angiography and nuclear medicine, among others.
• Resolve the severity degree and need of resolution of different cases of stone disease, as well as surgical treatment options –if needed–, at the moment of diagnosis and during the illness progress.

 Research and Education Activity

• To identify the design and implementation of a prospective database.
• To prepare and make prospective clinical trials.
• To identify interface between basic science and clinical care.
• To analyze statistic methods to test research studies results published properly.
• To recognize search methodology, analysis and selection of scientific journals.
• To train students and residents in the multidisciplinary handling of patients with diseases of endourology approach.
• To train no medical staff (medical assistants, nurses, etc.) in specialized endourology pathology assistance.

Specific Objectives

• To gain technical skills in performing complex endourology procedures to solve lithiasis pathology and other cases that require an endourology approach for its resolution.
• To acquire technical skills needed for performing Extracorporeal Shockwave Lithotripsy [ESWL].
• To have knowledge on metabolic aspects of the stone disease and its utility in prevention of its recurrence.

Requirements to Enter the Fellow Program

- To have at least 3 (three) full years of Urology residency in a Urology Service with a residence system approved by the national or international health agencies, regardless of race, color, sex, language, politics bias, national or social origin, economic status, birth or any other condition. Furthermore, there will be no distinctions based on political, legal or international condition of the country or territory of whose jurisdiction a person depend on.

- To have National License for medical practice. Those that had performed their residence period abroad must have their National License effective in accordance with the Ministry of Health [Ministerio de Salud de la Nación] regulations.

- To submit a research project that shall be assessed by the persons responsible for the Fellow Program and the Teaching and Research area, and shall be approved by the ethic and medical advisory committee, and, when your advanced training is completed, you shall submit the complete project.

- To pass an interview –that shall include a suitability and backgrounds assessment– coordinated by the persons responsible for the training program and by a representative of the Teaching and Research area. Subsequently, the chosen candidate shall be appointed.

Program Contents

Theoretical Contents

Through different aid and scientific activities (outpatient clinics, surgeries, research works, etc.), this program’s objective is to train doctors so that they know the handling of the endourology pathology and can practice surgeries, with criteria and suitability.

By the end of the program, the doctor shall:

• Identify the urological anatomy and pathophysiology.
• Identify the natural evolution of the stone disease.
• Analyze the handling of the stone disease in outpatient clinics.

Acquisition of skills on:

• Physical Examination.
• Requirement and interpretation of the complementary studies.
• Indications and contraindications of surgical procedures.

The instructional strategy is divided into three areas:

Cognitive Area

• Clinical Panel (weekly)
• Panel on Morbidity and Mortality (monthly)
• Bibliographic Panel (weekly)
• Attendance to the Sociedad Argentina de Urología sessions (monthly)

Skills and Capabilities Area

• Permanent supervision over the different practices developed in the office, admission and at the OR.

Attitude and Behavior Area

• Permanent supervision and accompaniment emphasizing on communication and the patient care, interrelationship with colleagues, responsible update of the medical knowledge.

All the teachers are responsible for the compliance of the strategies mentioned.

Practical Contents

Procedures that the doctor must perform autonomously:

• Stone Disease
• Extracorporeal Shockwave Lithotripsy [ESWL]
• Semi Rigid Ureteroscopy
• Pneumatic Intracorporeal Lithotripsy
• Laser Intracorporeal Lithotripsy
• Ultrasonic Intracorporeal Lithotripsy
• Retrograde Intrarenal Surgery (RIRS)
• Percutaneous Nephrolithotripsy (PCNL)
• Endoscopic Combined Intrarenal Surgery (ECIRS)

Procedures in which Endourology acts as secondary procedures:

• RIRS for the conservative treatment of upper track urinary cancers
• Percutaneous Renal Access for the conservative treatment of upper track urinary cancers

Assessment

The assessment shall be based on the compliance of the objectives set on the Fellow Program, and on the passing and compliance of the research project.

Assessment by Performance

Performance of the daily health-care activity on outpatient clinics, compliance with the health-care requirements, bibliography handling, performance on academic programs, skills to acquire new knowledge.

Assessment by Procedures

Development of the surgical procedures set as part of the practical contents as 1st Assistant and as Principal Surgeon.

A point-to-point evaluation of the steps of each surgical procedure set will be performed.

Length and Vacancy

One (1) vacancy shall be appointed for the one year Clinical Advanced Program on Endourology, within the framework of a pre-established study program, which shall last one (1) year, to allow the chosen candidate the opportunity of study and improve on endourologic techniques on the Clínica San Camilo.

Hourly Load

The 1-year program comprises approximately 2000 hours of training (40 hours weekly).

The working hours inside the Institution shall follow a timeline (see chart) which will allow Endourology Fellows to participate in academic activities in and out the Clínica San Camilo premises, such as teaching lectures, local, regional and national meetings. Each Fellow shall have a daily time dedication of approximately 8 hours inside the hospital. 

The Fellow shall have an annual recess of 30 (thirty) consecutive days.

Weekly Schedule

Staff

Directors:

Prof. Norberto Bernardo (MD, Chief of Urology Service)

Horacio Sanguinetti (MD)

Medical Team:

Santiago Battiston (MD, Urology Staff)

Mauricio Colicigno (MD, Endourology Staff)

Paula Grinstein (MD, Urology Staff)

Maximiliano López Silva (MD, Endourology Staff)

Resources

Program’s Learning Areas

Outpatient Clinics: the fellows learn about outpatient diseases, prevalent pathology and diagnosis methodology of patients with surgical conditions. They also learn about the monitoring methodology of surgical patients.

Admission Room: the fellows learn about the clinical surgical handling of diseases that require this therapy.

OR: fellows acquire the skills and technical concepts of the treated pathologies.

ESWL Room: fellows acquire the skills and technical concepts of Extracorporeal Lithotripsy.

Animal Lab Training Center (in an Associate institution).

Training center with simulators: in which courses are given, and where fellows as well as basic Urology residents are trained regularly.

The Clínica San Camilo has a state-of-the-art infrastructure to develop its health-care and teaching activities properly. To highlight: modern surgical instrument, state-of-the-art 100 watts Holmium laser device, CT scan, etc.

The Fellow is already an especialist in Urology whose main goal is the acquisition of knowledge in a branch of the specialty such as Endourology is. It has a wide activity in the clinical, diagnosis and therapeutic fields in which it is included in the surgical treatment.

The Fellow participates in all the activities. He enters the hospital at 7 AM and ends his shift at 3 PM approximately. The aim is that, in that period of time and under permanent supervision, he improves his performance in all the activities mentioned until he can perform most of them autonomously and in a responsible manner. His participation progresses on liability and complexity as he acquires knowledge and capabilities to perform them by himself. Fellows have a Residents and Fellows Room and a Doctors Room with desks, chairs and computers with Internet access, audiovisual technology where they can consult medical histories and studies as well as making presentations.