SUO Fellowship in Urologic Oncology

1. Demonstrate and apply a detailed working knowledge of the surgical anatomy and physiology of the genitourinary tract, retroperitoneum, abdominal cavity and the lower chest.
2. Demonstrate a detailed understanding of the natural history of bladder, kidney, prostate, testis and penile cancer
3. Know how to evaluate and manage early and late complications of the treatment of these cancers, including sepsis, pulmonary embolism, hemorrhage, urinary leak, ileus and bowel obstruction, fistulas, and cardiac arrhythmias and ischemia.
4. Demonstrate a working knowledge of the pathology of genitourinary cancers, and be able to recognize the basic variations of cell type, grade and invasion of each cancer.

1. Become proficient in the evaluation and management of cancers of the bladder, prostate, kidney, testis and penis.
2. Demonstrate and understanding of the role of surgery, radiation and chemotherapy in the treatment of localized, regional and metastatic urologic cancers, as well as other cancers such as colon cancer that may affect the urinary tract.
3. Be able to interpret urologic radiologic studies as they result to urologic oncology, including CT scans with and without contrast, retrograde pyelography and urethrography, renal testicular and prostate ultrasound, abdominal and pelvic MRI, and PET and bone scans.
4. Demonstrate appropriate use of medical and surgical consultants in patient management.
5. Become proficient in the evaluation and management of cancers of the bladder, prostate, kidney, testis and penis.
6. Demonstrate and understanding of the role of surgery, radiation and chemotherapy in the treatment of localized, regional and metastatic urologic cancers, as well as other cancers such as colon cancer that may affect the urinary tract.
7. Be able to interpret urologic radiologic studies as they result to urologic oncology, including CT scans with and without contrast, retrograde pyelography and urethrography, renal testicular and prostate ultrasound, abdominal and pelvic MRI, and PET and bone scans.
8. Demonstrate appropriate use of medical and surgical consultants in patient management.

1. Be able to perform independently basic open urologic oncology procedures including radical prostatectomy, radical cystectomy with ileal conduit, continent ileal neobladder, and continent cutaneous urinary diversion, partial and total penectomy, inguinal lymphadenectomy, inguinal orchiectomy, retroperitoneal lymphadenectomy, open radical and partial nephrectomy with regional lymphadenectomy with or without level 1 IVC thrombus.
2. Be able to perform with supervision more advanced urologic procedures, including nerve sparing post-chemotherapy RPLND, salvage cystectomy and prostatectomy, complex partial nephrectomy and nephrectomy with level 2 and 3 vena cava thrombus.
3. Demonstrate accurate endoscopic evaluation and treatment of bladder and upper tract tumors, ureteroileal anastomotic strictures and afferent valve strictures in continent urinary diversion.

1. Demonstrate an understanding of the AUA guidelines for the management of localized prostate cancer, non-muscle-invasive bladder cancer, localized prostate cancer, and small renal masses.
2. Locate, appraise and assimilate evidence from scientific studies related to the patient’s urologic problems. 3. Use information technology to manage information and perform effective literature searches related to his/her patients.

1. Communicate effectively with patients and their families, including obtaining informed consent, giving bad news, and managing difficult or confrontational patients and families.
2. Demonstrate effective communication with patients from diverse cultures, including the effective use of interpreters.
3. Communicate openly, respectfully, and effectively with colleagues, including non-surgical colleagues, nursing and ancillary staff to optimize global care of the patients.
4. Teach residents effectively, including clearly imparting knowledge, teaching surgical techniques and guiding independent study, including evaluating resident performance.
5. Maintain comprehensive, timely and legible medical records.

1. Consistently take into consideration the cost of health care and deliver cost-effective health care whenever possible
2. Demonstrate an understanding of the social and economic factors affecting health care of his/her patients.
3. Advocate for quality patient care and assist patients in dealing with system complexities, especially as it relates to uninsured and underprivileged patients 4. Assist in the maintenance of continuity of care for patients after discharge from the hospital.

1. Demonstrate an understanding of the multidisciplinary approach to the common urologic cancer management, including prostate cancer, bladder cancer, renal cancer and testis cancer.
2. Demonstrate knowledge of the most common medical therapies applied to urologic cancers, including the various types of chemotherapies, biologic therapies and hormone therapies.
3. Know the expected response rates of each therapy in each disease in the first line and salvage settings.
4. Learn the common complications of each type of therapy and the prevention and management of them.
5. Demonstrate an understanding of the basic principals of radiation therapy, including the physics of dose calculation.
6. Know the pros and cons of external beam (including IMRT), brachytherapy, and combined treatments in the primary treatment of prostate cancer.
7. Demonstrate and understanding of the role of external beam radiation therapy for bladder cancer.
8. Describe the effect of concomitant systemic chemotherapy on radiation therapy effectiveness and side effects, and understand the differences between different chemotherapies.

1. Perform efficient and accurate history and physical examinations
2. Independently formulate diagnostic and treatment plans for patients on the service.
3. Demonstrate an ability to manage common complications of systemic chemotherapy in the outpatient setting.

1. Demonstrate appropriate work habits, including timeliness, efficiency, integrity, and teamwork.
2. Demonstrate respect, compassion for the patient with a commitment to ethical principles pertaining to the provision or with holding of clinical care.
3. Show commitment to carry out all professional responsibilities regarding patient care, including accessibility and accountability, and appropriate consultation with attendings and senior residents on the service.
4. Act appropriately and professionally in all clinical settings, maintaining patient confidentiality and showing respect for both patients and the entire healthcare team.

1. Communicate effectively with patients and their families, especially with highly educated and informed patients.
2. Develop an understanding of cultural differences in the perception and understanding of cancer and cancer care, and learn to communicate effectively with patients from diverse cultures.
3. Communicate openly, respectfully, and effectively with colleagues, including non-surgical colleagues, nursing and ancillary staff to optimize global care of the patients.
4. Maintain comprehensive, timely and legible medical records.

1. Be aware of the cost of individual aspects of care and deliver cost-effective health care whenever possible
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Assist in the maintenance of continuity of care for patients after discharge from the hospital.

1. Learn the appropriate role of minimally invasive surgical approaches to renal masses, upper tract and bladder urothelial cancers, and prostate cancer.
2. Learn the risks and complications of minimally invasive surgeries compared to open surgical approaches for the same conditions

1. Perform accurate and efficient history and physical examinations of patients on the service.
2. Become adept in the pre- and post-operative management of patients undergoing minimally invasive surgical treatments, including the evaluation and management of such complications as bleeding, infection, and catheter-related problems.
3. Know how to evaluate and manage intraoperative complications of these procedures, including the appropriate role for conversion to open surgery.
4. Use information technology and evidence-based medicine to support patient care decision.

1. Master laparoscopic and robotic radical nephrectomy and partial nephrectomy, including retroperitoneal and transperitoneal approaches.
2. Become adept at robotic radical prostatectomy.
3. Begin learning the techniques for laparoscopic and robotic partial nephrectomy and robotic radical cystectomy with extended pelvic node dissection and urinary diversion.
4. Maintain comprehensive, timely and legible medical records.

1. Demonstrate appropriate work habits, including timeliness, efficiency, integrity, and teamwork.
2. Demonstrate respect, compassion for the patient with a commitment to ethical principles pertaining to the provision or with holding of clinical care.
3. Show commitment to carry out all professional responsibilities regarding patient care, including accessibility and accountability, and appropriate consultation with attendings and fellows on the service.
4. Act appropriately and professionally in all clinical settings, maintaining patient confidentiality and showing respect for both patients and the entire healthcare team.

1. Locate, appraise and assimilate evidence from scientific studies related to the patient’s urologic problems.
2. Use information technology to manage information and perform effective literature searches related to the patients’ problems.
3. Interpersonal and Communication Skills
4. Learn to communicate effectively with patients and their families, especially with highly educated and informed patients.
5. Develop an understanding of cultural differences in the perception and understanding of urologic care, and learn to communicate effectively with patients from diverse cultures.
6. Communicate openly, respectfully, and effectively with colleagues, including non-surgical colleagues, nursing and ancillary staff to optimize care of the patients.

1. Demonstrate an awareness of the cost of individual aspects of care and deliver cost-effective health care whenever possible
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Understand the different systems of health insurance, including HMOs, PPOs and Medicare and MediCal, and know the impact of the type of system on the patient and healthcare provider.
4. Assist in the maintenance of continuity of care for patients after discharge from the hospital.

Initially the faculty will directly supervise all oncology cases, with the fellow taking on increasing independence as competency is established. By the end of the training is expected that the fellow will be able to independently complete basic urologic oncology cases, including radical cystectomy with orthotopic, continent cutaneous or ileal conduit diversion, open radical and partial nephrectomy, laparoscopic radical and partial nephrectomy, open and robotic radical prostatectomy and open inguinal and retroperitoneal lymphadenectomy. Competency to independently perform more complex procedures such as difficult laparoscopic or robotic partial nephrectomy, post-chemotherapy RPLND, salvage cystectomy and nephrectomy with IVC thrombus is expected to be achieved by most fellows by the end of the clinical year, but will depend on the individual fellow’s prior experience and surgical skills.

The USC Norris Comprehensive Cancer Center, Keck Hospital of USC and Los Angeles General Medical Center all have state-of-the art imaging available, including 64-slice spiral CT scans with 3D reconstruction capability, MRIs including 3T MRI with endorectal coil at Keck Hospital, PET scans, and interventional techniques. The fellow will be expected to become competent in interpreting studies using all of these techniques on his/her patients as indicated.

The fellow will participate actively in our multidisciplinary Grand Rounds, which include faculty from urology, medical oncology, radiation therapy, radiology and pathology as well as basic science faculty. A multidisciplinary patient care conference takes place weekly at Los Angeles General Medical Center, again with faculty from oncology and radiation therapy. Finally, a bi-weekly pathology conference at Los Angeles General Medical Center focuses primarily on oncology cases. In addition, the fellows will have a formal 1-month rotation in both medical oncology and radiation therapy.

The Aresty Department of Urology has a long been recognized as a center of excellence for open surgical treatment of complex urologic oncology cases. Fellows trained by Dr. Donald Skinner over the past 20 years have been recognized as some of the most outstanding open surgeons in the field. This tradition has continued at USC with faculty trained by Donald Skinner and equally committed to his surgical techniques. We now have the addition of one of the world’s most accomplished laparascopic and robotic surgeons as our Chairman. We expect to be able to train fellows in both open and minimally invasive techniques, and will focus on the most appropriate application of each technique to optimize outcomes for the patients.

USC Urology is world-renowned as a center for continent diversion and lower urinary tract reconstruction. Approximately 60% of over 200 patients undergoing radical cystectomy at our 3 hospitals annually opt for continent urinary diversion, so the fellow will gain extensive experience in these surgical techniques, as well as in the management of their complications.

The Aresty Department of Urology maintains three mature databases of patients treated with radical cystectomy, radical prostatectomy, and radical and partial nephrectomy. Charts are abstracted by trained full-time professionals who are responsible for patient follow-up data as well. All three of these databases include patients treated over a 20+ year time period, and include detailed clinical and pathologic information. The fellows have ample opportunity to study outcomes using these databases, and can gain a clear knowledge of expected outcomes with each of these diseases. The bladder and prostate databases are also tied to a tissue repository, which will allow the fellows to actively investigate new pathologic variables in these patient groups.

The fellows will be expected to actively participate in clinical trials underway at USC, and to be involved in developing new study ideas. This will include study design, management of regulatory issues (IRB), as well as screening patients for study participation. Fellows will be required to take the USC on-line course in clinical trial management. They will meet regularly with the clinical trials group, including the biostatisticians under Dr. Susan Groshen. In addition, we have three large clinical databases available for clinical studies, and the fellows will be involved in data analysis of those for specific study questions.

Fellows will be expected to present topics regularly at our Grand Rounds and submit and present podium and poster presentations at regional and national meetings. They will have extensive experience interacting with private patients as both outpatient and inpatients at Norris and Keck Hospital, and they will be primarily responsible for communication with referring physicians for patients at Los Angeles General Medical Center.

The fellows will be interacting regularly with the basic scientists, through their own laboratory research year and throughout the clinical year as well. They will be expected to do regular reviews of the literature regarding the patients they are involved with, and will present those at our Grand Rounds and patient care conferences. The medical oncologists in the Aresty Department of Urology are actively involved in translational research, and the fellows will work regularly with them on patient care issues as well as clinical research.

The fellow will participate in all of the following conferences on a regular basis:

Multidisciplinary GU Tumor Board (Mondays 5:30-7 PM, Norris). This is a multidisciplinary case conference attended by the urologic oncologists and minimally invasive urologists, radiation therapists and GU medical oncologists. We discuss complex cases for management decisions, including review of radiologic studies as well as patholgogy.

1. Journal Club & Grand Rounds (Fridays 6:30-7:30 AM): Journal clubs are scheduled approximately monthly during the resident teaching conference timeslot. The format of journal club varies from discussion of selected papers from the current urology journals to discussion of seminal papers on a particular topic. Faculty participating vary depending on the topic chosen.
2. Urologic oncology Core Curriculum: The fellows will meet with one or more faculty of the departments of urology, medical oncology and radiation therapy on a monthly basis to discuss specific topics in urologic oncology.
3. Pathology Review (alternate Fridays, 2 PM, LAC): All residents on the Los Angeles General Medical Center rotations attend this conference held at the multiple-head microscopes in the pathology department. Dr. Yanling Ma (pathology) reviews pathology from all urologic surgical cases from the preceding 2 weeks.
4. Urology Research Meeting (quarterly Friday AM): ): All research support staff, residents, fellows, and faculty from urology, medical oncology, and basic science labs are invited to attend to discuss ongoing projects, ideas for new projects, funding, logistics, issues surrounding databases, as well as IRB related matters.

The oncology fellows will have significant responsibility for bedside teaching of residents, and to a lesser degree the students on the services. Effective teaching skills are highly valued within our department, and the fellow’s teaching abilities in the OR and on the wards will be evaluated by the residents on an annual basis, with feedback to the fellows. However, in general the fellows will not be assigned formal lecture-type teaching responsibilities.

All of the faculty who have worked with each fellow will evaluate them at the end of each rotation using a competency-based evaluation form. Evaluations will be completed using the MyEvaluations program for on-line evaluations. The research faculty in whose lab the fellow works will also be asked to evaluate his/her performance in the lab on a semiannual basis.

The program director will meet with the fellow twice yearly to review the evaluations and discuss the fellow’s progress in the fellowship.

The Program Director will complete a final written summative evaluation of the fellow at his/her successful completion of the fellowship and this will become part of their permanent employment file.

The faculty will address the core curriculum on an annual basis as part of a faculty retreat. They will evaluate the entire curriculum with special attention to formal and informal feedback from the fellows regarding their experience.

The faculty will be evaluated by the fellows on an annual basis, combined with the resident evaluations. These will be performed through the MyEvaluations system which maintains confidentiality.