Overview
The Harvard program in Urologic Surgery at Massachusetts General Hospital provides exposure to all aspects of adult, pediatric, and investigative urology.
Three residents per year are chosen in the American Urologic Association residency match. One year of general surgical training is a prerequisite to entering the urologic residency as a PGY-2.
During the year of general surgery, the resident rotates through thoracic surgery, surgical oncology, the emergency room, transplant service, general surgery, and the intensive care unit. Those matching at MGH for urology are also accepted into the general surgery department for their PGY-1 year.
Facilities
The Massachusetts General Hospital is an 886 bed teaching hospital of the Harvard Medical School. The Department of Urology is located on the eleventh floor of the Gray/Bigelow building. The academic offices and urology library are in this area. The Urology Service has four dedicated operating rooms in which over 2,800 operative procedures are performed yearly.
The outpatient offices are located in the adjacent Wang Ambulatory Care center. There are exam rooms and several procedure suites where faculty and residents perform cystoscopy, transrectal ultrasound, prostate biopsy, small bladder tumor resection, vasectomy and other minor surgical procedures. Approximately 3,000 procedures are performed in the outpatient clinic per year. The clinic is staffed by patient service coordinators, one specifically dedicated to the residents, as well as urology nurses and medical assistants. State of the art video urodynamics testing facilities are located here as well.
The research facilities are located in the Warren building on the MGH campus. Two well-equipped laboratories have capabilities for molecular biology, tissue culture, transport studies, histology, laser studies and renal and gut physiology. Additional research efforts with a urologic perspective are conducted in the departments of endocrinology, pediatric surgery, medical and radiation oncology, nephrology and in the Department of Urology, Children’s Hospital.
General Surgery at Massachusetts General Hospital
One year in general surgery is required. There is an opportunity for two of the three residents to have 4 to 8 months of general surgery in the PGY-2 year if so desired. The first year is a surgical internship with rotations in general surgery, thoracic surgery, urology, transplantation, burns/ICU and emergency medicine. In the first year urology residents are indistinguishable from their fellow general surgery residents. The goal of the year is to provide a knowledge base of surgical principles and techniques, and the ability to manage surgical patients on the ward and in the surgical intensive care unit.
Urologic Surgery
The program in urology is four years culminating in an appointment to the faculty with full attending privileges for six months. During the first two years residents have junior rotations in adult urology at Massachusetts General Hospital and pediatric urology at Boston Children’s Hospital, and a six month outpatient/research rotation. In the third year the resident has a senior rotation in pediatric urology at Boston Children’s Hospital. In the fourth year the resident is chief resident in endourology, laparoscopic surgery and open surgery at the Massachusetts General Hospital. Following the final year of urology, the trainee becomes a junior faculty member with full admitting and operating privileges and manages his/her own service.
The urology faculty and their patients are split into two services, the O'Neil Service and the Leadbetter Service.
- O'Neil Service Junior - Responsibilities include assisting the Cabot Attending with all cases, assisting faculty with open or endoscopic cases as assigned by the Chief Resident and following inpatient and outpatient Cabot consult patients from other services.
- Leadbetter Service Junior - Responsibilities include assisting faculty with open, laparoscopic and endoscopic cases as assigned by the Chief Resident.
- Pediatric Junior - Responsibilities include assisting faculty with open and endoscopic cases, management of patients, evaluation and management of outpatient clinic pediatric urology patients under supervision of pediatric faculty.
- Pediatric Senior - Responsibilities include assisting faculty with open and endoscopic cases, seeing and managing urologic consultations from pediatric and obstetrical services at Children’s Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, and inpatient and outpatient management of pediatric urological patients.
- Outpatient Clinic/Research Resident – Residents participate in the outpatient clinic and time is made available for the resident to pursue basic and clinical research projects in any area of adult or pediatric urology which interests the trainee. Dr. Aria Olumi is the director of research and mentors the resident during this period of time. Dr. Olumi directs one laboratory and Dr. Chin-Lee Wu directs the other basic science laboratory. For those interested in clinical research the Department has a large patient database. The resident will meet with the departmental chairman and Dr. Olumi prior to his/her research block to arrange the rotation.
- Endoscopy chief resident - Responsibilities include assisting the senior faculty on complex percutaneous and transurethral endourology as the primary surgeon, assuming primary responsibility for the inpatient care of endourologic patients under faculty supervision.
- Laparoscopic chief resident - Responsibilities include assisting senior faculty with laparoscopic management of their patients with faculty supervision.
- Open Service Chief resident - Responsible for assisting and staffing all open cases as the primary surgeon and primary responsibility for pre and post operative care of these patients with attending oversight.
- Cabot Attending - Responsibilities include attending surgeon for Ward Service patients and consults, attending urologic surgeon member of the level 1 trauma team, oversight of all resident staff functions, preparation of case conferences for urologic grand rounds, primary responsibility for pre and post operative care of Cabot Service patients.
Outpatient Responsibilities
Each resident starting at the PGY-2 level develops his/her own clinic population of patients whom he/she will follow for the next four years. Referrals are from resident staff clinics in other specialties and from the emergency room. In this way patients are followed by a single resident who is responsible for diagnosis, treatment and follow up care under the Cabot Service Chief and faculty supervision. This extremely rich outpatient experience ensures that residents gain experience in continuity of care by being the primary urologic diagnostician, deciding on therapy, and then observing the outcome of their decisions and actions. It also allows for the development of the skills for effective patient and family interaction, referring physician interchange, and interaction with radiology, medical and radiation oncology and pathology consult physicians. Procedures performed in the outpatient clinic by residents include cystoscopy, prostate ultrasound and biopsy, and vasectomy. The Resident Service sees their patients in the same clinic and with the same nursing staff as the senior faculty. They have their own dedicated secretary and reserved operating room time.
Clinical Subspecialties
Training in urology at Massachusetts General includes extensive experience under supervision by dedicated faculty in the following subspecialty areas.
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Oncology - Urologic oncology is the specialty of the majority of the faculty. A rich and productive collaboration between urology, radiation medicine and medical oncology has made Massachusetts General a worldwide tertiary referral center for difficult oncological disease. MGH is the home to minimally invasive techniques including bladder sparing and radiofrequency ablation of renal tumors. MGH is an extremely busy center for clinical and investigative work in prostate cancer with over eight hundred patients seen with newly diagnosed prostate cancer each year. There is a large clinical volume requiring various forms of treatment. As in many aspects of urology, a multidisciplinary approach is taken and is reflected in a multidisciplinary cancer clinic which meets four times a week to evaluate and consult on these patients.
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Laparoscopic and robotic surgery - MGH has a state-of-the-art laparoscopic surgery program under the direction of Dr. Douglas Dahl. Dr. Dahl has expertise in all areas of laparoscopic surgical management of urologic disease, including pediatrics and donor nephrectomy, but primarily focuses on applications in urologic oncology. Dr. Shahin Tabatabaei, Dr. Adam Feldman, and Dr. Aria Olumi, members of the division of laparoscopic and robotic surgery, also have a primary interest in laparoscopic oncological surgery. The MGH has one of the largest experiences in the U.S. of laparoscopic radical prostatectomy, laparoscopic partial nephrectomy and laparoscopic nephrectomy. Robotic surgery is also a part of this service.
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Endourology/stone disease - Endourology at the Massachusetts General Hospital is overseen by Dr. Stephen Dretler who is a pioneer in the field of stone disease, and by the co-director, Dr. Dianne Sacco. The MGH is a referral center for complex transurethral and percutaneous stone surgery.
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Transplantation - Massachusetts General performs approximately 100 renal transplants per year. During the first general surgery year the urology resident will spend four to eight weeks on the transplantation service under the direction of Dr. Dicken Ko, a urologic surgeon in the department specializing in clinical and research efforts in transplantation. Training includes surgical management including laparoscopic donor nephrectomy, nephrology of renal failure, and management of rejection and infectious complications of immunosuppression. Research centers on novel methods of immunotolerance including work in xenotransplantation.
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Incontinence/voiding dysfunction/female urology - Massachusetts General has an extensive clinical program in voiding dysfunction. There is a video urodynamics laboratory staffed by four urologic physicians in which problems of voiding dysfunction are evaluated. Dr. Joseph Grocela's primary interest is female urology and he is very active in the area of female voiding dysfunction and outcomes analysis. Dr. Pablo Gomery is primarily interested in neuro-urology and all other aspects of voiding dysfunction and associated clinical research.
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Impotence - Dr. Theodore Ongaro runs a clinic that specializes in the diagnosis, treatment and research into novel medical treatments of erectile and sexual dysfunction.
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Pediatrics - Subspecialty training in pediatric urology is provided at Children’s Hospital Boston under the direction of Dr. Alan Retik, Surgeon-in-Chief, and his twelve full-time faculty. This is an extremely rigorous training in all areas of pediatric urology. Weekly conferences include chapter reviews on pediatric subjects with faculty, clinical/radiographic case rounds, and pediatric grand rounds. Clinics include a myelodysplasia clinic and a general urologic ward service clinic. In addition to this training, there is a monthly pediatric urologic grand rounds at Massachusetts General.
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Prosthetics - Dr. Niall Heney has an active practice in both penile and urinary sphincter prosthetics.
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Urinary diversion/reconstruction - As a result of an extremely busy bladder cancer practice, MGH surgeons have a special interest in urinary diversion including orthotopic bladder. Extirpative surgery for cancers of the external genitalia may require a major reconstructive surgery. Dr. W. Scott McDougal is an international authority on urinary diversion and reconstruction of the external genitalia following a major extirpative cancer surgery and heads this effort.
- Infertility – Dr. Cigdem (Cori) Tanrikut leads the urological specialization in this area at the MGH. Dr. Tanrikut is part of the interdisciplinary Fertility Center, which is directed by the Obstetrics and Gynecology Service.
Academic Schedule
From September through June residents meet each Tuesday morning with Dr. McDougal to discuss a chapter of Campbell’s Urology. In two years this covers the entire curriculum of urology, and therefore each resident will complete the curriculum twice during their residency. Urology Grand Rounds takes place on Thursday mornings. These rounds include a case presentation, multidisciplinary oncology rounds with members of the departments of radiology, pathology, radiation and medical oncology; or a didactic lecture from a specialist in a field pertinent to the care of urologic patients such as the director of the IVF laboratory or the chief of the dialysis unit. In addition monthly conferences are held covering morbidity and mortality, stone disease, investigative urology, and journal club.
Call Schedule
Call during the general surgery years is in accordance with ACGME guidelines. In urology the PGY-2 resident takes first call for the first six months. Call thereafter is backup call to a junior resident which is generally taken out of house provided in house patients do not need immediate senior level care. Backup call for urology residents after the first six months of PGY-2 is approximately one in four and one in four weekends. At Children’s Hospital all residents take first call on a one in five schedule. While doing the senior rotation as the consult resident (usually one to two months) the resident does not take call. The Cabot Attending does not take resident call, but is on call as the attending for the Ward Service patients for six months.
Vacation
Surgical PGY-1 trainees have two weeks of vacation. Urology residents have four weeks per year; however, no vacation may be taken in the last six months of the urology residency. Therefore, the resident has sixteen weeks vacation between the PGY-2 and PGY-5.5 timeframe.
Salary and Benefits
Salary and benefits are determined by PGY level,
and for the year 2007-2008 are as follows:
Massachusetts General Hospital |
|
| PGY - 1 | $52,064 |
| PGY - 2 | $52,568 |
| PGY - 3 | $55,089 |
| PGY - 4 | $57,623 |
| PGY - 5 | $60,617 |
| PGY - 6 | $66,000 |
| PGY - 7 | $69,000 |
| PGY - 8 | $72,500 |
Benefits include family health/dental insurance, life insurance, and a generous disability insurance package. Parking in the lot one block from the hospital is provided for residents at a subsidized rate of $80/month. A free evening meal is provided for residents on overnight call, and a stipend is provided for meals for residents on weekend call. The Department of Urology provides each resident with an academic fund of $750/year to pay for journals, textbooks or other academic expenses. The department also pays for expenses for residents to attend any meeting where they will present a paper, and pays for one meeting in the PGY-6 year regardless of whether the resident is presenting or not. Two call rooms are maintained for the urology resident and intern on call.
Diversity
Workforce diversity is crucial to advancing the mission of MGH to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and, to improve the health and well-being of the diverse communities we serve. MGH leadership believes that we must value differences as well as similarities and be sensitive to staff as they strive to balance work, family, and personal lives.
The following committees and organizations are active at the MGH:
Association of Multicultural Members of Partners
MGH Diversity Committee
MGH GLBT Group
Multicultural Affairs Office (MAO) http://www.mgh.harvard.edu/mao/
Office for Women’s Careers
Organization of Minority Residents and Fellows (OMRF)
Patient Care Services Diversity Committee
Women in Academic Medicine Committee
In addition, the MGH offers several support systems to help staff balance the many demands on their lives:
· Flexible Benefits
· Child and Elder Care Resources Information
· Employee Assistance Program
· Wellness Programs
· On-Site Child Care Center
· Backup Child Care Center
· Vacation Day Camp for Children
· On-site Breastfeeding Suites
· On-site Spanish for Healthcare Provider classes
Electives
Elective rotations are arranged through the Harvard Medical School.
Inquiries should be directed to:
Registrar
Harvard Medical School
Building A
25 Shattuck Street
Boston, MA 02115
Or call 617-432-1515.
Application for Residency Training
The Harvard Program in Urologic Surgery at the Massachusetts General Hospital participates in the American Urologic Association (AUA) Residency Match. Our match ID number is 28371. Our department participates in the AAMC Electronic Residency Application Service (ERAS), and applications should be submitted using this system. To access the web site, point your web browser to http://www.aamc.org/eras. A completed application form, three letters of recommendation, a medical school transcript, a Dean’s letter and USMLE score should be submitted before September 30. After receipt of the application materials, applicants will be advised in the fall whether an interview would be appropriate.
Applicants must also register with the AUA to receive a personal match number, which must be given to each program where the applicant applies. There is a $75 non-refundable fee. Register with the AUA at the American Urological Association's web site (select "Students & Residents").
Inquiries Regarding Residency Training
All inquiries should be addressed to:
Residency Training Program in Urologic Surgery
Department of Urology
55 Fruit Street
GRB 1102
Boston, MA 02114.
Faculty
W. Scott McDougal, MD
Walter S. Kerr Jr. Professor of Urology, Harvard
Medical School
Chief of Urology
Douglas M. Dahl, MD
Assistant Professor of Surgery (Urology), Harvard
Medical School
Stephen P. Dretler, MD
Clinical Professor of Surgery (Urology), Harvard
Medical School
Brian H. Eisner, MD
Instructor in Surgery (Urology), Harvard Medical School
Adam S. Feldman, MD
Instructor in Surgery (Urology), Harvard Medical School
Pablo Gomery, MD
Instructor in Surgery (Urology), Harvard
Medical School
Joseph A. Grocela, MD
Assistant Professor of Surgery (Urology), Harvard
Medical School
Niall M. Heney, MD
Assistant Clinical Professor of Surgery (Urology), Harvard
Medical School
Dicken S. C. Ko, MD
Assistant Professor of Surgery, Harvard
Medical School
Francis J. McGovern, MD
Assistant Clinical Professor of Surgery (Urology), Harvard
Medical School
Aria F. Olumi, MD
Assistant Professor of Surgery (Urology), Harvard Medical School
Theodore J. Ongaro, MD
Clinical Instructor in Surgery (Urology), Harvard
Medical School
Dianne Sacco, MD
Instructor in Surgery (Urology), Harvard
Medical School
Shahin Tabatabaei, MD
Instructor in Surgery (Urology), Harvard Medical School
Cigdem (“Cori”) Tanrikut, MD
Assistant Professor of Surgery (Urology), Harvard Medical School
Current Resident Staff
Kashif Alvi, MD
King Edward Medical College, Pakistan
Brian F. Chapin, MD
Georgetown University School of Medicine
Christopher J. Cutie, MD
Yale University School of Medicine
Jairaam R. Eswara , MD
Harvard Medical School
Ying Hua, MD
Stanford University School of Medicine
Susan Lahey, MD
Boston University School of Medicine
Melina J. McCarty , MD
Boston University School of Medicine
Audley L. M. Osbourne, MD
Harvard Medical School
Mohummad M. Siddiqui, MD
Harvard Medical School
Associated Faculty
Michael Barry, MD
Department of Medicine
Outcomes Research
Gary Curhan, MD
Department of Medicine
Stone Disease
Donald Kaufman, MD
Department of Medicine
G.U. Medical Oncology
Dror Michaelson, MD, PhD
Department of Medicine
G.U. Medical Oncology
Peter R. Mueller, MD
Department of Radiology
Director, G.U. Radiology
William U. Shipley, MD
Department of Radiation Medicine
G.U. Radiation Oncology
Matthew Smith MD, PhD
Department of Medicine
G.U. Medical Oncology
James Talcott, MD
Department of Medicine
Outcomes Research
Chin-Lee Wu, MD, PhD
Department of Pathology
GU Pathology
Robert H. Young, MD
Department of Pathology
G.U. Pathology
Anthony L. Zeitman, MD
Department of Radiation Medicine
G.U. Radiation Oncology