Job Title: ESWL/Endourology Fellow

PURPOSE OF POSITION:

To provide a two (2) year long program of ESWL/Endourology/Laparoscopy training and endourology research in a unique learning environment for postgraduate, board eligible urologists who exhibit a desire to pursue an academic career in minimally invasive urology or who desire to specialize in this aspect of urology in a private practice setting. This two year fellowship is intended to provide a strong foundation for a successful career in minimally invasive surgery.

Washington University School of Medicine and Midwest Stone Institute together have one of the best equipped clinical centers in the country for minimally invasive urology. With regard to lithotripsy, there are two (2) HM3 lithotripters that are being used: one at Barnes-Jewish Hospital and one at Barnes-Jewish West County Hospital. Approximately 700-800 cases a year are performed on these two (2) lithotripters. Stones in all parts of the collecting system including the middle and distal ureter are being treated successfully using an outpatient protocol with intravenous sedation.

With regard to basic endourology, Barne-Jewishs Hospital has two (2) fully equipped endourology suites. The equipment available for performing endourology includes the latest developments in endoscopy and lithotripsy. Currently available in these suites is a wide variety of flexible cystoscopes, flexible nephroscopes, and the latest and smallest rigid and flexible ureteroscopes. In addition, all forms of intracorporeal lithotripsy are available including holmium laser. Furthermore, a wide variety of prototype instrumentation as well as clinical research equipment are available for use.

With regard to laparoscopic surgery, Washington University remains one of the most active centers in the country and has dedicated operating room space for laparoscopic surgery. Again, in this area the equipment is up to date and often times includes prototypes that have been developed by or have been made specifically available for the lab..

At Washington University, the minimally invasive urology group has a fully supported and endowed minimally invasive urology laboratory for both basic and animal laboratory studies. A full time technician is employed in the endourology laboratory to facilitate the fellow in performing research studies. The animal laboratory facilities have just recently been renovated and expanded. Two rooms in this facility are dedicated to minimally invasive surgery. Also, Washington University is one of the few minimally invasive surgery research sites supported by Ethicon and Olympus Inc. and as such research funding and a fully equipped laparoscopic laboratory are available to the fellow for studies. It is of note that the laboratory facilities are located directly in the medical complex and thus are a short walk from the operating room. In addition, at any given time there may be 1 to 3 research assistants also working in the endourology laboratory; as such, there is the opportunity for significant major collaborative efforts in the laboratory which should enhance the fellow’s experience and productivity. In addition, there is an ongoing collaborative effort between Dr. Louis Kavoussi, Johns Hopkins University, and Washington University with regard to developing telepresence surgery.

Finally, there are substantial ancillary facilities and support staff dedicated to the fellow. A personal computer, an office, and all appropriate networking facilities are provided to the fellow through Midwest Stone Institute.

HISTORY OF THE FELLOWSHIP:

The Endourology/ESWL fellowship, sponsored through Midwest Stone Institute, was the first fellowship training program in minimally invasive urology. The fellowship program has a proud heritage of training some of the current, and likely future, leaders in minimally invasive urology.

PRINCIPAL ACCOUNTABILITIES:

YEAR 1: BASIC/CLINICAL RESEARCH

Approximately 60% of the time during this year is spent doing basic and clinical in minimally invasive urology. A major research project will be designed by the fellow in collaboration with Drs. Sundram, Landman, and Figenshau. This project would be prepared such that it could be completed during the first year with a goal of providing data worthy of presentation and publication. Also, the fellow would have the opportunity to participate in several additional projects ongoing in the laboratory or in the clinical research realm such that by the end of the first year, the fellow would have participated as primary or co-author on upwards of 3 to 5 publications. During this year, all laboratory supplies and additional needs would be provided through Washington University. In addition, the laboratory has a full time technician to help support the fellow in all research projects along with Also, there is close supervision through Drs. Sundram, Landman, McDougall, and Figenshau available to the fellow throughout this year.

Laboratory meetings occur on a weekly basis to review progress and future directions; these meetings are attended by Drs. Landman, Sundaram, Figenshau and all other individuals working in the minimally invasive laboratory.

Clinical responsibilities during this year are limited to shockwave lithotripsy on a part time basis.: 2.5 days per week. In this capacity the fellow will be responsible for lithotripsy at the Barnes-Jewish West Lithotripter. Responsibilities in this regard include the following:

Reviewing patient histories and physicals (the fellow may need to perform a history and physical), attending the patient during radiographic procedures, and completing the required documentation related to the shockwave lithotripsy performed.

Evaluation and review of the patient’s history, physical examination and pertinent laboratory values (e.g. urine culture, CBC, SMA-6). Prior to the beginning of the surgery schedule, consultation with anesthesiology and the nursing staff in order to facilitate the schedule.

The Barnes West facility at which the fellow will be responsible for lithotripsy is largely an outpatient facility and as such there should be very little, if any, need for inpatient services.

YEAR 2: CLINICAL FELLOWSHIP

The major responsibility during this year is the clinical care of patients of Midwest Stone Institute at Barnes-Jewish Hospital facility and active involvement in a wide range of endourology procedures with Drs. Sundaram, Landman, and Figenshau. The fellow shall act in a manner consistent with having sole responsibility for providing and coordinating all direct clinical care of MSI ESWL patients and shall act as first surgical assistant on Monday or Wednesdays of each week, for all endourology cases. The fellow may also participate on other days in surgical activities with Division Physicians, following completion of any ESWL cases on that day or if permission is obtained through such that the ESWL cases on that day are properly covered.

Responsibilities:

In the rare event that the urology staff is not performing endourology on Monday or Wednesday the fellow’s primary responsibility shall be the clinical care of the MSI ESWL patients.

The fellow is expected to begin each working day in the surgical suite with the care of the ESWL/Endourology patients as defined and continue until such time as all ESWL cases have either been completed or assigned adequate staffing. The fellow should be present in the operating room by 7:00 a.m. to help co-ordinate patient care.

Basic functions in the care of the patient include, but are not limited to, reviewing histories and physicals, and completing the required documentation related to the lithotripsy procedure.

Evaluation and review of the patient’s history, physical examination and pertinent laboratory values (e.g. urine culture, CBC, SMA-6), prior to the beginning of the surgery schedule and consultation with anesthesiology and with the nursing staff in order to facilitate the schedule.

Inpatients having been attended by other physicians and/or staff should be reviewed prior to the day of treatment.

During this year, it is anticipated that the fellow will likely be preparing manuscripts regarding the basic research completed during the initial year of the fellowship. In addition, ongoing or new clinical research protocols will likely be initiated, advanced, and/or completed.

TEACHING AND TRAINING:

MSI is a certified AUA lithotripsy training site. The fellow, in conjunction with the Medical Director, shall be primarily responsible for the orientation, operations training, and support of trainees. Presently, this amounts to less than 5 physicians per year.

Implications:

The fellow is asked to make himself/herself available for teaching and support of the training physician during lithotripsy cases.

The fellow should schedule a period of one hour or more of operations training with each student/physician to assure that their questions have been answered, that operation of the equipment has been demonstrated, and that explanation of patient care protocols, indications and complications of shock wave lithotripsy have been made completed with each trainee.

TRAINING, EDUCATION, EXPERIENCE, OR OTHER REQUIREMENTS:

Candidates must be Board Eligible Urologists or have recently passed the FLEX exam with application made for Urology Board eligibility.

PHYSICAL DEMANDS:

Must be able to assist in patient handling during emergency.

VACATION AND EDUCATIONAL LEAVE POLICY:

The fellow is required to notify, in written form, all affected staff, (Physician Operators, Medical Director, Midwest Stone Administration), of any period of absence whether due to vacation or educational leave. This is essential to insure the smooth operation of MSI. Forms for notification are available in the MSI administration office. Further the fellow is asked to provide to the Administrator in writing who will serve as a first surgical assistant for all ESWL cases during his/her period of absence. This can be either a 3rd or 4th year resident with lithotripsy training or the physician operator for the given day( s) the fellow will be absent.

Educational leave shall be granted and not be counted as vacation if the fellow is either presenting the results of research or if he/she is undergoing clinical training as part of an education program. All other time away (i.e. job interviews, etc.) will be counted in the three weeks that are available for personal vacation.

MSI will fund reasonable expenses for the endourology international meeting during the clinical fellowship years and for the annual AUA meeting during the research and clinical fellowship year.

ALL FELLOWS ARE EMPLOYEES OF WASHINGTON UNIVERSITY WITH BENEFITS PROVIDED THROUGH WASHINGTON UNIVERSITY

Gerald L. Andriole, M.D.
Chief, Division of Urologic Surgery

Sam Bhayani , M.D.
MSI Research Director

Brian Benway, M.D.
MSI Assistant Research Director

For more information visit the Endourological Society Website