Urology Residency

The Virginia Mason Division of Urology began its own ACGME-accredited residency program in 2014. Prior to that, it had a nearly 50-year track record of training Virginia Mason clinical fellows, as well as urology residents from the University of Washington and Madigan Army Medical Center.

The Virginia Mason urology residency program is committed to providing our residents with sound training such that they can be fully prepared to pursue careers in either clinical urology or academic medicine. The program is a 5-year program, including the intern year during which the resident spends 6 months on urology and 6 months on carefully selected general surgery rotations. Residents will be required to learn about all facets of urology, ranging from oncology and pelvic floor reconstruction to transplantation, pediatrics and stone disease. Training will include the breadth of endoscopy, minimally invasive surgery (laparoscopy and robotics), and simple and complex open cases. The education will encompass the six Core Competencies as deemed by the ACGME, including patient care, medical knowledge, practice-based learning, systems-based practice, professionalism, and interpersonal skills and communication. The Virginia Mason program provides ample research opportunities, both basic science and clinical, protected research time, and faculty that is engaged at the local and national level of their subspecialty fields. A unique strength of this residency is the deep-seated camaraderie amongst the residents, and the tight-knit community of the Urology Department and Virginia Mason Medical Center as a whole.

While residents will be carefully and attentively guided through their training, they will be expected to have graduated responsibility as they mature in their clinical and surgical skills and knowledge base.

The Mission of the Urology Section

“To provide compassionate state-of-the-art urologic care for our patients and to advance the field of urology through top-quality research and education."

Residency Training Program

Post-graduate year 1

Residents will start their training as a categorical urology intern and spend half their time on Virginia Mason Urology and the remaining time performing general surgery internship rotations that include vascular surgery, acute care surgery, hepatobiliary surgery, critical care, emergency medicine and thoracic surgery. During their time on urology, interns will be managing the floor, but they will also be routinely assigned to cover junior level surgical cases. They will also begin to learn clinical urology and start covering daytime urologic consults.

Post-graduate year 2

The second year in urology is based entirely at Virginia Mason. This year focuses heavily on endoscopic surgery (encompassing treatment of stones, urinary tract tumors, and benign prostatic hypertrophy) as well as junior level open cases. Additionally, residents will start covering major open cases such as scheduled kidney transplants and will cover cases that come in while on call. Transplant surgery is a unique opportunity that few urology programs offer and provides residents early exposure to both urologic and vascular reconstructive techniques that are applicable throughout the remainder of training.

During the second year, residents will be assigned specific clinic days, during which they will work with different attendings to learn how to take a proper urologic history and perform a GU-focused physical examination, complete an appropriate diagnostic evaluation, and formulate a sound treatment plan. Residents will also be exposed to diagnostic testing, including office cystoscopy, ultrasound, prostate needle biopsies and urodynamics.

Post-graduate year 3

The PGY-3 year is the first year that residents leave Virginia Mason Medical Center. The year starts with a 3-month rotation at the Madigan Army Medical Center (MAMC) located outside of Tacoma, approximately 45 miles from Virginia Mason. Some residents choose to commute on non-call days, however, on call days, residents must spend the night near MAMC. Virginia Mason offers a significant additional stipend (currently $1650/month) for residents to secure additional lodging in Tacoma. The MAMC rotation provides an opportunity to gain exposure to a busy general urology service in a different hospital system with a unique patient population.

The PGY-3 year continues with 6 months of dedicated research time during which the residents have the option of pursuing either basic science or clinical research dependent upon their interest. Residents are required to identify an attending mentor to provide guidance during their research rotation and beyond, and the expectation is that each resident submit a minimum of one manuscript for publication by the completion of this rotation.

The year then ends with a short commute to the Swedish Medical Center (also located in the First Hill neighborhood two blocks from Virginia Mason) for a 3-month pediatric urology rotation under an apprenticeship model (one resident to two attendings) in a high volume pediatric urology practice. Residents work closely and exclusively with two attendings to gain concentrated exposure to fundamental pediatric urology concepts and practice.

Post-graduate year 4

There are four 3-month rotations in the PGY-4 year. Residents start at Virginia Mason for a rotation specifically focused on FPMRS*, prosthetics, and urinary diversions, where they will gain exposure to male and female voiding dysfunction and pelvic floor reconstruction, neurourology, prosthetics (including inflatable penile prostheses and artificial urinary sphincters), and urinary diversions of all types.

The second R4 rotation is at Tacoma General Hospital (~35 miles from Virginia Mason), where residents gain exposure to acute care/trauma and oncology. This rotation is highly valued by the residents and again there is an additional financial stipend for local housing support.

The residents then return for their final 3 months of pediatric urology at Swedish Medical Center, this time as senior residents. Following that, they complete the R4 year with an additional 3 months at Tacoma General.

*FPMRS: Female Pelvic Medicine and Reconstructive Surgery is the field that focuses on pelvic floor disorders that include urinary incontinence, pelvic prolapse and neurourology. It is an ACGME-recognized subspecialty.

Post-graduate year 5

During the resident’s PGY-5 year they return to Virginia Mason as the chief resident of the urology service. This training focuses heavily on laparoscopic, robotic, and complex open oncologic cases, in addition to continued exposure to FMPRS, prosthetics, diversions and transplant surgery. As the chief resident, the R5 is responsible for managing the heavy operative volume, overseeing the care of the inpatient urologic and transplant service, supervising the junior residents (Virginia Mason, visiting UW and visiting Madigan residents), and running the administrative aspects of the service.

Virginia Mason Block Diagram

Fellows

Virginia Mason has two 2-year fellowships, an ACGME-accredited FPMRS fellowship and a Society of Urologic Oncology (SUO) fellowship. There are two fellows in each fellowship, with one on clinical rotation and one on research at any given time. The residents work closely with the fellows and have ample opportunity to learn from them and participate in research projects with the fellows if they are interested.

Conferences

There is a robust didactics and conference schedule. The program includes an extensive didactic schedule with lectures occurring 1-2 times a week in addition to weekly uroradiology conference, bi-monthly tumor board, testis tumor board, monthly Morbidity and Mortality Conference, pelvic floor case conferences, and monthly journal club. The junior resident (R2) is responsible for management of the uroradiology case list and is expected to attend the weekly uroradiology preparation session with the radiology attendings and residents. There is also a monthly research meeting where the residents will learn about biostatistics, study design and data management. Pelvic floor conference, tumor board, and testis tumor board are attended by residents when they are on the respective services.