In selecting residents, urology residency programs highly value performance in the urology rotation or clerkship. In one study of program directors, "grades in urology" had a mean importance rating of 7.4 on a scale of 1 (no importance) to 10 (most importance). The only criteria rated more important were urology references and USMLE scores. Given its importance in the selection process, I am often asked how students can stand out in these important rotations. Below are some important recommendations for success during the urology rotation.
Understand Expectations of your
Urology Rotation and Then Exceed Them
Expectations will vary from one urology rotation to rotation. Even within a rotation, you'll find that expectations differ from attending to attending, and resident to resident. Take the time to meet with your resident and attending to learn what is expected. "Every service does things differently, and clarifying earlier rather than later will make less work for you, and a more cohesive and productive educational experience," writes the Department of Urology at the University of North Carolina.
Take Initiative in your
Urology Rotation
As with any other rotation, it's easy to be a passive participant during the urology clerkship. However, if you're seeking a career in urology, it'll be important for you to take initiative throughout the rotation. This will maximize your learning opportunities, and allow you to make a favorable impression on residents and attending physicians.
Once you understand the expectations of the rotation, you'll be ready to perform your tasks. As you fulfill your responsibilities, look for ways to show initiative. "We like students to take initiative and be proactive about their education," writes the Department of Urology at the University of North Carolina. A few examples include:
Taking advantage of time between operating room cases to check on PACU patients
Pre-rounding on patients not assigned to you in an effort to lighten the load on other team members and further your learning
Researching an issue or clinical question that came up during rounds, and reporting the findings to the team
Learn How To Workup Common Urological Symptoms
During your urology rotation, you'll have the opportunity to evaluate and manage patients with a variety of symptoms. Symptoms you'll commonly encounter include:
Obstructive symptoms (hesitancy, poor stream, intermittent stream, terminal dribbling)
Irritative symptoms (dysuria, frequency, urgency, nocturia)
Urinary incontinence
Hematuria
Fever
Pain
Renal colic
Erectile dysfunction
You'll also encounter urinary tract infections, acute scrotum, benign prostatic hyperplasia, and issues related to prostate cancer screening and management.
Develop an approach to evaluating these symptoms or problems. Although you will acquire this knowledge as you progress through the rotation, you will make much more of an impression if you arrive well read about the workup of these symptoms.
As you may expect, opinions vary on book or books you should use during your urology rotation. Most often recommended are the following:
The AUA has created clinical practice guidelines for key diagnoses in urology, and we encourage you to use this evidence-based resource.
Review Physical Exam Techniques
The evidence indicates that many physicians lack confidence in their ability to perform the urological examination. In one study, approximately 50% of primary care physicians lacked confidence in their ability to detect prostate nodules.
Digital Rectal Exam
Understand How to Interpret Basic Urological Investigations
Basic urological investigations include dipstick urine testing, urine culture, urine cytology, renal function (BUN, serum creatinine), and ultrasound. A video to help you become more familiar with ultrasound interpretation is shown below.
Ultrasound in Urology
Become Familiar with Different Imaging Modalities Available to the Urologist
The urologist is fortunate to be able to select among a variety of imaging modalities to diagnose and monitor disease. We recommend that you become familiar with these tests. In particular, you will want to develop imaging or testing strategies for different urological symptoms or diseases. This will help you answer the question, "What test should we order" or "What should we do next?"
Tests that you will encounter include, but are not limited to, the following:
Plain abdominal x ray
Ultrasound (see above)
Intravenous urogram
Urethrogram
Ureterogram (antegrade and retrograde)
MRI
Nuclear medicine (isotope renogram, isotopic glomerular filtration rate, isotope bone scan)
An excellent resource which provides guidance on appropriate testing is Urologic Imaging without the X-rays: Ultrasonography, MRI, and Nuclear Medicine available at Medscape.
Make the Most of your Urology Clinic Opportunities
Although the structure of many urology rotations can make it difficult for students to develop strong relationships with urology faculty, one way to do so is in the general or subspecialty urology clinic. In the clinic, it's not unusual for students to have one-on-one contact with attending physicians. Make the most of your clinic opportunities.
To meet the needs of your urology attending, it's best to meet before starting clinic. Through this conversation, you will learn about your role, responsibilities, and the attending preferences. Ideally, you will be able to independently interview and examine patients. However, you should never assume this. Always ask permission. How many patients should you see? How much time should you spend with each patient? Should you perform the urological exam alone or wait until the attending is ready? You should know the answers to these questions before you see your first patient.
Make the Residents' Lives Easier
You'll be a highly valued member of the team if you can consistently find ways to help your team accomplish work. Examples include:
Arriving early to record vital signs, Is/Os, etc.
Writing notes in advance of rounds
Carrying necessary supplies for rounds (suture removal kit, dressing changes, syringes and saline for drain removal or flushing)
Word travels quickly when you're a great team member, and your ability to work effectively within the team environment will be recognized and conveyed to other team members, including chief residents and faculty.
Shine in the Operating Room
Read and prepare for every case you'll be involved with in the operating room. For the patient you've been following, it is expected that you'll have a strong grasp on the patient's history, pathology, imaging, and indications for surgical intervention. There will be times when you have the opportunity to assist in surgery for patients you're not following. These can be valuable learning opportunities but some degree of initiative may be required to get up to speed on the patient's problem. Try to meet the patient before surgery. Review the medical record and images. Such effort will allow you to answer questions, engage in meaningful discussions, and ask insightful questions.
Make a Memorable Presentation
Although most students are not eager to make presentations, preparing and presenting a talk is a great opportunity to demonstrate your knowledge and grasp of clinical issues. Your stellar performance can definitely impress the department. "This is your chance to shine and impress the faculty and residents you didn't get to work with during your rotation," writes the Department of Urology at the University of Michigan. Some tips:
You may be given the flexibility to select your own topic. I recommend that you discuss your topic ideas with the residents and attending physicians on your service. Your goal is to select a manageable topic that would be of significant interest to your audience.
Time yourself while rehearing your presentation to ensure that you don't exceed your allotted time. Exceeding the time that you have been given is a common mistake, and takes time away from other activities or speakers.
Consider reviewing your talk with your attending or resident. The constructive criticism you receive can be invaluable.
Our book "Success on the Wards" has an extensive chapter on how to give memorable talks during rotations.
For more information on how to succeed in rotations, please check out our other posts in this series:
Dr. Samir Desai is the co-creator of the online course The Residency Interview 101 and the author of The Successful Match: Rules to Succeed in the Residency Match. He has been a faculty member in the Department of Internal Medicine at the Baylor College of Medicine for over 20 years, and has been the recipient of numerous teaching awards
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