Procedures

A pediatric urology fellow’s participation in a surgical procedure will be credited as an index case whether the fellow functions as surgeon, assistant, or teaching assistant.

To be recorded as surgeon, a fellow must be present for all the critical portions of the case, and must perform a considerable number of the critical steps of the procedure.

As a general principle, it is expected that over the course of their education, fellows will develop the skills necessary to perform progressively greater proportions of complex cases and will be given the opportunity to demonstrate those technical skills to the members of the program faculty. It is also important to remember that the Committee views involvement in preoperative assessment and post-operative management of patients to be essential elements of fellow participation.

Only one fellow or resident can claim credit as an assistant on a given case. Though it may well be valuable educationally, activity as “second assistant” should not be recorded, except for the exceptional cases listed below. A fellow may also be given index case credit when he or she acts as a teaching assistant. To be recorded as the teaching assistant, the fellow acts as supervisor, directing and overseeing major portions of the procedure being performed by the more junior resident surgeon, while the supervising attending physician (staff) functions as a second assistant or observer. For robotic procedures, the requirements for case recording as surgeon or assistant differ. In short, acting as a bedside assistant qualifies as assistant and any significant console time qualifies as surgeon. For the situation in which a fellow and a resident complete some portion of the case at the console, only one may log the case as surgeon. For robotic cases, both surgeon and assistant roles will be given index case credit for the “laparoscopic and robotic surgery” index categories.

Varicocelectomy Pediatric urology fellows must log at least five varicocelectomy cases during their year of ACGME-approved education. These procedures may be done on adolescent or pediatric patients with pediatric urology faculty members affiliated with an ACGME-approved education site. Alternatively, varicocelectomy procedures may also be logged if they are performed on adolescent or adult patients with adult urology faculty members, with or without a sub specialization in infertility/andrology. Procedures performed with adult urology faculty members may be arranged through an adult hospital associated with the ACGME approved pediatric urology education site or through an ACGME-approved education site. Epispadias Pediatric urology fellows must at least log two epispadias cases during their year of ACGME-approved education. To meet this minimum number of cases, epispadias cases can be performed as surgeon, assistant surgeon, teaching assistant, or as an observational event (observational events should be recorded as “assistant” when logging the case).

Additionally, observation of epispadias cases can take place at the pediatric fellow’s ACGME-approved education site or can be arranged to occur at another ACGME-approved education site if the primary education site has insufficient numbers of these cases. Cystoscopy with sub ureteric injection Pediatric urology fellows must log at least five cystoscopies with sub ureteric injection procedures for treatment of vesicoureteral reflux during their year of ACGME-approved education. To meet this minimum number of cases, cystoscopy with sub ureteric injection can be performed as surgeon, assistant surgeon, teaching assistant, or as an observational event (observational events should be recorded as “assistant” when logging the case). Additionally, observation of cystoscopy with sub ureteric injection can take place either at the pediatric fellow’s ACGME-approved education site or can be arranged to occur at another ACGME-approved education site if the primary education site has limited numbers of these types of cases. Exstrophy closure for tracking purposes, pediatric urology fellows must log at least one exstrophy closure cases during their year of ACGME-approved education. Given the rarity of this disease state, there are no set required minimums now; however, the ACMGE will track the logging of this procedure. To meet this minimum number of cases, exstrophy closure can be performed as surgeon, assistant surgeon, teaching assistant, or as an observational event (observational events should be recorded as “assistant” when logging the case). Additionally, observation of exstrophy closure can take place at the pediatric fellow’s ACGME-approved education site or can be arranged to occur at another ACGME-approved education site if the primary education site has limited numbers of these types of case.