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An update on Society of Urologic Oncology fellowship programs
Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240
News and topics
An update on Society of Urologic Oncology fellowship programs Society of Urologic Oncology (SUO) fellowship programs provide a unique educational opportunity for advanced education in urologic oncology. To provide guidelines for educational program content, the SUO Fellowship Committee began to certify fellowship programs in 2000. Since then and particularly over the last several years, there have been a growing number of fellowships seeking SUO certification. This expansion and the recognized variability in program content have led to a need for development of program requirements and a core curriculum. The inconsistent and unmonitored process of fellow application and selection has also prompted interest in a fellowship matching program. In this article, the current status of SUOcertified fellowships will be reviewed and the goals for development of program requirements, a core curriculum, and a fellowship matching program will be set forth. The Society of Urologic Oncology was created in 1984 in part to establish educational initiatives that would define state-of-the-art urologic oncology care. One of these initiatives was an effort to develop and standardize fellowship training in urologic oncology. To assure some consistency in program length and format, the SUO began to certify existing urologic oncology fellowship programs in 2000. Guidelines on educational objectives and curriculum were also developed. Currently, there are 23 academic centers that offer SUO-approved fellowships (see Figure 1). The goal of these fellowship programs is to offer urology residents the opportunity for specialized post-residency training in the medical and surgical care of urologic cancer patients. The minimum duration of SUO approved fellowship training is 24 months with 12 months of clinical experience and 12 months of research exposure. The research year is variable with some programs emphasizing clinical research and others providing a laboratory experience. The intent of the clinical year is to train fellows to manage complex urologic oncology cases and to develop expertise in both complex open and minimally invasive surgical techniques. These fellowships also emphasize the importance of a multi-disciplinary approach to patient care. Over the last several years, an increasing number of fellowships have sought SUO certification. Since 2005, the number of SUO-approved fellowships increased from 11 to 23, and in 2009 an additional 6 program applications have 1078-1439/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.urolonc.2009.12.004
been submitted. As the number of programs increases, it has become apparent that these fellowships vary significantly in program content and curriculum. While some variability in program content is unavoidable and assures diversity among programs for applicants to consider, there is growing concern that more specific goals and objectives are needed. The fellow application and selection process is also variable, unmonitored, and poorly-defined. The SUO Fellowship Committee has recently been tasked to create program requirements and to develop a fellowship core curriculum that can be applied to all SUO-approved programs. A fellowship matching program has also been initiated. The purpose of this correspondence is to update SUO members on the status of urologic oncology fellowships, the goals and terms of curriculum development and the implementation of a fellowship matching program.
Certification process For a urologic oncology fellowship program to become certified by the SUO, a program application form must be completed. This form is available on the SUO website. Once the application is submitted, the SUO Fellowship Committee reviews it and assigns a committee member or another SUO member to arrange an on-site evaluation of the program. At the site visit, program curriculum, surgical case volume, faculty expertise, and research experience are each evaluated in the context of the central requirements for a fellowship-trained urologic oncology surgeon (see Table). The site visitor meets with all key clinical and research faculty. They also review case logs and assess the complement of multidisciplinary care. Following the site visit, the site visitor creates a written report evaluating the program. This is then considered by the Fellowship Committee. Should the fellowship program meet the requirements outlined by the SUO, the Fellowship Committee will approve the program for SUO certification. These approvals are granted throughout the year. Initial program certification is granted for a period of 5 years, at which point recertification is required. Certified fellowship programs are required to submit an annual progress report by August 1 each year. This report details the fellow’s involvement in research and includes a
238
C.L. Amling / Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240
SUO Approved Fellowships Univ. of Washington Virginia Mason
University of Toronto Mayo Clinic
Western Ontario Roswell Park Univ. of Chicago
MSKCC Univ. of Michigan Fox Chase
UCSF
Univ. of Kansas Indiana Univ.
NCI
Univ. of Colorado Washington Univ.
UCLA
Duke Vanderbilt
UT San Antonio
MD Anderson Moffitt Cancer Center Univ. of Miami
Fig. 1. SUO Approved Fellowships. (Color version of figure is available online.)
bibliography of his or her research activity over the 2-year academic period. An operative log covering the same time period is also submitted. In order to maintain certification, the SUO Fellowship Committee must also receive a copy of the surgical log for each fellow, which is signed by both the fellow and the fellowship director. Each fellow must also submit a written evaluation of the strengths and weaknesses of the program. A copy of each fellow’s final summary evaluation is also included. Once all of these documents are received and reviewed favorably by the Fellowship Committee, a certificate of fellowship completion is be granted to the fellow by the SUO.
Program requirements and curriculum development As the number of fellowship programs seeking certification continues to increase, there is a greater than ever need to define program requirements and to develop a core curriculum that is consistent among approved programs. The movement to establish program requirements and a core
curriculum has been prompted by several concerns. First, there is significant variability among programs in the clinical and surgical experience that fellows receive. For example, while some programs provide a good open surgical experience, an adequate minimally invasive surgical experience may be lacking. Conversely, some programs’ surgical focus is on laparoscopic or robotic surgery while experience with open surgical procedures is limited. There is also significant variability among programs with regard to their emphasis on multidisciplinary care. While some programs promote this as a key aspect of the fellowship, in other programs medical oncology and radiation oncology faculty contribute relatively little to the fellow’s education. The research experience is also inconsistent. While it is to be expected that the research experience will vary between programs, general guidelines are needed to define more precisely what is expected from the research year. The real challenge in developing program requirements and a core curriculum is balancing the need to create minimum requirements with the desire to preserve program variability and uniqueness.
C.L. Amling / Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240 Table 1 Essential requirements for a fellowship trained urologic oncologic surgeon 1. Advanced expertise in the multidisciplinary management of patients with urologic cancer 2. Knowledge and the ability to apply the critical principles of: (a) Medical oncology (b) Radiation oncology (c) Uropathology (d) Urologic imaging techniques 3. Ability to perform complex tumor resections with a clear understanding of the benefits and the technical limitations of surgical procedures. 4. Extensive knowledge of and technical experience in urinary tract diversion and reconstruction 5. Knowledge of the biology of urologic malignancies 6. Comprehension of and facility with scientific methodology, study design, biostatistics, clinical trials, and data analysis 7. Ability to manage academic or tertiary referral clinical practice and participate in continuing education 8. Skills for self-education and collaboration in translational research
While program requirements and curriculum are currently under development, there are several key aspects of fellowship training that will be emphasized in these documents: Multidisciplinary educational program A focus on multidisciplinary urologic cancer care has been a foundation of the SUO. This must be emphasized in fellowship training programs. Knowledge and ability to apply the clinical principles of medical oncology, radiation oncology, uropathology, and urologic imaging techniques is what separates fellowship-trained urologic oncologists from urologists who treat urologic oncology patients without this training. The new program requirements will set stricter criteria for the involvement of medical oncologists and radiation oncologists in these programs. It will require that fellows have a dedicated experience in these disciplines rather than peripheral exposure to faculty with expertise in these specialties. Diverse surgical experience The clinical experience that is obtained from a urologic oncology fellowship program is designed to provide the fellow with knowledge of the most up-to-date methods for the diagnosis and treatment of urologic malignancies. As such, fellowship programs must also offer a diverse surgical experience encompassing both complex open surgical procedures and minimally invasive surgical treatments. The practice of minimally invasive urologic oncology surgery including both laparoscopic and robotic approaches is a growing field and will be a skill that is important to any fellow graduating from a SUO-certified program. However,
239
a minimally invasive surgical experience alone is not sufficient to produce a fully trained urologic oncologist. Adequate training in complex open surgical procedures will also be required. While the relative experience in minimally invasive and open surgical procedures may vary from institution to institution, it will be made clear in the new requirements that an experience in one without the other is inadequate for the kind of quality fellowship training that is expected of certified programs.
Research experience While many approved programs provide education in evidence-based medicine and grant writing skills, the majority of programs do not specifically offer this training. Since SUO-certified fellowship programs train the academic urologists of the future, it will be important that the research training component support those who want to pursue a career as a physician-scientist. Education in grantsmanship, statistical analysis, and evidence-based medicine will be considered important components of the research experience. In education vernacular, a core curriculum is a course of study deemed central to and usually made mandatory for all students in a particular educational system. A core curriculum is usually administered in the form of didactic conferences, reading assignments or learning modules. There is currently no well-defined core curriculum for SUO-certified fellowship programs and significant variability in educational content among programs. The SUO Fellowship Committee has begun to develop and will implement a core curriculum that can be applied to and utilized by all SUOcertified programs. This core curriculum should be available by the start of academic year 2010.
Fellowship match Another important component that varies significantly among SUO-certified fellowship programs is the fellow application and selection process. Historically, fellows at some programs have been selected and committed to training spots many years in advance of beginning their fellowship. The purpose of a matching program is to allow fellowship directors and fellowship applicants to evaluate each other fully and to eliminate premature decisions based on incomplete information. A recent survey of SUO fellowship Program Directors revealed that the vast majority believe that a fellowship matching program would standardize the process for fellow selection and provide a fairer means of recruitment. A matching system can also alleviate many of the adverse situations associated with fellow recruitment such as applicants hoarding multiple offers, applicants reneging on a prior acceptance in order to accept a more
240
C.L. Amling / Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240
preferred subsequent offer and fellowship directors overfilling well in advance the number of positions available in their program. A matching program will allow candidates to continue to apply directly for positions and for applicants and fellowship directors to evaluate each other in the usual manner. The only difference is that no offers can be made until applicants and programs submit a preference list and the match is performed. This process is a well-accepted form of recruitment used by other fellowship programs and will be a key component of selection to urologic oncology programs in the future. The urologic oncology fellowship program match has been implemented and the first fellows to participate will be selected in June 2010 to begin fellowship training in July 2011. A standard application form is available to fellow applicants on the SUO website. These applications can be printed and completed and then forwarded to program directors in the SUO-accredited fellowship sites where they would like to interview. In addition to completing the SUO application, prospective fellows will also be required to formally register for the match with the AUA. The AUA will be the organization that performs the match in similar fashion to the current urology resident matching program. Interviews will be held starting in December 2009 and match lists will be submitted in June 2010. Specific directions regarding submission of rank and preference lists and a fellowship match timeline is available on the SUO website.
Conclusion Society of Urologic Oncology fellowship programs provide a unique educational opportunity for advanced education in urologic oncology and exist as a important foundation on which the future of the SUO is built. As such, it is important to maintain the level of excellence associated with these training programs. Development of program requirements and a core curriculum will further this goal and a matching program will allow a fairer and more standardized selection process. While it is anticipated that there will be a growing number of fellowship programs seeking SUO certification, it is the position of the SUO that it is better to have a few good fellowship programs that meet the requirements and maintain a level of excellence than a large number of programs that either don’t fill their positions or fall short of meeting educational and curricular expectations. This is a time of significant change and expansion in SUO fellowship training. Newer requirements and standardized curriculum are needed. As always, the goal of these endeavors is to continue to improve upon the quality and uniqueness of education that SUO fellowships continue to offer. Christopher L. Amling, M.D., F.A.C.S. Department of Urology Oregon Health and Science University Portland, OR, USA
News and topics
An update on Society of Urologic Oncology fellowship programs Society of Urologic Oncology (SUO) fellowship programs provide a unique educational opportunity for advanced education in urologic oncology. To provide guidelines for educational program content, the SUO Fellowship Committee began to certify fellowship programs in 2000. Since then and particularly over the last several years, there have been a growing number of fellowships seeking SUO certification. This expansion and the recognized variability in program content have led to a need for development of program requirements and a core curriculum. The inconsistent and unmonitored process of fellow application and selection has also prompted interest in a fellowship matching program. In this article, the current status of SUOcertified fellowships will be reviewed and the goals for development of program requirements, a core curriculum, and a fellowship matching program will be set forth. The Society of Urologic Oncology was created in 1984 in part to establish educational initiatives that would define state-of-the-art urologic oncology care. One of these initiatives was an effort to develop and standardize fellowship training in urologic oncology. To assure some consistency in program length and format, the SUO began to certify existing urologic oncology fellowship programs in 2000. Guidelines on educational objectives and curriculum were also developed. Currently, there are 23 academic centers that offer SUO-approved fellowships (see Figure 1). The goal of these fellowship programs is to offer urology residents the opportunity for specialized post-residency training in the medical and surgical care of urologic cancer patients. The minimum duration of SUO approved fellowship training is 24 months with 12 months of clinical experience and 12 months of research exposure. The research year is variable with some programs emphasizing clinical research and others providing a laboratory experience. The intent of the clinical year is to train fellows to manage complex urologic oncology cases and to develop expertise in both complex open and minimally invasive surgical techniques. These fellowships also emphasize the importance of a multi-disciplinary approach to patient care. Over the last several years, an increasing number of fellowships have sought SUO certification. Since 2005, the number of SUO-approved fellowships increased from 11 to 23, and in 2009 an additional 6 program applications have 1078-1439/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.urolonc.2009.12.004
been submitted. As the number of programs increases, it has become apparent that these fellowships vary significantly in program content and curriculum. While some variability in program content is unavoidable and assures diversity among programs for applicants to consider, there is growing concern that more specific goals and objectives are needed. The fellow application and selection process is also variable, unmonitored, and poorly-defined. The SUO Fellowship Committee has recently been tasked to create program requirements and to develop a fellowship core curriculum that can be applied to all SUO-approved programs. A fellowship matching program has also been initiated. The purpose of this correspondence is to update SUO members on the status of urologic oncology fellowships, the goals and terms of curriculum development and the implementation of a fellowship matching program.
Certification process For a urologic oncology fellowship program to become certified by the SUO, a program application form must be completed. This form is available on the SUO website. Once the application is submitted, the SUO Fellowship Committee reviews it and assigns a committee member or another SUO member to arrange an on-site evaluation of the program. At the site visit, program curriculum, surgical case volume, faculty expertise, and research experience are each evaluated in the context of the central requirements for a fellowship-trained urologic oncology surgeon (see Table). The site visitor meets with all key clinical and research faculty. They also review case logs and assess the complement of multidisciplinary care. Following the site visit, the site visitor creates a written report evaluating the program. This is then considered by the Fellowship Committee. Should the fellowship program meet the requirements outlined by the SUO, the Fellowship Committee will approve the program for SUO certification. These approvals are granted throughout the year. Initial program certification is granted for a period of 5 years, at which point recertification is required. Certified fellowship programs are required to submit an annual progress report by August 1 each year. This report details the fellow’s involvement in research and includes a
238
C.L. Amling / Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240
SUO Approved Fellowships Univ. of Washington Virginia Mason
University of Toronto Mayo Clinic
Western Ontario Roswell Park Univ. of Chicago
MSKCC Univ. of Michigan Fox Chase
UCSF
Univ. of Kansas Indiana Univ.
NCI
Univ. of Colorado Washington Univ.
UCLA
Duke Vanderbilt
UT San Antonio
MD Anderson Moffitt Cancer Center Univ. of Miami
Fig. 1. SUO Approved Fellowships. (Color version of figure is available online.)
bibliography of his or her research activity over the 2-year academic period. An operative log covering the same time period is also submitted. In order to maintain certification, the SUO Fellowship Committee must also receive a copy of the surgical log for each fellow, which is signed by both the fellow and the fellowship director. Each fellow must also submit a written evaluation of the strengths and weaknesses of the program. A copy of each fellow’s final summary evaluation is also included. Once all of these documents are received and reviewed favorably by the Fellowship Committee, a certificate of fellowship completion is be granted to the fellow by the SUO.
Program requirements and curriculum development As the number of fellowship programs seeking certification continues to increase, there is a greater than ever need to define program requirements and to develop a core curriculum that is consistent among approved programs. The movement to establish program requirements and a core
curriculum has been prompted by several concerns. First, there is significant variability among programs in the clinical and surgical experience that fellows receive. For example, while some programs provide a good open surgical experience, an adequate minimally invasive surgical experience may be lacking. Conversely, some programs’ surgical focus is on laparoscopic or robotic surgery while experience with open surgical procedures is limited. There is also significant variability among programs with regard to their emphasis on multidisciplinary care. While some programs promote this as a key aspect of the fellowship, in other programs medical oncology and radiation oncology faculty contribute relatively little to the fellow’s education. The research experience is also inconsistent. While it is to be expected that the research experience will vary between programs, general guidelines are needed to define more precisely what is expected from the research year. The real challenge in developing program requirements and a core curriculum is balancing the need to create minimum requirements with the desire to preserve program variability and uniqueness.
C.L. Amling / Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240 Table 1 Essential requirements for a fellowship trained urologic oncologic surgeon 1. Advanced expertise in the multidisciplinary management of patients with urologic cancer 2. Knowledge and the ability to apply the critical principles of: (a) Medical oncology (b) Radiation oncology (c) Uropathology (d) Urologic imaging techniques 3. Ability to perform complex tumor resections with a clear understanding of the benefits and the technical limitations of surgical procedures. 4. Extensive knowledge of and technical experience in urinary tract diversion and reconstruction 5. Knowledge of the biology of urologic malignancies 6. Comprehension of and facility with scientific methodology, study design, biostatistics, clinical trials, and data analysis 7. Ability to manage academic or tertiary referral clinical practice and participate in continuing education 8. Skills for self-education and collaboration in translational research
While program requirements and curriculum are currently under development, there are several key aspects of fellowship training that will be emphasized in these documents: Multidisciplinary educational program A focus on multidisciplinary urologic cancer care has been a foundation of the SUO. This must be emphasized in fellowship training programs. Knowledge and ability to apply the clinical principles of medical oncology, radiation oncology, uropathology, and urologic imaging techniques is what separates fellowship-trained urologic oncologists from urologists who treat urologic oncology patients without this training. The new program requirements will set stricter criteria for the involvement of medical oncologists and radiation oncologists in these programs. It will require that fellows have a dedicated experience in these disciplines rather than peripheral exposure to faculty with expertise in these specialties. Diverse surgical experience The clinical experience that is obtained from a urologic oncology fellowship program is designed to provide the fellow with knowledge of the most up-to-date methods for the diagnosis and treatment of urologic malignancies. As such, fellowship programs must also offer a diverse surgical experience encompassing both complex open surgical procedures and minimally invasive surgical treatments. The practice of minimally invasive urologic oncology surgery including both laparoscopic and robotic approaches is a growing field and will be a skill that is important to any fellow graduating from a SUO-certified program. However,
239
a minimally invasive surgical experience alone is not sufficient to produce a fully trained urologic oncologist. Adequate training in complex open surgical procedures will also be required. While the relative experience in minimally invasive and open surgical procedures may vary from institution to institution, it will be made clear in the new requirements that an experience in one without the other is inadequate for the kind of quality fellowship training that is expected of certified programs.
Research experience While many approved programs provide education in evidence-based medicine and grant writing skills, the majority of programs do not specifically offer this training. Since SUO-certified fellowship programs train the academic urologists of the future, it will be important that the research training component support those who want to pursue a career as a physician-scientist. Education in grantsmanship, statistical analysis, and evidence-based medicine will be considered important components of the research experience. In education vernacular, a core curriculum is a course of study deemed central to and usually made mandatory for all students in a particular educational system. A core curriculum is usually administered in the form of didactic conferences, reading assignments or learning modules. There is currently no well-defined core curriculum for SUO-certified fellowship programs and significant variability in educational content among programs. The SUO Fellowship Committee has begun to develop and will implement a core curriculum that can be applied to and utilized by all SUOcertified programs. This core curriculum should be available by the start of academic year 2010.
Fellowship match Another important component that varies significantly among SUO-certified fellowship programs is the fellow application and selection process. Historically, fellows at some programs have been selected and committed to training spots many years in advance of beginning their fellowship. The purpose of a matching program is to allow fellowship directors and fellowship applicants to evaluate each other fully and to eliminate premature decisions based on incomplete information. A recent survey of SUO fellowship Program Directors revealed that the vast majority believe that a fellowship matching program would standardize the process for fellow selection and provide a fairer means of recruitment. A matching system can also alleviate many of the adverse situations associated with fellow recruitment such as applicants hoarding multiple offers, applicants reneging on a prior acceptance in order to accept a more
240
C.L. Amling / Urologic Oncology: Seminars and Original Investigations 28 (2010) 237–240
preferred subsequent offer and fellowship directors overfilling well in advance the number of positions available in their program. A matching program will allow candidates to continue to apply directly for positions and for applicants and fellowship directors to evaluate each other in the usual manner. The only difference is that no offers can be made until applicants and programs submit a preference list and the match is performed. This process is a well-accepted form of recruitment used by other fellowship programs and will be a key component of selection to urologic oncology programs in the future. The urologic oncology fellowship program match has been implemented and the first fellows to participate will be selected in June 2010 to begin fellowship training in July 2011. A standard application form is available to fellow applicants on the SUO website. These applications can be printed and completed and then forwarded to program directors in the SUO-accredited fellowship sites where they would like to interview. In addition to completing the SUO application, prospective fellows will also be required to formally register for the match with the AUA. The AUA will be the organization that performs the match in similar fashion to the current urology resident matching program. Interviews will be held starting in December 2009 and match lists will be submitted in June 2010. Specific directions regarding submission of rank and preference lists and a fellowship match timeline is available on the SUO website.
Conclusion Society of Urologic Oncology fellowship programs provide a unique educational opportunity for advanced education in urologic oncology and exist as a important foundation on which the future of the SUO is built. As such, it is important to maintain the level of excellence associated with these training programs. Development of program requirements and a core curriculum will further this goal and a matching program will allow a fairer and more standardized selection process. While it is anticipated that there will be a growing number of fellowship programs seeking SUO certification, it is the position of the SUO that it is better to have a few good fellowship programs that meet the requirements and maintain a level of excellence than a large number of programs that either don’t fill their positions or fall short of meeting educational and curricular expectations. This is a time of significant change and expansion in SUO fellowship training. Newer requirements and standardized curriculum are needed. As always, the goal of these endeavors is to continue to improve upon the quality and uniqueness of education that SUO fellowships continue to offer. Christopher L. Amling, M.D., F.A.C.S. Department of Urology Oregon Health and Science University Portland, OR, USA