1. Education in Urology. The American Perspective
J.Edson Pontes M.D.
Professor Urologic Oncology
WSU/KCI

2. American Medicine. Historical Background
Medical Schools in the USA proliferated in the 19th Century with little quality control.
In 1908 the AMA created the CME and recruited Abraham Flexner to survey all 155 Medical Schools in the Country, and make specific recommendations.
This has became know as the Flexner report with profound changes in Medical Education in the USA.

3. The Flexner report. Recommended changes.
Used the Johns Hopkins University as model.
Admission to Medical School to require a high school education and 2 years of College .At the time only 16/155 Medical Schools met these requirements.
Proprietary Schools should be closed or incorporated into Universities.

4. Consequences of Changes
Flexner suggested to decrease the number of Medical Schools to 31 in the USA.
Decrease the number of graduates from 4400 to 2000.
Between 1910 and 1935 >half of all Medical Schools in the USA were either closed or merged into Universities.

7. ACGME Recommendations for present training in Urology
One or 2 years of General Surgery- minimal of 3 months in general surgery ,critical care vascular surgery and trauma.
A minimum of 4 years of Urology. Residents must serve a minimum of 12 months as chief resident.
Resident’s expertise to include: management of patients with complex urological problems, advanced procedures and a high level of responsibility and independence.

8. Sponsoring Institutions
Must assume ultimate responsibility.
Program Director: single program director, approved by GME and submitted to ACGME.
The program director should be in that position for a minimum of 6 years.

9. Qualifications for a program director
Urological Expertise and Administration experience.
Board Certification.
Medical licensure.
Documented clinical and scholarly expertise in Urology.

10. Duties of Program Director
Oversees and assures quality.
Selection of program faculty.
Monitor resident’s supervision
Provides residents with biannual evaluation and progress.
Monitor resident’s duty hours to mitigate excessive fatigue, etc…

11. Didactic conferences Combined morbidity and mortality conferences.
Urological Imaging conferences.
Urologic Pathology
Journal Club.

12. Core Domains. Adult Urology
General Urology-TUR, TRUS/Biopsy, scrotal, inguinal surgery, urodynamics- minimal 200 cases.
Endo urology and stone disease: ESWL,PCN procedures, ureteroscopy: minimal 100 cases.
Laparoscopy: minimum 20 cases.
Reconstruction: minimum 60 cases.
Oncology: minimum 100 cases.

13. Core Domain Pediatric Urology
Minor: endoscopy, hydrocele, hernia repair, orchiopexy: minimum 30 cases.
Major: hypospadia, ureter: minimum 15 cases.

14. The Future
Medical Schools and medical training are undergoing significant changes.
In Urology we have seeing a shift from open surgery to minimally invasive procedures, with surgery being only a player among different disciplines.
In the near future, the training of a Urologist needs to adapt to the new realities of other procedures until now being done by radiologists etc..