Fellowship Curriculum


First Year: Research Component

The Department of Urology at the University of Texas Health Science Center in San Antonio has a tradition of excellence in research. Our focus is in understanding disease processes to optimize prevention and treatment opportunities. It is our goal to have a vision of dramatic improvements in understanding, preventing, and treating disease to substantially improve the quality of health in Urologic Disease. The research opportunities will be integrated in the following proposed curriculum:

Months 1-3:

The incoming fellow will be encouraged to identify his/her area of research interest and submit one or two clinical research proposals/protocols related to urologic oncology in the first month of the fellowship. The Department of Urology has a proven track record of high-quality clinical research with well-trained research personnel and clinical research associates that would translate into expedited IRB and other regulatory approvals to get the research project started. The fellow would also be encouraged to enroll in focused courses that would enrich their ability to conduct high quality clinical research. By month 2-3, all regulatory approvals will be obtained, and the research studies will be initiated by the 3rd month of fellowship at the latest.

Months 3-9:

A team of Clinical Research Nurses, research associates and database manager will be primarily involved in the active day to day research issues including patient accrual, data collection, data entry and database management. We have a team of qualified statisticians that will initially format the studies and subsequently help with statistical analyses. The fellow will closely work with the entire team under close supervision with the faculty mentor. The fellow will also be given an opportunity to enroll in the Masters of Science in Clinical Investigation courses or take selected courses tailored to their individual interests. A monthly Journal Club will be conducted evaluating important articles in urologic oncology as well as different surgical specialties. The fellow will be encouraged to submit findings of their research to national and international meetings and will be supported to present their research.

Months 9-12:

The fellows will be expected to complete their research and prepare their manuscript(s) for submission to a peer-reviewed journal in the field. We will provide complete statistical as well as editorial support for the same. If the research initiated by one fellow has an ongoing component, the next incoming fellow will be entrusted with the responsibility of completing the project as planned.

Masters of Science in Clinical Investigation Degree

The fellow will also be given an opportunity to enroll in the Masters in Science in Clinical Investigation courses or take selected courses tailored to their individual interests. The MSCI Program is interdisciplinary and involves all five UTHSCSA Schools.  Experienced faculties direct each course and take responsibility for designing the teaching materials with the course leaders.  Specific learning objectives and discussion-based activities have been created for each weekly session.  Teams of instructors (course faculty), who are particularly qualified to teach the selected topics, deliver these integrated courses. The MSCI Degree program at UTHSCSA consists of 10 required integrated courses plus a mentored research project.

Program website: https://iims.uthscsa.edu/education/education/programs/msci-ts/

Office and Connectivity

The fellow has a private office and administrative support available within the Department of Urology.  A laptop computer for research, choice of PC or Apple, will be provided in addition to the desktop computer in the office. Remote log-ins to research and clinical work are seamless with any internet connection on or off campus.

Department Commitment to Research and Productivity

The Department of Urology at UTHSCSA will provide significant facilities and resources to the conduct meaningful clinical research in urologic oncologic surgery.  A conference room within the Department School of Medicine building will be used for all meetings. Due to the extensive clinical, translational and basic science research efforts of the Department of Urology, an experienced staff of research associates provides the foundation for research.

  • Clinical Research: We have extensive experience in the development of Clinical Research Forms (CRFs) as well as systems for data entry and retrieval.
  • Current Clinical Trial in the Department of Urology: Fellows have the opportunity to participate in current active clinical trials in the department of urology.
  • Basic Science: Several high-quality options are available for the fellows to train themselves in basic science research. The Department of Urology has active collaborations with 6 independently funded NIH investigators and PhDs with major emphasis on basic science, molecular and translational aspects in all areas of Urologic Oncology. Dr. Robin Leach, PhD, who serves as the Director of Research in the Department of Urology will guide the fellows to pursue their individual areas of interest.
  • Biostatistical Support: The design, monitoring, analysis and accurate reporting of the research data are critical to the success of the proposed study. Dr. John Cornell, PhD, will serve as lead statistician for the biostatistical support.
    • Monitoring: The Biostatistical Support will review the project and data collection forms to ensure compatibility and adherence to NCI standards.
    • Analysis: The Biostatistical Support will be responsible for the data and statistical analysis integrity for the fellow research project. Advanced modern statistical methods will be tapped for adjusted analyses due to biases as needed.
    • Publication: The Biostatistical Support will be responsible for writing the statistical methods section and results section in a timely manner upon conclusion of the research project, for clarifying results in person with the primary investigator, and for performing additional analyses upon request. They will review finished publications to ensure that conclusions match those that can be inferred from the statistical analysis.

Second Year: Clinical Component

Urologic Oncology Training:

The Society of Urologic Oncology (SUO) accredited fellowship at UT Health San Antonio is designed to provide comprehensive training in all aspects of urologic cancer surgery, including open, laparoscopic, and robotic-assisted techniques. Our goal is to train future leaders and provide experience needed to become an outstanding urologic oncologist.

Following are highlighted areas of surgical training for the urologic oncology fellow:

  1. Kidney cancer (Open, robotic and laparoscopic approach): Radical nephrectomy, partial nephrectomy, IVC thrombectomy (Level 0 to IV)
  2. Urothelial cancer (Open and robotic approach): Radical cystectomy, salvage cystectomy, urinary diversion with conduit, continent reservoirs, and orthotopic neobladder, extended pelvic lymph node dissection, partial cystectomy, pelvic exenteration, radical nephroureterectomy, ureterectomy and reconstruction
  3. Prostate cancer (mostly robotic approach): Multi-port and single port prostatectomy, salvage prostatectomy, MRI/US fusion biopsy
  4. Testis cancer: Primary retroperitoneal lymph node dissection with nerve-sparing, post-chemotherapy retroperitoneal lymph node dissection, robotic RPLND
  5. Penile Cancer: Partial penectomy, total penectomy, radical Inguinal and pelvic lymph node dissection open and robotic
  6. Adrenal Surgery: Open and robotic approaches

Robotic Surgery Training:

In addition to extensive training of the fellows to open approach, we have developed a structured approach towards education and training in the practice of robotic surgery and its application in all areas of Urologic Oncology. We have a comprehensive curriculum in place towards training our fellows.

Open and minimally invasive surgery are interactive and equally important skills for urologic oncology training. To that end, all our rotations include open and minimally invasive approaches, which insures:

  1. Fundamental knowledge of the surgical anatomy
  2. Step by step understanding of urologic oncologic procedures the traditional open or the minimally invasive approach
  3. Proficient, precise and efficient use of a surgical robot in performing the entire spectrum of urologic oncologic procedures

Unlike most other academic and community settings, the robotic surgery in our program is exclusively performed by fellowship trained Urologic Oncologists who have expertise in both open and robotic surgery. Individualization of treatment approach based on unique attributes of each patient and their cancers is our preferred method as opposed to adopting a ‘one size fits all’ approach.

For those with minimal robotic experience, the first 2 months of the clinical year will be devoted extensively to:

  1. Planning of port placements along with practicing a safe approach towards port placements for all urologic oncologic procedures.
  2. Efficient and accurate docking and undocking of the robot.
  3. Familiarize with the several instruments available through the robotic platform along with their insertion and exchange in a safe, timely and effective fashion.
  4. Learn and perform common ‘tips and tricks’ for troubleshooting common faults, errors and hurdles while performing robotic surgeries.
  5. Patient side active (first) assistance in all robotic surgeries to get acquaintance and expertise in all the steps involved towards successful performance of robotic urologic oncologic procedures. The fellow should be able to anticipate the surgical steps and act well in advance to facilitate a seamless and smooth performance of the surgical procedures.

Those with extensive robotic experience in residency or practice will be accelerated as necessary.

Months 0-6:

The fellow will be initiated to operate through the Da Vinci Console. The training module of the Da Vinci S system will be used to facilitate this step. Each index urological oncologic procedure performed with the robot will be broken down into several systematic steps based on complexity of the skills involved. These steps will be given to the fellow in advance for their preparation. An objective method of evaluation will be used by the mentors to confirm that the fellow performs the structured training steps in a satisfactory fashion before advancing to the more complex steps.

Months 6-9:

The complex steps of each robotic urologic oncologic procedure will be identified. The fellow will be graduated to perform these steps under direct supervision of the mentors. Objective evaluation along with visual feedback will be continued for this step as well. The fellow will also be expected to ‘mentor’ the residents of the program to get initiated into the basics of robotic surgery.

Months 9-12:

The fellow will be expected to perform a major part of the entire spectrum of robotic urologic oncologic procedures under faculty supervision in an independent fashion. During the final month, the fellow will perform robotic surgery as independent staff under official proctoring by the faculty such that all the criteria required to obtain practice privileges for robotic surgery in their future employment are fulfilled during the end of the fellowship.