Affiliated Hospitals - Urology Residency
University of Maryland Medical Center
The University of Maryland Medical Center (UMMC) is a Level I Trauma Center. The UMMC Emergency Department (ED) is staffed with emergency medicine attendings.
The urology resident is called for all urologic problems, ranging from the minor to major trauma from inside the Baltimore Beltway. The attending is contacted regarding problem cases and admissions. The UMMC ED educates the resident broadly in general ED urologic cases seen in an urban environment.
For clinic, the PGY-3 urology resident is the primary physician for these patients. The urology faculty are immediately available in clinic for consultation and advice in patient management. However, many of our outpatient surgical procedures are performed by the residents with attending supervision.
Every effort is made to have the residents see the patients in the outpatient area for both pre-op planning and post-op follow-up.
Baltimore VA Medical Center
The Baltimore Veterans Affairs Medical Center (VA) does not have an ED, but does have a screening area where acute cases appear after-hours. The area is staffed by medical and surgical residents with attending back-up on-call.
Very few true urologic emergencies are admitted through this area, but patients do need to be seen with retention, stones, hematuria, epididymitis, etc. The experience contributes to the resident's education only as these cases can train. The ER is staffed by emergency physicians, and medical and surgical residents from Johns Hopkins' programs.
The urology resident is called for urologic emergencies and then contacts the attending on-call about each case. Urology attendings are available on a rotational basis (two months/year), 24 hours per day. The emergencies tend to be less life-threatening, although some gunshot wounds are seen. This more suburban ER experience is particularly heavy with acute ureteral calculi in the summer months.
During the resident’s time at the Veterans Administration Medical Center at Baltimore, all patients are considered the primary responsibility of the PGY-4 Urology resident. The PGY-4 resident does all the pre- and post-operative patient and family communication. His/her decisions are discussed with the attending staff, but the PGY-4 resident is viewed as the primary urologist within the institution.
UM Baltimore Washington Medical Center
At the University of Maryland Baltimore Washington Medical Center site, the PGY-3 residents rotate on a small non-private service. Since many of these patients are a part of a private practice group, the resident is less responsible for the direct patient care decisions being made, but does so in conjunction with the practice faculty. The PGY-3 resident is responsible for the in-hospital care of these patients.
The PGY-3 resident participates in surgical procedures and at times is consulted by some of the practicing urologists for advice, especially in newer areas of treatment.
Maryland Institute for Emergency Medical Services Systems
The Maryland Institute for Emergency Medical Services Systems (MIEMSS) is one of the premiere shock trauma units in the nation. All major traumas within the State of Maryland occurring outside the Baltimore Beltway are airlifted to the MIEMSS by a State helicopter system.
The trauma bays are manned at all times by trauma fellows and attending trauma surgeons. The urology attending on-call (Drs. Michael Naslund, Andrew Kramer, Michael Phelan or Mohummad Siddiqui) is also on-call for shock trauma.
The urology resident on-call is the first person called for urologic trauma. The urology resident on-call contacts the URO-4 resident, who then contacts the attending on-call. All surgical procedures are directly supervised by the attending on-call.
Virtually all of the shock trauma patients have multiple injuries; the urology service generally cares for their urologic problem only. This experience gives the residents a broad-based practical education, not only in urologic trauma care, but also in general trauma care.
Johns Hopkins Hospital Emergency Department
The Johns Hopkins Hospital Emergency Department is a full-service Level I Trauma Center. Patients are seen by the urology resident on-call and are discussed with the chief resident. The chief resident will then discuss the patient's care with the attending urologist on-call, as necessary.
The entire spectrum of pediatric urologic emergencies is seen, particularly including trauma and testicular torsion.
At the Johns Hopkins Hospital, all patients are the private patients of the urology faculty. Although the residents have in-hospital responsibility for these pediatric patients, the faculty has the ultimate decision-making responsibility.