Curriculum

FNB Fellowship

MINIMAL ACCESS
UROLOGY
Introduction

Aims and Objectives of Fellowship

Teaching and Training

Syllabus

Log Book

Other Recommendations
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 INDEX
S. No Contents Page No.

I Introduction 5

II Aims & Objectives of Fellowship 5

III Teaching and Training 5

IV Syllabus 10

V Log Book 11

VI Other Recommendations 12

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I. INTRODUCTION

In the present era of urology, except endourology most of the surgeries are still being
practiced as open surgery. In view of morbidly associated with open surgery, laparoscopic
/robotic urology can be an answer to an affordable and standardized urological care.

The goal of the Minimal access urology Fellowship is to provide the fellow with the
necessary training and education to be comfortable in the performance of a wide variety of
minimally invasive operations in the field of urology.

The activities of the fellow will be a blend of clinical experience, research, and teaching
responsibilities for medical students. Clinical experience is to include both operative time
and clinic hours. Prior fellows have performed both basic science research, as well as clinical
research. Topics have varied from surgical education to virtual reality simulation. Teaching
responsibilities will range from formal Grand Rounds presentations for the Department of
Surgery to informal clinical instruction in the operating room and surgical clinic.

II. AIMS & OBJECTIVES OF FELLOWSHIP

1. To produce competent specialists in Minimal access urology – who can provide

highest quality comprehensive care.
2. To give wide exposure in the field of Minimal access urology.
3. To understand in depth knowledge of various aspects of Minimal access urology.
4. To train, to carry out advanced laparoscopic/robotic surgeries independently.

III. TEACHING AND TRAINING

1. THE ACTIVITIES WILL BE DIVIDED AS FOLLOWS:

a. Clinical 60%
b. Research 20%
c. Teaching/Education 20%

2. PATIENT CARE:
Fellows must be able to provide patient care that is compassionate, appropriate,
and effective for the treatment of health problems and the promotion of health.
Fellows are expected to perform the following:

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 a. Communicate effectively and demonstrate caring and respectful behaviours
when interacting with patients and their families
b. Gather essential and accurate information about their patients
c. Make informed decisions about diagnostic and therapeutic interventions
based on patient information and preferences, up-to-date scientific evidence,
and clinical judgment
d. Develop and carry out patient management plans
e. Counsel and educate patients and their families
f. Use information technology to support patient care decision and patient
g. Perform competently all medical and invasive procedures considered
essential for the area of practice
h. Provide health care services aimed at preventing health problems or
maintaining health
i. Work with health care professionals, including those from other disciplines,
to provide patient-focused care

3. MEDICAL KNOWLEDGE:

Fellows must demonstrate knowledge about established and evolving

biomedical, clinical, and cognitive (epidemiological and socio-behavioral)
sciences and the application of this knowledge to patient care. Fellows are
expected to perform the following:
a. Demonstrate an investigatory and analytic thinking approach to clinical
situations

b. Know and apply the basic and clinically supportive sciences which are
appropriate to their discipline.

4. PRACTICE-BASED LEARNING AND IMPROVEMENT:

Fellows must be able to investigate and evaluate their patient care practices,
appraise and assimilate scientific evidence, and improve their patient care
practices. Fellows are expected to perform the following:
a. Analyze practice experience and perform practice-based improvement
activities using a systematic methodology
b. Locate, appraise, and assimilate evidence from scientific studies related to
their patients’ health problems
c. Obtain and use information about their population of patients and the larger
population from their patients are drawn
d. Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and of information on diagnostic and therapeutic effectiveness

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 e. Use information technology to manage information, access on-line medical
information, and supplement their own education
f. Facilitate the learning of students and other health professionals

5. INTERPERSONAL AND COMMUNICATION SKILLS:

Fellows must be able to demonstrate interpersonal and communication skills that

result in effective information exchange and teaming with patients, their patients’
families, and professional associates. Fellows are expected to perform the
following:
a. Create and sustain a therapeutic and ethically sound relationship with
patients
b. Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory questioning, and writing skills
c. Work effectively with others as a member or leader of a health care team or
other professional group.

6. PROFESSIONALISM:
Fellows must demonstrate a commitment to carrying out professional
responsibilities and sensitivity to a diverse patient population. Fellows are
expected to perform the following:
a. Demonstrate respect, compassion, and integrity; a responsiveness to the
needs of patients and families that supercedes self-interest; accountability to
patients, society, and the profession; and a commitment to excellence and
ongoing professional development
b. Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical treatment, confidentiality of patient information,
informed consent, and business practices
c. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender,
and disabilities.

7. SYSTEMS-BASED PRACTICE:
Fellows must demonstrate an awareness of and responsiveness to the larger
context and system of health care and the ability to effectively call on system
resources to provide care that is of optimal value. Fellows are expected to
perform the following:
a. Understand how their patient care and other professional practices affect
other health care professionals, the health care organization, and the larger
society and how these elements of the system affect their own practice

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 b. Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources
c. Practice cost-effective health care and resource allocation that does not
compromise the quality of care
d. Advocate for quality patient care and assist patients in dealing with system
complexities
e. Know how to partner with health care managers and health care providers to
assess, coordinate, improve health care and know how these activities can
affect system performance.

8. ORGANIZATION OF TRAINING:

a. Training programs in MIS should be in a multidisciplinary centre of

minimally invasive surgery and should be organized by a qualified,
accredited specialist in MIS.
b. The Centre should use the guidelines and protocols by national professional
bodies and are reviewed at regular intervals.

9. THE MEANS OF TRAINING:

a. The trainees should participate in all relevant activities of the training unit
such as the care of Out -Patients and In -Patients, on call duties during both
day and night, also participating in educational activities, including the
teaching of other health professionals. Participation in audit and clinical or
basic research is essential.

b. The duration of MAU training should cover the clinical and research aspects
of the following areas:
 Good text books on MAU written by leading and experienced Authors
 Educational tools such as Video tapes /CD ROMS
 Simulators for Endo – Training
 Box trainers to master the skills
 Endo trainer rooms with adequate space and good air-conditioning
facility to work long hours in the simulators so the trainee can avoid
fatigue.
 Endo-cameras mounted on a special stands with the monitors
 Special hand instruments to learn the hand and eye co-ordination
 To learn depth perception
 To learn tactile sensations

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 c. Schedule:

OR Days 4 Days/ week

3 days / week (at least half an hour
Clinical Dry lab (Lap Mentor)
before OT, endo suturing)
OPD 2 Days/ week
Symposium One in 15 days
Journal Club once a week
Recent Advances once a week
Academics
Audit once a month
Instrument care and
once a week
Sterilization

d. Trouble Shooting: Laparoscopic procedures are inherently complex. Many

things can go wrong. The surgeon must learn sufficiently about all
equipment’s which can trouble shoot and to solve it. Common problems to be
learnt are:
 Cause of Poor insufflations
 Reason for excessive pressure for insufflation
 Reasons for inadequate lighting
 Reasons for too bright lighting
 Reasons for loss of picture on monitors
 Reasons for poor quality pictures /fogging / haze
 Reasons for flickering electrical interference
 Reasons for inadequate cauterization/inadequate irrigation and suction

e. Administration: Setting up the laparoscopic/robotic surgery unit, quality

control and assurance, creating protocol for management and organizing and
coordinating of clinical meetings.

The course will ensure training in all three domains of learning i.e.
 Cognitive (Knowledge)
 Affective (Behavior, communications skills towards the patients)
 Psychomotor (Development of skills)

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IV. SYLLABUS

1. The syllabus consists of:

a. Upper tract Laparoscopy:

 Laparoscopic / Robotic cyst deroofing

 Laparoscopic / Robotic ureterolithotomy
 Laparoscopic / Robotic Pyeloplasty
 Laparoscopic / Robotic Donor Nephrectomy
 Laparoscopic/ Robotic Nephroureterectomy
 Laparoscopic/ Robotic Simple Nephrectomy
 Laparoscopic/ Robotic Radical Nephrectomy
 Laparoscopic/ Robotic Partial Nephrectomy
 Laparoscopic/ Robotic Adrenalectomy
 Laparoscopic/ Robotic Nephrolysis
 Laparoscopic/ Robotic Ureterolysis

b. Lower tract Laparoscopy:

 Laparoscopic / Robotic Ureteric Reimplantation

 Laparoscopic / Robotic VVF repair
 Laparoscopic / Robotic Partial cystectomy
 Laparoscopic / Robotic Radical cystectomy
 Laparoscopic / Robotic Radical prostatectomy
 Laparoscopic / Robotic Boari Flap
 Laparoscopic / Robotic Augmentation Ureterocystoplasty
 Laparoscopic / Robotic Pelvic Lymphnode Dissection
 Laparoscopic / Robotic Seminal Vesical cyst Excisison

c. Miscellaneous:

 Diagnostic Laparoscopy
 Laparoscopic / Robotic Orchiopexy
 Laparoscopic Assisted PCNL

2. JOB DESCRIPTION:
a. Attending outpatient clinic to do pre – op evaluation.

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 b. Attending in follow up outpatient clinic – dealing with recently performed
surgeries.
c. Taking ward rounds, seeing patients and bedside case discussion.
d. Managing Postoperative complications.
e. Coming to operation Theatre – assisting & performing various surgeries.
f. Assisting emergency procedures if required.
g. Coordinating with research team about data analysis.
h. Conducting prospective / retrospective studies.
i. Participation in weekly morbidity/mortality meet.
j. Paper presentation in various conferences & publications in index journals.

V. LOG BOOK

A candidate shall maintain a log book of operations (assisted / performed) during the
training period, certified by the concerned post graduate teacher / Head of the department
/ senior consultant.

This log book shall be made available to the board of examiners for their perusal at the time
of the final examination.
The log book should show evidence that the before mentioned subjects were covered (with
dates and the name of teacher(s) The candidate will maintain the record of all academic
activities undertaken by him/her in log book.

1. Personal profile of the candidate

2. Educational qualification/Professional data
3. Record of case histories
4. Procedures learnt
5. Record of case Demonstration/Presentations
6. Every candidate, at the time of practical examination, will be required to produce
performance record (log book) containing details of the work done by him/her
during the entire period of training as per requirements of the log book. It should be
duly certified by the supervisor as work done by the candidate and countersigned
by the administrative Head of the Institution.
7. In the absence of production of log book, the result will not be declared

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VI. OTHER RECOMMENDATIONS

1. OPERATIVE EXPERIENCE:

The Fellowship operates with a mentor system. The Fellow will act as the
assistant surgeon early during the training period. As the Fellow’s skill increases,
she or he will graduate to the role of Primary Surgeon under supervision, and
assist the Residents in performing procedures.

At the end of Fellowship Programme, fellow must have experienced:

Checklist:

Sr No. Procedure Numbers

1. Port insertion 25
2. Colon mobilisation 20
3. Hilar dissection 15
4. Intra corporeal endo suturing 10
5. As a first assistant surgeon 30
Fellow must perform following surgeries independently:
6. Laparoscopic / Robotic Simple Nephrectomy 3-5
7. Laparoscopic / Robotic Radical Nephrectomy 3-5
8. Laparoscopic / Robotic Adrenalectomy 1
9. Laparoscopic / Robotic VVF Repair 2
10. Laparoscopic / Robotic Donor Nephrectomy 1
11. Laparoscopic / Robotic Nephroureterectomy 1
12. Diagnostic Laparoscopy 2
13. Laparoscopic / Robotic Pyeloplasty 3-5
14. Laparoscopic / Robotic Radical Prostatectomy 1

2. THE ACADEMIC ACTIVITIES OF THE PROGRAM IN THE

HOSPITAL SHOULD INCLUDE:

a. Publication Requirement: Fellow are required to have 1 article submitted

to the index journal and one article accepted for publication or publised in
any journal from work they performed during fellowship with fellow as the
first author, to receice certification.

b. Other:
 Regular academic sessions.
 Case discussion and seminars.

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  Paper presentation.
 Audit/Biostatistics
 Conferences/CME’s/Live workshops.
 Fine tuning skills in the purpose built animal (wet) laboratory.
 The programme is organized to have maximum “Hands-on” practice
sessions in the “Purpose Built” animal laboratory.
 Lecture hall for CME, conference and live workshop transmission with
good acoustics.
 Medico legal aspects relevant to the discipline
 Health Policy issues as may be applicable to the discipline

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Ministry of Health & Family Welfare, Govt. of India
Medical Enclave, Ansari Nagar, New Delhi- 110029

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