Starting a Urology Residency Program: A Comprehensive Step-by-Step Guide

Launching a urology residency program is a complex but rewarding process that spans several critical steps, from initial planning to achieving accreditation and implementation. On average, it takes at least five years from the initial idea to the program’s inception. Below is a detailed guide to help you navigate the process successfully.

1. Conduct a Needs Assessment

• Evaluate Demand: Begin by assessing the regional demand for a urology residency program. Consider local healthcare needs, the number of practicing urologists, and the pool of potential applicants in your area.
• Define the Purpose: Identify why the program is being developed. Are you addressing a shortage of urologists, improving care quality in underserved regions, or offering specialized training opportunities?
  • What is your mission statement?
• Determine the Scope: Decide on the program’s scope. Will it be limited to a single institution; will it involve subspecialties within urology or serve a rural track?
  • What is your AIMs statement?
• Engage Stakeholders: Collaborate with key stakeholders such as medical schools, hospitals, and community urologists. Ensure their interest and support but also consider opposition from other educational centers in the region, as conflicts can negatively impact accreditation and resident education.
  • Identify your Institutional Sponsor and DIO (Designated Institutional Officer)
• Perform a SWOT Analysis: Use a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) to organize your findings, stimulate discussions, and document your needs assessment effectively.

Timeline Overview:

• Initial Accreditation Process: 2–5 years
• Full Accreditation: 5–7 years after program launch, depending on performance and ACGME (Accreditation Council for Graduate Medical Education) review cycles

Clear communication from program leadership is essential to prevent misunderstandings and setbacks.

2. Secure Funding and Develop a Financial Plan

• Understand CMS Funding: Familiarize yourself with CMS (Centers for Medicare & Medicaid Services) funding structures, which support graduate medical education (GME). Over the past two decades, CMS has placed limitations on training spot expansions, with a particular focus on rural and underserved specialties.
• Anticipate Gaps: Identify potential funding shortfalls and create a plan to address them. This may involve securing institutional support or alternative funding sources.
• Develop an understood timeline: Create an implementation timeline to set realistic goals and expectations for faculty and administration. Mismanaging expectations can destabilize faculty morale and jeopardize funding.

3. Develop a Program Proposal

• Define Objectives: Clearly articulate the mission, vision, and educational goals of the residency program.
• Consider an AIM Statement to organize objectives.
• Outline Curriculum: Develop a robust curriculum covering all aspects of urology, including clinical training, surgical techniques, and research opportunities.
• Design Rotations: Plan rotations to offer residents a diverse range of experiences, including subspecialty training and clinical exposure. Outline objectives for learning during each rotation.

4. Secure Institutional Support

• Engage the DIO: The DIO likely has already been involved at this point, but you must obtain approval from your institution’s Designated Institutional Official (DIO), as well as hospital leadership and medical school administration.
• Budget Planning: Develop a detailed budget covering salaries, equipment, educational materials, and administrative costs.

5. Recruit Faculty and Build a Department

• Recruit Qualified Faculty: Assemble a team of experienced urologists and educators who can provide both clinical training and academic mentorship. They should be likeminded in regard to starting the program and understand the commitment involved.
• Define Roles and Responsibilities: Assign clear responsibilities to each faculty member, including teaching, supervision, and program governance.

6. Establish Program Infrastructure

• Develop Facilities: Ensure the availability of well-equipped operating rooms, patient care areas, and simulation labs.
• Implement Administrative Systems: Set up systems to manage residency applications, track resident progress, and maintain records.
• Identify/Hire your Program Coordinator: Ideally this is someone with significant GME experience. This is a critical administrative decision that supports the day-to-day operations, compliance, and overall success of the residency. The Program Coordinator is the organizational backbone of the residency and works closely with the Program Director, residents, faculty, GME office, and accrediting bodies (like the ACGME).

7. Seek Accreditation

• Prepare Documentation: Collect all necessary documentation for submission to the accrediting body, such as the ACGME in the U.S.
• Submit the Application: Provide detailed information about the program’s structure, curriculum, and faculty to the accrediting body.
• Prepare for the Site Visit: Accreditation bodies will visit your institution to evaluate facilities and compliance with their standards.

8. Recruit Residents

• Establish Selection Criteria: Develop clear criteria for selecting residents, focusing on academic qualifications, relevant experience, and personal attributes.
• Advertise the Program: Promote the residency through social media, medical school websites, professional organizations, and residency fairs.
• Conduct Interviews: Assess candidates for their suitability and alignment with your program’s goals.

9. Launch the Program

10. Ensure Continuous Improvement

• Orientation for Residents: Welcome the first cohort with a structured orientation program. Familiarize them with the curriculum, institutional policies, and expectations.
• Monitor and Evaluate: Continuously track the program’s progress, gathering feedback from both residents and faculty. Use this input to make improvements.
• Regular Reviews: Conduct periodic reviews to evaluate whether the program is meeting its objectives and maintaining compliance with accreditation standards.
• Adapt the Curriculum: Update the curriculum to reflect advancements in urology, feedback from participants, and changes in accreditation requirements.
• Maintain Accreditation: Stay proactive about maintaining compliance with accrediting bodies and preparing for routine reviews.

11. Promote Resident Professional Development

• Encourage Research: Offer research opportunities and support scholarly activities to foster residents’ professional growth.
• Provide Career Support: Guide residents in planning their careers, including fellowship opportunities or entry into independent practice.

12. Address Challenges for Established Programs

• Respond with Increased Complement: Be prepared to adjust resources and support systems as the program grows.
  • Complement increases will be the first challenge a new program face. Generally, this is not allowed until the program graduates a resident and has Continued Accreditation with data.
    • The factors most influencing this decision involve faculty to resident ratio and surgical case volume.
    • Maintaining records of uncovered surgical case volume is essential in establishing the missed educational component and reasoning for expansion.
    • Programs seeking expansion should demonstrate a solid educational rationale for doing so.
• Manage Probation Issues: Develop strategies to address concerns flagged by accrediting bodies.

13. Creating Training Opportunities in Community Based Programs and Private Practices

• Institutional Alignment – Sponsorship or Partnership
• How to identify an Institutional Sponsor
• Unique Finance Structures
• Unanimous Parter Commitment or Bifurcated Partnership Tracts
  • Nonteaching Partner
  • Teaching Partner

Final Thoughts/What We Learned

• Unanticipated Challenges
  • Resident Numbers
  • Managing Expectations
    • For administration
    • For patient access
  • APPs – Integration and evolution
• What we did right
  • Resident/Faculty complement and commitment
  • Culture of growth
  • Resident selection and away rotations