Institutional Program Requirements
A. Definition of the Specialty
Urologic oncology is a subspecialty of urology focusing on the evaluation and treatment of patients with malignancies of the genitourinary tract, including the adrenal gland. Specialists in this discipline must demonstrate knowledge of the basic and clinical sciences related to genitourinary malignancies as well as attendant skills in the medical and surgical therapy of these cancers. Fellowship programs must educate fellows in the evaluation and treatment of urologic cancers to include an understanding of the molecular mechanisms of cancer development and progression, urologic cancer pathology, radiation and chemotherapy treatments, surgical management options and supportive care. Education in reconstruction of the genitourinary tract must also be provided. Fellowship programs must provide adequate exposure to the non-surgical disciplines of radiation and medical oncology so that trainees will graduate with knowledge of a multidisciplinary approach to urologic cancer care.
B. Duration and Scope of Education
- The prerequisite for selection to a urologic oncology fellowship is either completion of an ACGME accredited urology residency program or a similarly accredited international residency program in urology. This training must provide education in all aspects of urology including broad exposure to the evaluation and treatment of urologic malignancies. Of note, SUO Fellowship programs are accredited by the Society of Urologic Oncology, and not the Accreditation Council for Graduate Medical Education.
- A minimum of 24 months of urologic oncology education is required. This period of education will be divided into at least 12 months of clinical urologic oncology training and 12 month s of urologic oncology research.
- The clinical training year must provide a broad exposure to routine and complex urologic oncology conditions. This exposure must include education in the multidisciplinary approach to urologic cancer care. This includes exposure to radiation oncology, medical oncology, urologic cancer pathology and supportive care. The clinical year must include at least 80% protected time for clinical training without research responsibilities.
- Surgical training during the clinical year should include adequate exposure to both minimally invasive and open surgical procedures. Although the ratio of minimally invasive and open surgical experience during this training will vary from program to program, fellows must be provided with a volume of surgical training in both that will allow the graduating fellow to perform both open and minimally invasive surgery with competence. Adequate exposure to complex open surgical procedures will be an important part of this training. Although there are no formal requirements for each index case, typical case volumes for graduating fellows would involve a minimum of 40 prostatectomy, 35 nephrectomy, 20 cystectomy, and 8 retroperitoneal node dissection cases, including a minimum of 40 minimally invasive procedures.
- The research training year may consist of a health services track or laboratory research, or may include a combination of both. The research year must include at least 80% protected time for conducting research without clinical responsibilities. The research training may vary from program to program, but must provide the fellow with a valuable educational experience that will result in peer-reviewed publications in urologic cancer journals. Research training must also include instruction in evidence-based medicine, clinical trial design, biostatistics, and grant writing. Fellows must also receive education in the basic science and molecular aspects of urologic cancer. Research opportunities may be EITHER in health services research or basic science research although SUO accredited institutions are encouraged to offer both options.
- If approved by the SUO Fellowship Committee, the fellow may complete the clinical training year and research year at separate institutions. The clinical year must be completed at the SUO-accredited institution; however the research year may be executed at another institution with prior approval from the Fellowship Committee. The research year cannot be waived for prior research experience regardless of whether this research was done before, during or after urology residency training.
One sponsoring institution will assume ultimate responsibility for the fellowship training program and this responsibility extends to the fellow’s assignments at all participating sites. Ideally, the sponsoring institution should be affiliated with an academic medical center. Assignments at participating sites must be of sufficient length to ensure a quality educational experience and should provide the opportunity for continuity of care. Although the number of participating sites may vary from program to program, all participating sites must demonstrate the ability to promote the program goals and have educational rationale for the training of the fellow.
D. Program Personnel
- There must be a single program director with the authority and accountability for the operation of the fellowship program. Program directors must have completed an SUO accredited fellowship in urologic oncology and be an active member of the SUO. Exceptions to this condition for senior members who are recognized as national leaders in the field of urologic oncology will be granted if a fellowship-trained faculty member is not available at the program. If a fellowship-trained faculty member is present at the program, no exception will be made. Senior members requesting an exemption to this rule must be active members of the SUO and attend fellowship director meetings. Additional qualifications of the Program Director must include requisite subspecialty expertise in urologic oncology and documented educational and administrative experience acceptable to the SUO Fellowship Committee. Documented clinical and scholarly expertise should be apparent from the Program Director’s curriculum vitae. The program director should continue in his/her position for a length of time adequate to ensure program stability.
- The Program Director must administer and maintain an educational environment conducive to educating urologic oncology fellows. They must oversee and ensure the quality of didactic and clinical education at all sites that participate in the program. On a regular basis, they must also evaluate program faculty and approve the continued participation of the faculty members based on these evaluations. Program Directors are also responsible for the preparation and submission of all information required and requested by the SUO Fellowship Committee, including but not limited to annual program evaluation forms and documentation of each fellow’s academic and clinical experience.
- The Program Director must also ensure that the operative experience performed by fellows is logged accurately. The Program Director will review these logs annually for each fellow. Upon graduation from the fellowship program, the Program Director is responsible for submitting the fellows’ final aggregate log for review by the SUO Fellowship Committee. The Program Director must ensure that the fellow’s surgical experience consists of an adequate volume and variety of cases.
- The Program Director must complete a structured evaluation of each graduating fellow, and graduating fellow(s) must complete a confidential structured evaluation of the program which will be sent directly to the Fellowship Committee. All supporting documentation from the program director and graduating fellows must be received within one year of the fellow completing the program; otherwise the fellow will not be granted the SUO certification.
- The Program Director must provide a brief yearly update to the Fellowship Committee that enumerates any major changes to program structure, faculty, or facilities.
- In order to establish the validity and reliability of the OKAT (Oncology Knowledge Assessment Test) examination, the Program Directors or a designated faculty member must take this exam every year. Program Directors must also assure that fellows take this examination each year that they are a fellow. For extenuating circumstances a request for a deferment must be submitted to the SUO Fellowship Committee within 6 weeks of the exam. Programs in which the fellow(s) do not take the examination and do not receive an exception, the fellow(s) will not receive SUO certification. .
- The following consequences will be taken into action for programs in which the Program Director or designated faculty members does not take the OKAT (Oncology Knowledge Assessment Test) examination.
- If a Program Director or designated faculty member does not take the OKAT, the first offense will be a written warning.
- If a Program Director or designated faculty member does not take the OKAT after 2 times, the second offense will call for the inability of the program to participate in the match the following year.
- If a Program Director or designated faculty member does not take the OKAT after 3 times, the third offense will trigger re-review of the program.
- All Program Directors are required to attend the Program Directors Meeting at the annual SUO Winter Meeting. If the Program Director is unable to attend they are required to send a faculty representative from their program on their behalf.
Urologic Oncology Faculty
- At each participating site, there must be a sufficient number of faculty members with documented qualifications in urologic oncology to instruct and supervise all of the fellows at that location. The program faculty must devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities. They must administer and maintain an educational environment conducive to educating urologic oncology fellows. The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. To provide a diverse educational experience, faculty members should have subspecialty education and concentrate their practice in varied urologic oncology domains. The faculty must regularly participate in organized clinical discussions, rounds, journal clubs and conferences. Some members of the faculty must demonstrate scholarly activity by peer-reviewed funding, publication of original research or review articles in peer review journals and/or participation in local, regional and national professional and scientific meetings.
- There must be at least two urologic oncology faculty members, one of them must have completed a Urologic Oncology Fellowship, devoting sufficient time to supervise and teach fellows, and who are committed completely to the educational objectives of the fellowship program. A faculty: clinical fellow ratio of at least 2:1 in the total program is required. The Program Director may be included in determining the ratio. The Program Director must inform the SUO Fellowship Committee if the number of urologic oncology faculty members falls below the 2:1 ratio and remains below that level for longer than one year. Faculty must be practicing urologists, not from another discipline, and hold appointments at the sponsoring institution.
Other Program Faculty
The fellowship training program must include faculty members with expertise in non-surgical disciplines related to urologic cancer care. These include faculty with expertise in medical oncology, radiation oncology and urologic cancer pathology. These faculty members must devote a sufficient amount of time to the educational program including direct interaction with the fellow in both clinical and academic settings. Non-surgical faculty must also participate in multidisciplinary conferences or clinics and contribute to the fellow’s didactic education.
E. Educational Program
- The fellowship curriculum must contain the overall educational goals of the program which must be distributed to the fellows and faculty annually. There should be regularly scheduled didactic sessions that the fellows attend. The curriculum should also delineate the fellow’s responsibilities for patient care, progressive responsibility of patient management and continuity of care.
- Fellows must demonstrate knowledge of established and evolving urologic oncology concepts as well as application of these to patient care. Fellows must have didactic instruction that includes the core clinical domains of urologic oncology and follows the written SUO core curriculum including: prostate cancer, bladder cancer, renal cancer, penile cancer, testicular cancer, radiation oncology, medical oncology, urologic oncology pathology and urologic cancer imaging. Fellows must also receive instruction in the surgical techniques associated with performing complex open urologic cancer surgery, minimally invasive surgery (including robotic surgery) and the endourologic evaluation and treatment of genitourinary tract malignancies. Fellows should additionally demonstrate progression towards independence and autonomy in the surgical management of oncology cases. It is strongly encouraged that the fellows participate in at least one SUO-sponsored educational course as available during their fellowship in addition to attending the Annual/Winter Meeting and the AUA/Spring Meeting.
- During the research experience, the fellowship curriculum must provide for exposure to and instruction in the basic principles of research design, evidence-based medicine, biostatistics and grant writing strategies. Fellows must also receive education in the basic science and molecular aspects of urologic cancer. They must also be familiar with how research is conducted, evaluated, explained to patients and applied to patient care. Fellowship participation in scholarly activities must be documented by manuscript preparation, lectures or presentations, teaching activities and the active performance of clinical and/or laboratory research. The research year must include at least 80% protected time from clinical duties to allow a productive research experience.
F. Fellow Evaluation
The Program Director and faculty must evaluate fellow performance in a timely manner after educational assignments and document these evaluations at the completion of their fellowship training and within one year of the completion of training; failure to comply with these requirements will result in the fellow(s) not receiving SUO certification. As an important part of fellowship evaluation, the fellow must take the OKAT examination during each year of their fellowship in order to receive their SUO certification. All programs reserve the right not to put a fellow’s name forward for SUO accreditation with supporting evidence as to why the fellow is not sufficient for SUO accreditation. Fellows may consider an appeal to the SUO Fellowship Committee and each case will be considered individually.
G. Program Application and Selection of Fellows
Initial program application, annual review, and recertification
- SUO approved fellowship program applications are available on the SUO website. This initial application is completed by the program and program director and submitted with the required application fee of $3,000. A site reviewer will be identified and a site visit will then be arranged after review of the application by the SUO Fellowship Committee. Please note that once a site reviewer has been identified, it is the responsibility of the Program Director to contact the reviewer to make arrangements for the visit. Site visits will generally be completed within three months of receipt of the complete application packet. Following completion of the site visit, a report will be created and distributed to Fellowship Committee members for review. Site reviews are confidential and will not be supplied to Programs, although if a program is not approved then a letter detailing the concerns of the SUO Fellowship Committee will be sent to the Program Director.
- The Fellowship Committee will meet on a biannual basis at the AUA Annual Meeting and at the Winter SUO Meeting. To be eligible for approval at the AUA Annual Meeting and Winter SUO Meeting, complete applications must be received by January 1 and July 1 of that year, respectively. At these meetings, programs that have submitted complete applications and have undergone their site visit will be reviewed for approval by the Fellowship Committee. In order to be considered for approval, new programs must have had their site visit within the period between these meetings and must have addressed any site review requests or concerns prior to this meeting. Recommendations for approval/denial will be made by the Fellowship Committee and sent to the SUO Executive Committee for final approval. Approval for the program will include a specific number of fellowship slots for that program. Existing fellows of a new institution are not eligible for SUO accreditation. However, newly-accredited programs interested in taking a fellow who would start after the program is accredited and prior to participation in the program’s first SUO Match may send a request for SUO fellowship certification for the fellow to the SUO Fellowship Committee for review. If a program applies for initial program status and are not granted approval, then they may reapply as soon as the next application cycle.
- After the five year period, programs will be required to complete a recertification application that will be reviewed by the Fellowship Committee at the AUA and SUO winter meetings. This application must be submitted along with a check for the required $1,000 recertification fee. Programs that raise concern after Fellowship Committee review will require a recertification site visit. Approval for recertification will include the specific number of fellowship slots for that program.
- Initial program certification and recertification will be granted for a period of five years. Programs may be approved for two years at time of the initial application or recertification with subsequent review to fulfill metrics and identified program concerns specified by the fellowship committee.
- During the course of annual reviews, issues may be identified that will trigger early review of the program outside the routine five-year cycle and, if necessary, a site visit may be needed. Examples of these issues include, but are not limited to significant loss of faculty, concerns over operative logs, and research experience, and fellow evaluations. After review by the fellowship committee, significant issues that cannot be adequately resolved by the program will result in either loss of certification, loss of the number of fellowship slots, or a probationary period for which the program can address the specified issues.
- Programs that lose their certification for any reason are required to wait two years before reapplication under the above guidelines for initial application.
Selecting Fellows — SUO Fellowship Match Program
- All SUO certified fellowship programs are required to participate in the SUO match administered by the American Urological Association (AUA). Each fellowship program will be approved for selection of a predetermined number of fellows per year in each match. A program’s educational resources and clinical volume must be sufficient to support the number of fellows appointed to the program.
- The Program Director must not appoint more fellows than approved by the SUO Fellowship Committee.
- Programs may choose to sit out of the match for a particular year. However, if they choose to sit out of the match and accept a fellow outside of the match, that fellow will not be eligible for SUO certification. If fellowship programs do not participate in the match for two consecutive years, they will lose their SUO accreditation.
- Programs that participate in the match and do not match the full number of slots for which they are registered may accept a fellow with the approval of the SUO Fellowship Committee. That fellow will be eligible for SUO certification. It is the Program Director’s responsibility to gain approval of the SUO Fellowship Committee for these fellows to be eligible for certification.
- Programs that participate in the match and take a fellow outside of the match without prior approval of the SUO Fellowship Committee will lose SUO accreditation.
- Newly approved SUO training programs are not expected to participate in the match for one calendar year from the date of approval but may participate within this time frame at their own discretion. Failure to participate in the match beyond this grace period will be considered an unmatched position.
- Programs that do not fill all their allocated fellowship slots for two consecutive match cycles will be reviewed, and this review may result in reduction in the number of fellowship slots.
- Programs who fail to match a fellow for two consecutive years will be subject to early review by the fellowship committee as previously described.
Changing complement of fellows
Requests for the change in the complement of fellows must be submitted January 1 and July 1 for approval at the AUA Annual Meeting and Winter SUO Meeting, respectively. Decisions for change in complement will be considered by the Fellowship Committee and will be based upon documentation of the structured clinical, didactic, and research programs, including the 2:1 faculty: fellow ratio and appropriate case logs. Recommendations will be made by the Fellowship Committee and approved by the Executive Board. Changes in fellow complement are permanent until additional change request.
H. Appeal and Grievance Procedure
Established programs undergoing re-accreditation (or other SUO fellowship committee deliberations) or institutions applying to become a program may appeal decisions made by the SUO fellowship committee. In the event such an appeal is desired, the program is responsible for submitting a written appeal explaining which aspect(s) of a given decision are being appealed and the rationale for that appeal within 60 days from receipt of the decision in question. The appeal will first be considered by the SUO Fellowship Committee and a written response returned to the program within 30 days from receipt of the appeal request. The program may then:
- Accept the ruling of the Fellowship Committee on all points.
- Accept certain points but ask for further appeal on others.
- Ask for a further appeal on all counts.
Should the program opt for either points 2 or 3, then a written response shall be submitted by the program outlining which points are being further appealed and the rationale for so doing within 14 days from receipt of that decision. That appeal will be forwarded to the Executive Committee of the SUO for deliberation. The SUO Executive Committee shall make its deliberations and come to a final decision on all relevant points that shall be binding for all parties within 30 days.
In the event that an SUO fellow/trainee has a grievance with an SUO accredited fellowship program or vice versa, then either party may submit that grievance for review to the SUO Fellowship Committee. Upon receipt, the Committee shall request from both parties a written account of the circumstances surrounding the issue in question. The Committee may also request other supporting documents from either party to further clarify the issue at the committee’s discretion. The Committee shall make its deliberations and come to a decision which will be forwarded to the SUO Executive Committee for review and approval. After approval by the SUO Executive Committee, that decision will be forwarded on to both the program and fellow. Either party may then accept that decision or request an appeal as indicated in section on the appeals process.