Department of Urology333 City Blvd. West, Suite 2100Orange, CA 92868714.456.5371

Copyright © 2008 The Regents of the University of California. All rights reserved.

SURGICAL EDUCATION CENTER

Minimally Invasive UrologicSurgery Training Program

We welcome your participation.

MINI-FELLOWSHIPUniversity of California, Irvine School of Medicine, Department of Urology

The UC Irvine Surgical Education Center's mini-fellowship program in urology is the first and onlytraining program of its kind in the United States.There are only two attendees per week who workclosely with a dedicated instructor and other UCIrvine faculty in didactic and hands-on laboratorysessions along with observation of surgical proceduresin the selected module. The mini-fellowship programprovides a unique, one-week, focused training modulefor postgraduate urologists in the areas of ureteroscopyplus percutaneous urolithiasis surgery, percutaneous andlaparoscopic image-guided needle ablative cryotherapyof renal tumors, laparoscopic and robotic renal surgery,KTP laser treatment of the prostate, and robot-assistedlaparoscopic prostatectomy on an ongoing, weekly basis.

Elspeth M. McDougall, MD, FRCSC, MHPEProfessor of UrologyAssociate Dean, Clinical Science EducationDirector, UC Irvine Surgical Education Center

This postgraduate mini-fellowshipcourse in minimally invasive urologicsurgery is a unique week-long educa-tional experience designed for urolo-gists. It is entirely devoted to the trans-fer of advanced endourological skillsfor performing all types of minimallyinvasive procedures in urology.Participation in the laparoscopy trainingmodules requires documentation ofcompletion of a basic laparoscopycourse.

The training program comprises distinctminimally invasive surgery teachingmodules including, Ureteroscopy /Percutaneous urolithiasis surgery,Needle ablative cryotherapy of renaltumors via laparoscopic or percutaneousaccess, Laparoscopic and robotic renalsurgery, KTP laser therapy for theenlarged prostate, and Robot-Assistedlaparoscopic prostatectomy. Each mod-ule is five days long, and each partici-pant is assigned to a specific preceptor.

The module includes didactic sessionswith the preceptor, pelvic trainerand simulator training, live animaland/or cadaveric hands-on laboratorysessions, observing several module spe-cific surgery cases at UC IrvineMedical Center operating room, andassisting or performing minimally inva-sive procedures with the preceptor inthe attendee's operating room. Duringthe training program, each attendee pro-ceeds through a series of skills testsand completes a questionnairepertaining to their individual surgicalactivities. Each attendee is requested tocomplete a multiple choice examination

at the completion of the program aswell as a repeat of the skills testing.

In addition, an attendee with aCalifornia license, may elect to bring apatient to UC Irvine Medical Center fora procedure within the module that theattendee is taking. In this case, the sur-gical procedure the attendee performswhile at UC Irvine would be done witha UC Irvine faculty member and wouldbe evaluated with a validated surgicalscoring system to provide the attendeewith a documented evaluation of thesurgical procedure, he or she performed.In addition, the director of the specificeducational program will provide eachattendee with a written summary thatverifies attendance and achievementof the course objectives.

If you hold a valid California StateMedical Board license, complete andsubmit the application for temporaryUC Irvine Medical Center hospitalprivileges for the specific dates of yourattendance at the UC Irvine SurgicalEducation Center.

If you are planning to perform a proce-dure in a UC Irvine Medical Centeroperating room on one of your patientswith your proctoring preceptor, it isnecessary to submit a written summaryof the patient, all diagnostic radiograph-ic films and a working diagnosis andplanned surgical procedure to the UCIrvine preceptor 4 weeks before yourplanned attendance in the mini-fellow-ship. You and your proctor can thendiscuss the case and the planned proce-dure. All surgical procedures must beconfirmed and approved by the precep-tor before the Clinical Coordinator canproceed with surgical scheduling.

Your office will be requested to assistthe UC Irvine Department of UrologyClinical Coordinator with the authoriza-tion process for the surgical procedure.

If you do not hold a valid CaliforniaState Medical Board license, you havetwo options.

1) You may attend the mini-fellowship,and be involved only as an observer ofthe surgical procedures performed in theUC Irvine Medical Center operatingroom. You may be able to have theassigned preceptor or one of theendourology/laparoscopy fellows attendyour operating room and proctor one ortwo surgical cases related to your cho-sen mini-fellowship with you. The mal-practice coverage at your medical centerfor the preceptor/proctor to participatein the surgical procedures with youwould be the responsibility of you oryour hospital.

2) You may obtain a California StateMedical Board license, following whichthe temporary privilege application canbe submitted to the UC Irvine MedicalCenter credentialing office. This entireprocess will take approximately six tonine months to complete. The cost foryou to obtain a California State MedicalBoard License is approximately $1,200.

COURSE

2

LEARNING OBJECTIVESUreteroscopy and Percutaneous Renal Access forUrolithiasis Mini-Fellowship1. Identify patient selection, indications and contraindications for ureteroscopy and/or

percutaneous renal access for intrarenal surgery.

2. List the instrumentation, techniques and adjuvant techniques, content validity andcost considerations for ureteroscopy and percutaneous renal access intrarenalsurgery.

3. Discuss the diagnosis, management and prevention of complications associatedwith ureterorenoscopy and percutaneous renal access as they apply to urolithiasis.

4. Discuss pre- and post-procedural care for ureterorenoscopy and percutaneous renalaccess intrarenal surgery.

5. Discuss follow-up care and metabolic analysis for stone treatment followingureteroscopy and percutaneous renal access intrarenal surgery.

Percutaneous and Laparoscopic Image-Guided NeedleAblative Cryotherapy of Renal Tumors Mini-Fellowship1. Identify the patient selection criteria and indications and contra-indications for

laparoscopic or percutaneous cryoablative urologic surgery.

2. Discuss the techniques, adjuvant techniques and instrumentation for laparoscopic or percutaneous cryoablative urologic surgery.

3. Describe the cost considerations for laparoscopic or percutaneous cryoablative urologic surgery.

4. Review the identification, management, and prevention of complications associated with laparoscopic or percutaneous cryoablative urologic surgery.

5. Discuss the pre- and post-procedural care for patients undergoing laparoscopic or percutaneous cryoablative urologic surgery.

6. Review the follow-up policies and outcome analysis for laparoscopic or percutaneous cryoablative urologic surgery.

3

Please note, for those parti-cipating in the Robot-AssistedLaparoscopic ProstatectomyMini-Fellowship, if your hospitalrequires you to have completed a daVinci® Robot Training Course for cre-dentialing at your medical center, youmust complete this course prior to the5-day mini-fellowship training pro-gram. The Robot-Assisted Laparo-scopic Prostatectomy module onlytrains in the clinical aspects and not inthe full robot management training.*

Please note that the robotic certifica-tion course is limited to two surgeonsper course. The tuition may be cov-ered by the medical center at whichyour robot is located as an integralpart of the purchase price. However, it is your responsibility to determinewhether this funding is available toyou.

For program availability, pleasecontact Cynthia Shell, UrologyEducation Co-ordinator.Office Tel: 714.456.5371

*Depending on the laboratory sched-ule, if you would like, you can obtainyour robotic certification at the UCIrvine Surgical Education Center twodays prior to your scheduled roboticprostatectomy or laparoscopic/roboticrenal surgery mini-fellowship.

4

Laparoscopic and Robot-Assisted Renal Surgery Mini-Fellowship1. Identify the patient selection criteria and indications and contra-indications for

laparoscopic renal and/or robot-assisted renal surgery for renal cancer and uretero-pelvic junction obstruction.

2. Discuss the techniques and adjuvant techniques and instrumentation for laparo-scopic and robotic renal surgery.

3. Review the identification, management and prevention of complications associatedwith laparoscopic or robot-assisted renal surgery.

4. Discuss the pre- and post-procedural care for laparoscopic and robot-assisted renalsurgery.

5. Review the follow-up policies and outcome analysis for laparoscopic and robot-assisted renal urology.

Robot-Assisted Laparoscopic Prostatectomy Mini-Fellowship1. Identify the patient selection criteria and indications and contraindications for

robot-assisted laparoscopic prostatectomy surgery.

2. Discuss the techniques and adjuvant techniques and instrumentation for robot-assisted laparoscopic prostatectomy surgery.

3. Describe the cost considerations for robot-assisted laparoscopic prostatectomysurgery.

4. Review the identification, management and prevention of complications associatedwith robot-assisted laparoscopic prostatectomy surgery.

5. Discuss the pre- and post- procedural care for robot-assisted laparoscopicprostatectomy surgery.

6. Review the follow-up policies and outcome analysis for robot-assistedlaparoscopic prostatectomy surgery.

ACCREDITATIONSTATEMENTThe University of California,Irvine School of Medicine isaccredited by the AccreditationCouncil for Continuing MedicalEducation to provide continuingmedical education for physicians.

DESIGNATIONSTATEMENTThe University of California,Irvine School of Medicine desig-nates this educational activity for amaximum of 44 category 1 creditstoward the AMA Physician'sRecognition Award.* Each physi-cian should claim only those cred-its that he/she actually spent in theactivity.

*While there are CME creditsdesignated for participation in thiscourse, this does not implycertification of skills acquisition.

5

DISCLOSURE

It is the policy of the University ofCalifornia, Irvine School ofMedicine and the University ofCalifornia CME Consortium toensure balance, independence,objectivity, and scientific rigor inall CME activities. Full disclosureof conflict resolution will be madein writing via handout materials orsyllabus.

California Assembly Bill 1195This activity is in compliance withCalifornia Assembly Bill 1195which requires continuing medicaleducation activities with patientcare components to include cur-riculum in the subjects of culturaland linguistic competency. Forspecific information regarding Bill1195 and definitions of culturaland linguistic competency, pleasevisit the CME web site atwww.cme.uci.edu.

MINI-FELLOWSHIP PROGRAM FACULTY

Elspeth M. McDougall, MD, FRCSC, MHPEProfessor of UrologyAssociate Dean, Clinical Science EducationDirector, UC Irvine Surgical Education Center

Ralph V. Clayman, MDProfessor and ChairCo-Director, UC Irvine Surgical Education Center

Thomas E. Ahlering, MD, F.A.C.S.Professor of Urology and Vice Chairman

Duane J. Vajgrt, MDClinical ProfessorDepartment of Radiology

Department of Urology FellowsClinical Endourology and Laparoscopy FellowResearch Endourology and Laparoscopy FellowMinimally Invasive Surgery Education Fellow

LocationUniversity of California, Irvine MedicalCenter, Building 55, 101 The City DriveSouth, Orange, California. Map and parking information will be included withyour registration acknowledgement.

ParkingParking is available at UC Irvine MedicalCenter, Visitor's Parking structure, cor-ner of The City Drive and Dawn Way(Medical Center parking garage on theleft side of Dawn Way as you drive in).

Attire Comfortable clothes and shoes (sneakers)are recommended, especially for the laboratory sessions. And it is recom-mended that you bring a jacket or sweater,since meeting room temperatures are dif-ficult to regulate to everyone's preference.

Course ExpensesThe costs to the participants includecourse tuition, travel and accommodationexpenses to attend the 5-day courses. Ifyou have not received an acknowledge-ment within two weeks of your registra-tion submission, please call Cynthia Shell,Department of Urology, 714.456.5371.

FlightsIt is recommended that you book flightsto John Wayne Airport in Irvine or theLong Beach Airport. These airports areabout a 30-minute drive to the two hotelsnear the UC Irvine Medical Center.

Hotel AccommodationsPlease make your hotel reservationsdirectly with the hotel. Both of thesehotels are walking distance to UC IrvineMedical Center.

Doubletree Hotel Phone: 714.634.4500 100 The City DriveOrange, California 92868Special UC Irvine Rate: Ask the Registration Desk to "key in"UCI Medical Center to retrieve the roomsat the UC Irvine Medical CenterCorporate Discount rate.

Ayres InnPhone: 714.978.9168 3737 W. Chapman AvenueOrange, California 92868

Special NeedsAmericans With Disabilities Act (ADA) The University of California, IrvineSchool of Medicine complies with theAmericans With Disabilities Act. Pleasecontact Cynthia Shell at 714.456.5371 orcshell@uci.edu by no later than twoweeks prior to your course. Every rea-sonable effort will be made to accommo-date your special needs.

Please NoteUniversity of California, Irvine is notresponsible for airline or hotel reserva-tions. Please confirm meeting registrationand hotel registration acceptance prior topurchase of non-refundable or penalty airline tickets.

Complete the applicationform and submit it to:Elspeth M. McDougall, MDAttention: Cynthia ShellDepartment of UrologyUC Irvine Medical Center333 City Blvd. West, Suite 2100Orange, CA 92868 Tel: 714.456.5371Fax: 714.456.5062

GENERALINFORMATION

6

UC IRVINE SURGICAL EDUCATION CENTER APPLICATIONFOR MINI-FELLOWSHIP TRAINING PROGRAM

Name: Last ___________________________________ First________________________________ Initial__________

Address:_________________________________________________________________________________________________________________________________________________________________________________________

Daytime Phone Number: ___________________________________________________________________________

Fax Number:______________________________ E-mail:_________________________________________________

Social Security Number (for CME Credits, last 5 digits only): _____ - _____ _____ _____ _____

State of Medical License: __________________________________________________________________________

Date (Monday) Requested to Start Mini-Fellowship:_____________________________________________________ Requested Mini-Fellowship: (check one) Tuition

1) URS/PCN Urolithiasis, upper tract TCC, UPJ and ureteral obstruction $3,5002) Percutaneous and Laparoscopic Image-Guided $3,500

Needle Ablative Cryotherapy of Renal Tumors Laparoscopic and Percutaneous Access

3) Renal Robotic and Laparoscopic Surgery $3,500Pyeloplasty, nephrectomy, nephroureterectomy, and partial nephrectomy

Are you a pediatric surgeon, and would you like a pediatric urology didactic session?

Advanced certification on the da Vinci® robot is only required if you wish to study robot-assisted laparoscopic pyeloplasty. Please contact Cynthia Shell, urology education coordinator, Tel: 714.456.5371

4) Robotic Prostatectomy $3,850This module has a prerequisite that you compete the da Vinci® robot certification course.

Does your medical center have a da Vinci® surgical robot?_______________Has your medical center agreed to pay for you to take the da Vinci® robot certification course? ___________Will you need to get robot certification?______________________________________ (see #5 if certification required)Date you completed the da Vinci® robot certification course____________________ (Attach copy - certificate)

5) If you require certification on the da Vinci® robot, please contact Cynthia Shell, urology education coordinator, Tel: 714.456.5371.

Please enclose these required documents with your application form:1) Copy of state medical license with expiration date2) Copy of DEA certificate3) TB test or chest X-ray test results (current within 12 months of your coming to UC Irvine Medical Center)4) Document confirming that you have medical insurance5) Copy of certificate indicating completion of a basic laparoscopy course6) Verification of medical malpractice insurance7) If applicable, copy of certificate indicating completion of the da Vinci® robot course

Registration Fee (Two Convenient Ways to Pay Tuition) Total Enclosed: $_____________________________

1) MAIL this completed form with your check payable to UC Irvine:Cynthia Shell / UC Irvine Medical Center / Department of Urology333 City Blvd. West, Suite 2100Orange, CA 92868 Tel: 714.456.5371 Fax: 714.456.5062

2) FAX this completed form with your credit card information to 714.456.5062MasterCard Visa Discover American Express

Name on Card _____________________________________________________________________________

Telephone:__________________________________________Zip Code:_______________________________Billing Address for Credit Card:_________________________________________________________________

Fax To: Cynthia Shell 714.456.5062