Fellowship Program

The Stone Centre Endourological Fellowship Program:

Overview:

The goal of this unique fellowship is to provide top-tiered training in both clinical and research aspects in the area of kidney stone disease. Under the leadership of Ben Chew, MD, Ryan Paterson, MD, and Dirk Lange, PhD, the candidate will be well-positioned to receive expert training both clinically and academically, resulting in the production of an academically oriented endourologist who will make significant future clinical and research contributions to endourology. By involving the fellow in our current research program pertaining to ureteral stent development, biomaterials, stone fragmentation, and the pathophysiology of kidney stone development/prevention, the fellow will receive training on how to develop and answer important research questions using a translational approach, to ultimately improve the way that we treat kidney stones. In addition, the fellow will be directly involved with teaching local courses we hold for visiting urologists as well as resident trainees and to have them teach and contribute to future industry-led educational activities as well as expert panel discussions. With this in mind, we will be preparing this fellow for a future academic career by having them give talks at international meetings and will also be introducing them to our industry contacts, as these fellows will be the future thought leaders of endourology, collaborating with various research leaders such as ourselves and and industry leaders on the development of devices and new methods for the treatment of stone disease. The split is is approximately 70% research and 30% clinical. It is a two-year fellowship.

Key Faculty:

Ben Chew, MD, MSc, FRCSC: Ninety percent (90%) of his practice involves the treatment of kidney stones and 35% of his time is dedicated to research—both basic and clinical. He will be the main clinical fellowship director overseeing the clinical and clinical research aspects.  Dr. Chew has worked with Olympus on international presentations and collaborative projects.

Dirk Lange, PhD is the Director of Basic Science Research at the Stone Centre at Vancouver General Hospital. He has a research area specialized in smooth muscle function in the ureter and mediators of inflammation and peristalsis.  No one else has examined this area of signaling and by taking this tact, he will be able to identify targets to prevent ureteral stent-related problems and improve their overall function.  A microbiologist by training, he is well recognized for his work in biomaterials in medicine. Also, his project on the microbiome of kidney stone formers is a unique project evaluating the differences in colonic bacteria of kidney stone formers.  Together with Ben Chew, they form a unique translational team not found elsewhere in North America.  Dr. Lange will oversee the basic science research aspect of the fellow’s training, which we believe to be an important characteristic of a future clinical and academic leader.

Ryan F. Paterson, MD, FRCSC: is an endourologist who spends approximately 70% of his time treating and managing patients with kidney stones.  A fellowship trained endourologist from Dr. Jim Lingeman at Indiana University, Dr. Paterson provides excellent clinical care of patients with stones as well as BPH, being one of a handful of urologists in Canada who is adept at the HoLEP procedure.  The fellow will spend time with Dr. Paterson learning clinical and surgical management of stones including percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and metabolic management.

Elspeth McDougall, MD, FRCSC, MHPE: is a professor of urologic sciences who is also the immediate past Chair of the AUA Office of Education. She is no longer practicing clinically, but remains involved in the clinical research at the Stone Centre and attends the biweekly research meetings.  Her current role as the Provincial Coordinator for Health Simulation Education will offer the fellow further teaching experience with our state of the art simulator laboratory for endourology procedures, HoLEP, and laparoscopy.  Her guidance as an experienced academic endourologist will be helpful to the fellow.

 Clinical Volume:

The Stone Centre at Vancouver General Hospital is a tertiary care center and due to the centralized Canadian health care system, has a large volume of stones from all across the province of British Columbia.  Below is the clinical volume seen between Dr. Ben Chew and Dr. Ryan Paterson:

Shockwave lithotripsy: 2,000/year

Ureteroscopy: 600/year

Percutaneous nephrolithotomy: 300/year

Training Program Focus

The program will focus exclusively on kidney stones. During the fellowship, the trainee will be educated in the medical management of stones including seeing patients in the Stone Clinic and working with nephrologists and dieticians as part of a combined kidney stone specific program between the two specialties. Therefore, the fellow will receive training in both surgical and metabolic aspects of managing kidney stone disease, both of which are important for a comprehensive treatment regime.

Surgical experience will consist of learning shockwave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL).  Scheduling of this will include 2.5 days per week of clinical work:

  • 5 days/week seeing patients in clinic
  • 1 day/ week performing ureteroscopy, PCNL and SWL with Dr. Ben Chew
  • 1 day/ week performing ureteroscopy, PCNL and SWL with Dr. Ryan Paterson

The remaining 2.5 days per week will be spent on research in both the basic science laboratory as well as clinical research.

  • 5 days/week working on database clinical research with our Clinical Research Coordinator/Manager developing and learning IRB protocols
  • 1 day/week in the laboratory with Dr. Dirk Lange learning microbiology techniques, biomaterials, and DNA sequencing for metagenomic projects
  • 1 day/week of research with either Dr. Dirk Lange or Dr. Ben Chew depending on which projects the fellow will be involved in.
  • The split will be 50% research and 50% clinical activity for each of the 2 years of the fellowship.

We have many projects ongoing at the Stone Centre and our goal is not for the fellow to work on all of them, but to focus heavily on 1-2 projects which they are most interested in. In addition, they will play secondary roles in another 1-2 projects to expose them to multiple research areas in endourology resulting in their learning of a broad range of basic science and clinical research analytical techniques. Clinician researchers with expertise in basic science research techniques are rare in our field, and our unique program will graduate fellows with the basic knowledge required to begin their own translational program. Teaching the principles and mechanics of how to do research will be very important. Therefore, seeing how to start a project and then having the fellow see projects that are close to completion and manuscript preparation will be very important for their development.

Towards the end of the fellowship, we expect the trainee to have collected enough data to present at national and international meetings and to prepare and publish peer-reviewed manuscripts. We will fully support the travel of the fellow to the annual AUA and WCE meetings which we think are very important for the career progression of any trainee. We have put applied for an Endourology Society approved Endourology Fellowship. The fellow, upon graduation, will receive a designation and certificate from the Endourology Society.

Curriculum Outline

  • Clinical expertise and surgical management of kidney stones using
    • metabolic evaluation and treatment
    • ureteroscopy
    • percutaneous nephrolithotomy
    • shockwave lithotripsy
  • Research:
    • To understand how to start research projects, write protocols, grants, research ethic protocols, budgets, and work with industry and the university
    • To observe and learn how to manage research personnel and funds
    • To give presentations, write manuscripts and book chapters on original research
    • To learn how to work with Industry partners and work together towards common goals of improving patient care.
  • Teaching
    • Teaching of visiting urologists to our centre who come to observe and learn
    • Teach residents and medical students at the University of British Columbia
    • Be involved with developing teaching material for residents and urologists internationally.

Accreditation Conferred Upon Completion

The fellowship is fully accredited by the Endourology Society which is the authority in the field of Endourology. The trainee will also receive a certificate of completion for an Endourology Fellowship from the University of British Columbia with the fellowship directors’ names and signatures.

Summary:

In summary, the unique translational program in kidney stone disease at The Stone Centre at VGH will produce a highly trained endourologist and prepare him/her for an academic career. One of the most important things we offer compared to other programs is our collaborative work with industry leaders.  This individual will help with collaborative projects we undertake with industry and groom them to be a future KOL in the field of endourology.