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Top 10

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martymcfly
User offline. Last seen 4 years 46 weeks ago. Offline
Joined: 2010-01-30

I was curious what everyone else thought as to what are the top 10 progams for training in Urology.

Here is my impression of the "Top 10" (in no particular order)


Cleveland Clinic
Columbia
Cornell
Hopkins
Mayo Clinic
Vanderbilt
UCSF
U Michigan
U Penn
UT Southwestern




GUru
User offline. Last seen 4 years 46 weeks ago. Offline
Joined: 2009-09-10
Looks good. Add Emory

Looks good. Add Emory though. Top 11.

Anonymous User
No such thing.

beauty is in the eye of the beholder. No such thing exists unless you spend significant time at all programs.

Anonymous User
agree

Top 10 for what? need some guidelines

Anonymous User
all strong programs, but

all strong programs, but there are at least 4-5 more in the same caliber, with many more half a notch down. I was pleasantly surprised that there are so many great urology programs. I matched at one of the programs listed, but I would be quite happy at any of those and several others if not for personal considerations (significant other, geography, etc).

Anonymous User
Just an opinion

I feel for many medical students when they try to get an idea of what some of the top programs are when it comes to residency. I know because when I was in those shoes I got many different answers from everyone I asked. Frankly before you get a chance to do away rotations or go on interviews it's really hard to evaluate any program except your home program. A lot of what people say when they talk about top 10 programs comes from opinions. Also those US and World Report rankings get in peoples heads. In fact this website will give a variety of opinions about who's at the top.

I can tell you now that I have gone through allot and heard even more that having an idea of what the top programs are is helpful when looking at yourself as a applicant. As far your list I think they are all great programs. In fact outside of some top programs all urology programs are "mid tier" aside from the very bottom (which are usually easy to find since they have trouble matching). Programs like Cleveland Clinic, Mayo Clinic,Vanderbilt, UCSF, U Michigan are top places and will be for a while. Of course there's allot of top places that change over the years due to famous faculty leaving or retiring. The places mentioned previously are able to absorb the loss better due to the fact they have 15-30 faculty on staff and there is usually someone all ready to take their place. For instance when Blute leaves Mayo not much is going to change.

I think there are plenty of examples of programs that sit right outside the top four or five. A lot of these places have maybe dipped in their national reputation because of a loss of some famous faculty recently. Places like UCLA, Wash U, Emory, MGH, Northwestern, U Pitt and University of Washington come to mind. These places will likely rise in there reputation as their younger faculty rise in their reputation and will become part of the top programs. They are all strongly funded programs with great traditions which will always keep them near the top. Of course like any thing in life this is a business and when people are at top places and get enticed by money or opportunity (chairmen) the whole cycle will start all over again.

Places like Cornell and Baylor I fell have dipped recently due to the loss of some big time faculty but like the program mentioned above they will likely be back on top soon. U Penn I think is a program way to dependent on their chair. While he is a big name in the field and one that brings that program a lot of recognition there is going to be a point where he will be gone they program will lose a step.

In the end when your looking at where you want to go, picking from a list of the "top" programs is usually never a bad choice. They are usually built on a strong fundamental of always bringing new talent and being prepared to lose their best people, especially if they are well funded. Of course what really matters is the "fit" of a program with you. This is something you can only get an idea of when you rotate places and hopefully get some idea of when you interview places. Like I said before almost all of the programs are going to prepare you to be a good urologist. If you are worried about fellowship then yeah going to a strong program will help but the fact is residency is what you make it. If you go to a program outside the top ones but publish like hell, meet the right people at the national conferences then you can know that you will be highly sought after no matter where your from. I also think there is some bias when it comes to geography, west coast vs. east coast vs. south vs. midwest. Each region has it's strong programs and own opinions.

My list for the hell of it:

Perennial Top programs (i.e. won;t change for the next 5-10 years):
JHU
Mayo
Cleavland Clinic
UCSF
Vandy
UCSF
U Mich (recently became a top program about seven years ago but I think here to stay)

Top Programs on the Rise (next 5-10 years):
UCLA
Wash U
Northwestern
Emory
Cornell
U Pitt
Wash U
UT Southwestern

Top Programs that may fall some (next 5-10 years):
U Penn
Columbia
Baylor
Duke
Harvard-BWH
OR any program that loses it's top name

Top Programs that are currently under the radar:
USC
Univ. of Chicago
UC Irvine
NYU
Lahey Clinic
Jefferson

Anonymous User
The Bottom 12

Einstein/Montefiore
Geisinger
Lenox Hill
Maimonides
Saint Louis Univ
Southern Illinois University
UConn
Univ. of Louisville
Univ. of New Mexico
Univ of Toledo
Wake Forest
Yale

Anonymous User
SIU

I interviewed at SIU - I wasn't expecting a whole lot, but was genuinely surprised. It is a great program with really down to earth faculty and residents. I ended up ranking them in my top 5. The only thing that hindered me from ranking them higher was the fact that it is in Springfield, and it is kind of in the middle of nowhere and not a bunch to do there. I certainly would not consider them "bottom 12" by any means. They are definitely in the top half of programs in this country.

Anonymous User
Nah

I don't agree with this at all...

Top Programs that may fall some (next 5-10 years):
U Penn
Columbia
Baylor
Duke
Harvard-BWH

I think that the only program that belongs in that list is Columbia. All others will remain strong programs with excellent training.

Anonymous User
Another program that I think

Another program that I think is really up and coming is Ohio State in Columbus. They have a strong chairman and they've recruited several young faculty who are excited about being there and growing the program. They have something like 13 or 14 faculty for 3 residents/yr and they're building a big new cancer center there in which urology will be a prominent player. I was definitely surprised by them at the interview and they ended up much higher on my list than I originally thought they would be. Would have been happy to match there.

Anonymous User
Wow, I only interviewed at a

Wow, I only interviewed at a few of those (and didn't match at any), but from what I saw, I'd certainly strongly disagree with your list. Especially SIU (nowhere will you get better dedicated resident education- and the people are great), Univ of New Mexico (incredible operative experience, attendings who really invest in the residents), and Wake Forst (great training if you can get past starting with a year of research).
I'm not sure if your rank list is helpful to anyone anyway...

Balls in the air
User offline. Last seen 3 years 8 weeks ago. Offline
Joined: 2009-09-10
Completely agree about SIU

Completely agree about SIU (good program, good education, amazing hours, lot of focus on resident education, sadly in the middle of nowhere), and this is a perfect example of why everyone says "you get good training everywhere". Luckily this means that most people won't turn up their noses at you regardless of where you wind up.

It's a lot easier to pick out the top tier, but as someone pointed out previously, you can't even really do that unless you know what type of program you're looking for (research heavy, private practice bent, very strong in a particular area, well-rounded, good hours w/ good training, killer hours with good/great training).

And this is why it sucks to try to figure out where you have a fair chance, where you can use as a fall back, and where is a long shot. One person's "fallback" is another's dream program.

Anonymous User
Yale!?!? come on get outta

Yale!?!? come on get outta here. Great residents and great reputation. New cancer facility and greatly expanding program. I think personal biases must definitely be accounted for.

Anonymous User
I think the OP is right

I think Yale has a "national reputation" as a weak program plus the whole Q2 and the distance between hospitals is a big drawback. I am sure it ain't aweful but I think I wouldm't be the only one to hear some less than stellar remarks from people who have rotated there or interviewed there.

Anonymous User
Stop hating

I didnt end up at any of these programs, but is this really necessary?

I thought Toledo was a solid program with great operative experience/ chill residents/ very respectable and approachable faculty. The only negative was that it was in Toledo.

Cant speak for the rest, but it sounds like some of these are good programs that just happen to be in undesirable places to live.

UmuserMatch
User offline. Last seen 4 years 46 weeks ago. Offline
Joined: 2010-01-25
cheel out

I'm proud of where I'm going..and its not on any of these lists. Ya'll need to relax and quit the rankings/comparisons and all that bs. Be happy you matched and just ease up until July. We are urologists people we supposed to be chill. Take the dick measuring elsewhere.

Call me if you need your culo poked son...

Peace

Anonymous User
Don't get it

Not sure why people are all up in arms about these things. If you are happy at a place that's all that matters. But I don't get why people find it "not okay" to rank programs. Hell look at the world we live in, we rank everything from College football teams, to "best states to live in" all the way to "best song's of the 90's". I think it's part of our culture. I also think that when people rank programs it is rarely about the "people" there like residents and most of the faculty. It's mostly about the things that don't change easily like location, resources, facilities and tradition. These are things people look at when making a choice about a program and they are things that should be a big part of the whole matching process. One man's ideal place may be another's worse nightmare, so is life. But I think it would be ignorant to deny that some places are better than others and they may be better for different reasons. I have a hard time thinking any program that is considered "low tier" is so because of the residents. It's likely because of things like tradition, money the department has to spend on residents/education, facilities and of course location. Many of the same people who hate ranking things go out and secretly read the stupid "US News and World Report" magazine when their "best hospitals" rankings come out (one of there highest selling issues next to the "best colleges" issue)

Anonymous User
broseph

Its ok if u sleep with the us news under ur pillow.

I luv u anyway

Balls in the air
User offline. Last seen 3 years 8 weeks ago. Offline
Joined: 2009-09-10
The wrong end

I think it's pretty natural to try to make comparisons, and everyone wants to know who the "best" is. By the time you match you don't really give a shit anymore. But everyone is curious before they've gone through the process, so I really think it's a fair question for people to ask.

However, talking about the WORST programs is a bit counterproductive.

Anonymous User
I think you may need to get

I think you may need to get your facts straight. Coming from a direct source, your intern year is q4-q5, and GU call will now be q4. Also, the Waterbury hospital is about 35-40 mins away, but it is a private hospital and many residents say that they seldom get called in at night. Just like any program, there are ups and downs. I think talking down on programs is the OP's way of reassuring his/herself of some ill-founded superiority. We are all going to be urologist at the end of our training. This is the problem with medicine (particularly academic medicine)... we easily lose sight of the most important function of a doctor for want of prestige and a God-complex. What we accomplish or achieve is going to be based on the personal efforts we put forth, not by hiding behind the name of an institution. Last time I checked, getting a GU fellowship (if you wanted one) was not that difficult, no matter what program you came from.

Anonymous User
Regarding the OP's list, what

Regarding the OP's list, what are folks' impressions about the NY programs? I had the opportunity to interview at most these top programs, but did not particularly feel strongly about Cornell and Columbia about being "top tier".

Anonymous User
Applause

:)

Anonymous User
Thumbs down to Columbia.

Thumbs down to Columbia. Rude faculty. Residents didn't seem very happy. Heard some horror stories from other residents and from Columbia students. Great research opportunities, though.

Cornell just didn't phase me. I left there underwhelmed.

Anonymous User
Ranking good, bad, and ugly

I don't think you can accurately rank any program out there. You and the program do the dance of courtship and hopefully by interviews, research interests, personalities, and motivation you get the mix YOU need to succeed. Don't worry about the program GIVING YOU opportunity...you really have to make it happen on your own regardless of the program ranking. The only real training comes from taking care of patients in the OR and outside of it...not any name people associate with the hospital. The sicker and more difficult the patients are, the more you will learn, grow, and mature as a surgeon and patient advocate. Nothing is more important in the OR than the human that lies before you!

Anonymous User
...

Cleveland clinic has taken a hit recently, it remains to be seen whether will remain a "top ten" place to train...

Anonymous User
Agreed. I got the feel that

Agreed. I got the feel that at Columbia, they were more interested in furthering their name than training good residents. They went from a 5 to 6 year program just to make it more academic, though this didn't change (for better or worse) the success of residents getting fellowships. So if not for the residents, what does that extra year do? Well, it allows more publications to be pumped out which translates into molding Columbia's image as a "strong" academic program. It seems they're idea of success mirrors other institutions in NY (like and particularly Cornell)and they see their progress in terms of how they can be like other programs there.

Cornell: you don't operate at MSK until you're a chief and your rotation there early in your residency is basically playing medical student (resident there said exactly that). You're patient population is also lacking in diversity-rich Manhattanites. Yea, MSK has the international referral base, but you won't get to touch em' until you're a chief.

Once again, rankings and reputations are forged. The names of amazing faculty members don't alter the more fixed features of a program. It seems, however, that rankings and reps are largely a product of who's at a program. If this weren't true, people wouldn't be debating a program rising to or falling from stardom based on who is leaving or not or chairmanship stability.

Anonymous User
nah

I like wearing scrubs whenever

Anonymous User
Disagree

Wake is a solid program - more of a 1 trick pony with just Atala, but the same could be said for Henry Ford, Irvine, etc... where there is a big name who is the namesake of dept. By no means is this slant to these programs, just an observation.

Anonymous User
Sure

Sure its a fair question to ask...when your stroking yourself whilst looking at the "top ten" list generated by one of your peers...

Anonymous User
Add Indiana

Shouldn't Indiana University be on your top 10 list too?

Anonymous User
go wear your scrubs elsewhere

I agree with the first post regarding Ohio State as a strong program. The growth of the department with nothing but fellowship-trained attendings is impressive. When you factor in the lack of any fellows to compete with for cases, it seems like the operative experience is really second to none.

To the above poster... go ahead and wear your scrubs to work and then go hold camera for some minimally-invasive fellow. Those of us interested in operating will happily show up in shirt and tie.

Anonymous User
hand down man down

I ain't the above poster....

but dam you sound like a clown.

Anonymous User
Relax

Of course Ohio State is a great program that produce excellent surgeons. However they do not have a monopoly on the "operative experience is really second to none" phrase. It is obvious to many other normal people that many urology programs have managed to bring in fellowship-trained faculty in all subspecialities, provide great operative autonomy in the OR, produce excellent surgeons capable of managing the majority of GU pathology; those same programs also allow residents to where scrubs. Relax and stop catching feelings.

Anonymous User
Indiana?

Indiana is a top 15 program in adult and 3rd in Peds uro. However, I ranked it #10 on my rank list. All the smaller southern programs beat them in my ranking. Reason: I want to operate a lot at a laid back program. This program is in no way laid back. They do like to say they don't let fellows take your cases which makes you feel giddy inside. I'll believe it when I hear from one of my friends about to start.

Anonymous User
I'm beginning to think this

I'm beginning to think this thread was worthless. Anyone reading this and applying in the future, remember the bullshit you read here and take away the vital lesson inherent in the very essence of these postings- SUBJECTIVITY. The only RANKINGS that truly matter are the rankings YOU will assign to the programs YOU visit and YOU want to be at. There is only one error you can make during this process. Ranking your programs based solely on US NEWS rankings. If you want someone to stroke your ego and make you feel amazing, I'm sure there is a local strip club you can go to (and I'm sure there are several other ways to accomplish the same thing).

Anonymous User
I thought the residents were

I thought the residents were socially awkward (minus one or two) and not a very cohesive group during my interview/visit. That dropped it to the bottom for me.

Anonymous User
really? I left with

really? I left with completely the opposite impression. I had a lot of fun that day hanging out with the residents. That aspect actually made it go up in my list. I do agree that they work too hard, although that may change when they fill out the program with 4 residents/yr.

Anonymous User
Indeed ...

Indeed, from someone who knows, the fellows do not choose their own cases at Indiana. The chief of University Hospital decides the schedule and what cases the Onc fellow does. The lap fellow is a different story - he/she operates with Dr. Sundaram. Regardless, it doesn't matter. The volume is simply, huge. The training at Indiana means that you will be one of the best trained technical surgeons in the country - if we are basing our "Top Ten" list via this criteria, then Indiana easily makes the top ten, maybe top five?

Anonymous User
EJ?

EJ?

Anonymous User

Mine:
Hopkins
Cleveland clinic
Ucsf
Lahey
Vandy

Anonymous User
Indiana

2-0 Chromic wrote:
Indiana is a top 15 program in adult and 3rd in Peds uro. However, I ranked it #10 on my rank list. All the smaller southern programs beat them in my ranking. Reason: I want to operate a lot at a laid back program. This program is in no way laid back. They do like to say they don't let fellows take your cases which makes you feel giddy inside. I'll believe it when I hear from one of my friends about to start.

Anonymous User
Indiana

2-0 Chromic wrote:
Indiana is a top 15 program in adult and 3rd in Peds uro. However, I ranked it #10 on my rank list. All the smaller southern programs beat them in my ranking. Reason: I want to operate a lot at a laid back program. This program is in no way laid back. They do like to say they don't let fellows take your cases which makes you feel giddy inside. I'll believe it when I hear from one of my friends about to start.

As a current IU chief, I can tell you that this absolutely true at University hospital.  The peds fellow picks his/her cases, but as a chief on the adult service, you have complete control of the case assignments every single day.  This allows ample opportunity to tailor your experience, work on deficiencies, work with the chairman, etc.

Good luck to all of you as match approaches.  The wait is almost over.

Anonymous User
new top 10

JHU

CCF

UCSF

UCLA

MAYO

VANDY

MICH

NU

NYU

USC

Anonymous User
houston

thoughts? comments? feelings? about this program

Anonymous User
disagree

Anonymous User wrote:

JHU

CCF

UCSF

UCLA

MAYO

VANDY

MICH

NU

NYU

USC

 

agree but would remove Northwestern, NYU, USC. Lots to choose from for the last spots: UTSW, Penn, Indiana, Cornell etc

Anonymous User
USC

though i have obviously not experienced every training program in the country, i would certainly argue that no program can offer what USC can- the best MIS surgeon alongside the best open surgeons who still operate a shit ton. may not have the best research in the country, but that's quickly changing with gill. 

Anonymous User
Everyone needs to chillax

Hey guys, I think it's fun and all to give these places "rankings" but face the reality, 90% of us here will be happy to get into 90% of any of these schools. Think about it this way, the worst Urology program will still get you a job, will still give you ACGME accreditation, will adhere to the same AUA guidelines, and will have ample research opportunity. I think it is kind of rediculous to rank these schools. Here's the truth of the matter, 99% of the patients you get won't give a rat's member about where you trained at. All they see is a white coat and a title that begins with Dr.

Would anybody here take the number 1 ranked gen surg program over the bottom 1 Urology program?

FYI, Medical College of Georgia = sleeper program. Great school with zero reputation outside the South located 2 miles from Augusta National.

Anonymous User
Indiana

Anonymous User wrote:

2-0 Chromic wrote:
Indiana is a top 15 program in adult and 3rd in Peds uro. However, I ranked it #10 on my rank list. All the smaller southern programs beat them in my ranking. Reason: I want to operate a lot at a laid back program. This program is in no way laid back. They do like to say they don't let fellows take your cases which makes you feel giddy inside. I'll believe it when I hear from one of my friends about to start.

I'm a current cheif at IU. I can tell you that the program has made a lot of improvements in the past 5 years. Adding a 4th resident helped a lot. 

 You will not have a better operative experience anywhere else in the world.

We now have a 2 services at the Univeristy, each with a chief. The Chiefs pick the cases, the fellows do about 4-5 cases a week. This is not a problem with finding cases as we have 45 cases next week, (and there are 0 small cases, this is all tertiary referral cancer, all the time) You can't really operate more then all day every day. The great thing is with two services you can split up who stays late operating and it makes you life much better then the old days. Also, we now have a PA/NP on each team and each have a junior resident.

 This month I have done 9 cystectomies, 12 prostates, 2 complex ureteral replacements, 2 large pelvic mass resections and 2 complex urethroplasties (I'm not on the RPLND service) with a number of other cases.

You will do 100+ PCNL accesses and 40+ HoLEP's in your 6 months at Methodist with Dr Lingeman

 You will do ~40 reimplants/pyeloplasties and ~20-40 hypo's along with 1-2 major reconstructions (Mace/Monti/Augment) while at Riley

We now have a rotation where you will spend several days a week with Dr Thompson doing Male infertility and will get to be involved in 10-20 VV's/VE's and a bunch of Microscopic Varicoceles.

You will have total control and autonomy of your service at both the VA and the county hospital. (I did around 30 vasectomies in the morning before the OR in clinic, and now feel great about doing them)  Our VA hospital also now has a robot with duel consoles and you will be able to do your own robotic cases as a chief.

There has been a systemic push to get everyone involved in research and you are assigned faculty mentor's as an intern. We have very large databases for RPLND/Cystectomy/Urethroplasties/Prostates to do research with. 

 We are very strict about duty hours for the Juniors and while you will be here a lot, no one violates works hours and we are rigorous about post-call work rules.

 The faculty is supportive and we have just added several new fellowship trained staff along with incorporating many of the areas hospital under IU health (which we are now rotating at as juniors)

If you want to be a urologist that operates I would for sure consider IU in my top 5 and would certainly come here if I had the chance again.

ralprobot
User offline. Last seen 33 weeks 1 day ago. Offline
Joined: 2013-06-11
resurrecting?

Why are you resurrecting a 3 year old thread?

 

 

Anonymous User wrote:

Hey guys, I think it's fun and all to give these places "rankings" but face the reality, 90% of us here will be happy to get into 90% of any of these schools. Think about it this way, the worst Urology program will still get you a job, will still give you ACGME accreditation, will adhere to the same AUA guidelines, and will have ample research opportunity. I think it is kind of rediculous to rank these schools. Here's the truth of the matter, 99% of the patients you get won't give a rat's member about where you trained at. All they see is a white coat and a title that begins with Dr.

Would anybody here take the number 1 ranked gen surg program over the bottom 1 Urology program?

FYI, Medical College of Georgia = sleeper program. Great school with zero reputation outside the South located 2 miles from Augusta National.

Anonymous User
Early Operative Experience vs Top Heavy?

Looking at these top 10 lists, I had a question. How important is early (PGY1/2/3) operative exposure to big open/robotic cases in terms of overall training? Can a "top heavy" program make up for 3 years of mainly endo cases, bed-side assists, and double-scrubbing on big cases?

I ask this because some programs on the above lists definitely seem to be top heavy while others emphasize early surgical involvement. From my limited perspective I would assume the earlier the involvement, the better training you get because you get more years of supervision and teaching in the OR.

Anonymous User
RE: Early Operative Experience

Anonymous User wrote:

Looking at these top 10 lists, I had a question. How important is early (PGY1/2/3) operative exposure to big open/robotic cases in terms of overall training? Can a "top heavy" program make up for 3 years of mainly endo cases, bed-side assists, and double-scrubbing on big cases?

I ask this because some programs on the above lists definitely seem to be top heavy while others emphasize early surgical involvement. From my limited perspective I would assume the earlier the involvement, the better training you get because you get more years of supervision and teaching in the OR.

To be honest, any operative experience is good experience because it gives you a foundation to build on.

Once you have basic surgical skills (tying reliable knots, ligating small vessels, basic anastomosis knowledge, principles of good closure - essentailly all of which can be obtained outside of the OR or as a second assist) and understand the anatomy (which can be learned from a textbook and observing cases), the biggest hurdle most residents face is seeing tissue planes. For some, it's intuitive. For others, it takes time seeing someone else dissect planes and then fail miserably on your own for you to finally "see" what they see. The other big issue is exposure and retraction which simply takes a few years of practice to really understand... it still amazes me (and pisses me off) how much I'll struggle with something and then have the attending come in and make a few adjustments that result in perfect exposure and a relatively easy case.

I am lucky enough to train in a program where the Uro I frequently does "chief-level" cases with just an attending. While I think it accelerated my development a bit, I think that ground is quickly made up and in the end it doesn't matter all that much WHAT type of cases you are doing as a Uro I but more HOW MANY cases you are doing as a Uro I, regardless of role. As you move into the Uro III/Uro IV year, it becomes pretty important that you are the "surgeon", though, and that you aren't simply assisting a fellow or attending with big cases (which suprisingly does happen at some programs...).

Don't underestimate how much work outside of the OR will benefit you, though. Be able to tie good, square knots with both hands and both with one- or two-handed throws - I think a lot of medical students and early residents are too focused on tying knots FAST, which is the wrong approach. I can't tell you how many general surgery residents I see during combined cases that cannot consistently throw square knots... Know how to use slipknots with monofiliment suture to help you get good, tight knots deep in a hole where it is difficult to keep tension. Know what instruments are called and when it is appropriate to use them. When you have free time (sometimes limited, I know) ask one of your OR nurses or techs to let you practice setting up retractors or using different instruments. Know not only which suture your attending likes to use for a certain application but also what other valid alternatives are. Work on laparoscopic and robotic simulators if they are available to you. 

This is all stuff that will improve your efficiency during an ACTUAL case, show your attending that you are competent, and result in you getting to do a larger percentage of the case and therefore give you an advantage in training.

A Step I score of 260 is great and acheiving >95th percentile on the inservice is amazing, but it doesn't matter when your anastamosis consistently falls apart, your patients get hernias (or worse yet, dehisce), or you can't ask the scrub for what you need during a case.

Also, don't discount your "bread-and-butter" cases like TURPs, ureteroscopy, hydrocelectomies, etc. as these will be your money makers in private practice (if you go that route) and you want to get enough experience with the difficult "easy" cases as much as you can during residency so nothing will shock you in practice and you can maximize efficiency.