For applicants

Console and autonomy progression

Autonomy follows observed preparation, judgment, technical execution, communication, and follow-through. It is not awarded by calendar month. The fellow is expected to work as a junior faculty member, and the path there stays supervised and case specific.

In practice that means progression is tracked by operative step, not by date. The operations the service does often are broken into their component steps, and the fellow takes the next step when the step before it is consistent. In robotic peritoneal flap vaginoplasty, for example, the peritoneal flap itself, the egg, is one of those steps. The fellow takes it once the dissection that precedes it is reliable, and that happens when it happens. A fellow who is ready for it in October does it in October.

The year is therefore not uniform, and it is not meant to be. Early cases are defined steps with active coaching. Later cases are led with the attending immediately available. The rate is set by the fellow’s own performance, and because the fellow operates with the fellowship director on most operating days, that performance is observed directly rather than inferred from a form at the end of a quarter.

The ladder is kept separately for open, multi-port robotic, and single-port robotic work, because skill in one approach does not transfer automatically to another. The same operation can sit at different points on different platforms, and it usually does.