Download department of urology

DEPARTMENT OF UROLOGY
Residency Program Goals and Objectives
By Rotation and Year of Training
INTRODUCTION
Residency is an essential dimension of the transformation of the medical student to the independent practitioner
along the continuum of medical education. It is physically, emotionally and intellectually demanding and requires
longitudinally-concentrated effort on the part of the resident.
DEFINITION OF UROLOGY
Urology is the specialty that evaluates and treats patients with disorders of the genitourinary tract, including the adrenal
gland. Specialists in this discipline must demonstrate knowledge of the basic and clinical sciences related to the normal and
diseased genitourinary system as well as attendant skills in medical and surgical therapy. Residency programs must educate
physicians in the prevention and treatment of genitourinary disease, including the diagnosis, medical and surgical
management, and reconstruction of the genitourinary tract.
MISSION OF THE DEPARTMENT OF UROLOGY
The mission of the Department of Urology is to provide excellence and innovation in urologic clinical care, education and
research.
OVERALL EDUCATIONAL GOALS – ALL YEARS
At the completion of residency, the resident will be able to:
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Become skilled in patient care and be able to generate a relevant differential diagnosis based on accurate
history and physical examination and review of relevant clinical data. (PC, MK, PBLI)
Be able to communicate effectively with other health care providers and demonstrate compassion and
benevolence in all patient interactions including the capacity to communicate effectively with patients and
their families. (ICS, P, PC)
Understand the indications and contraindications for diagnostic and therapeutic procedures and be skilled
at performing these procedures. (MK, PBLI, PC)
Be able to think critically and participate in scholarly research projects. (MK, PBLI, P)
Demonstrate commitment to professionalism and possess an appreciation of the humanistic and ethical
aspects of medicine. (P, SBP)
Be able to achieve practice-based learning (improving practice through the care of patients and their
educational activities). (PBLI, MK)
Appreciate the entire scope of health care system and call upon resources in the system to optimize
patient care and outcomes. (PC, SBP)
Perform specialty-based consultations on inpatients and outpatients (MK, PC, SBP)
Review literature and reference material to improve fund of knowledge through case based learning and practice
based improvement (P, PBLI, MK)
Understand the role of inpatient services and the importance of continuity in transitioning from inpatient to outpatient
management in caring for patients (SBP, PC, MK)
Possess a broad fund of knowledge (MK),
Prior to graduation, each resident/fellow will be able to demonstrate a thorough knowledge of the core competencies and
their application to the practice of urology
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RESPONSIBILITY FOR RESIDENT EDUCATION AND SUPERVISION
The Department of Urology Residency Program Faculty assumes full academic and administrative responsibility
for the planning and execution of the educational program, including, but not limited to, advancement or promotion
of residents, final determination of residents’ satisfactory completion of training requirements, programming,
curriculum content and faculty appointments.
EDUCATIONAL OBJECTIVES
The program director, faculty and participating hospitals will provide the supervision, facilities and resources for
residents to have didactic experience and ongoing direct patient contact in both an inpatient and outpatient setting
to gain a core knowledge base, expertise and skill in the diagnosis and management in all domains and techniques
of urology as outlined in the ACGME Urology Program Requirements. Those core domains and techniques as well
as the additional components required by the ACGME are listed below:
Core domains:
o voiding dysfunction
o female urology
o reconstruction
o oncology
o calculus disease
o pediatrics
o reproductive and sexual dysfunction
Core techniques:
o endo-urology
o minimally-invasive intra-abdominal and pelvic surgical techniques (e.g., laparoscopy/robotics)
o major flank and pelvic surgery
o perineal and genital surgery
o urologic imaging including fluoroscopy, interventional radiology, and ultrasound
o microsurgery
In addition to the core domains and techniques listed above, residents will be given instruction in the following:
Additional components:
o bioethics ***
o radiation safety
o biostatistics ***
o epidemiology
o geriatrics
o infectious disease
o renovascular disease
o renal transplantation
o trauma
o plastic surgery
o medical oncology
o patient safety ****
o quality of care ****
o sleep and fatigue *, **, ****
o disruptive behavior **
o scholarly activities
* All residents attend the yearly joint surgical services grand rounds conference which educates residents and faculty as to
the signs of fatigue and sleep deprivation.
** All residents and faculty attend the yearly conference presented by Dr. Slobodov.
*** All residents and faculty attend the yearly conference presented by Drs. Reiner and Wisniewski.
**** IPM online education modules.
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Goals and Objectives - Surgical
Do not stop logging cases when you have reached the minimum required.
DATE: February 1, 2013
RE: ACGME Memo - Definitions for Surgeon and Assistant
Resident participation in a surgical procedure will be credited as an index case whether the resident functions as
surgeon, assistant, or teaching assistant.
To be recorded as surgeon, a resident must be present for all of the critical portions of the case and must perform a
significant number of the critical steps of the procedure. As a general principle, it is expected that over the course of their
education, residents will develop the skills necessary to perform progressively greater proportions of complex cases and
will be given the opportunity to demonstrate those technical skills to program faculty. It is also important to remember that
the committee views involvement in preoperative assessment and postoperative management of patients to be important
elements of resident participation.
Only one resident can claim credit as an assistant on a given case. Though it may well be valuable educationally, activity
as “second assistant” should not be recorded.
A resident may also be given index case credit when they act as a teaching assistant. To be recorded as the teaching
assistant, the chief or senior resident acts as teaching assistant (supervisor) directing and overseeing major portions of
the procedure being performed by the more junior resident surgeon while the supervising attending physician (staff)
functions as a second assistant or observer.
For robotic procedures, the requirements for case recording as surgeon or assistant differ. In short, acting as a bedside
assistant qualifies as assistant and any significant console time qualifies as surgeon. For the situation in which two
residents complete some portion of the case at the console, only one resident may log the case as surgeon. The index
category for “laparoscopy,” will now be named “laparoscopic/robotic surgery.” Case minimums for this index category will
remain unchanged at 20, but there will be no specified case minimums for robotic surgery. For robotic cases, both
surgeon and assistant roles will be given index case credit for the “laparoscopic/robotic surgery” index category.
Starting July 1, 2012, the urology resident case logs for ultrasound procedures expanded to include not only the
commonly performed transrectal ultrasound (TRUS) but also less common procedures such as renal (including
intraoperative), pelvic, scrotal and penile ultrasound cases. While TRUS for prostate biopsy will remain an index case with
a minimum number required (25), there will be no minimum number of cases required for other ultrasound procedures at
the current time.
Guidelines on logging of robotic cases, ultrasound cases, and “unbundling” of CPT codes for the purpose of case recording
can be found in the online FAQs regarding these topics, which provides specific examples of how residents are to log
complex cases.
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Date: January 2013 ACGME Memo - Unbundling
In the Next Accreditation System, case log data will continue to provide key information regarding the adequacy of
breadth and depth of surgical training for both the program and individual trainee. To allow for fair comparisons of surgical
experience, it is important for all residents/fellows to record cases in a uniform manner. The Review Committee (RC) for
Urology would therefore like to clarify the appropriate practices for unbundling of surgical procedures for the purposes of
case recording, since the ideal method of coding for measurement of educational experience may differ from methods
used for billing.
Unbundling in the context of case recording occurs when portions of a single procedure are parceled out and logged
separately. This is relevant when an individual case has several segments that may count towards index case credit in
more than one category. For example, a Radical Cystectomy with Ileal Conduit (CPT 51595) contains portions that may
contribute to the required minimums in the Oncology/Pelvic/Bladder category as well as in the Reconstruction/Intestinal
Diversion category.
In 2009, the Urology RC identified a list of cases that provide a meaningful educational experience in more than one
category and automated the process of unbundling for these procedures in the case log system. Therefore, an entry of
the single CPT code 51595 automatically populates both the Oncology/Pelvic/Bladder and Reconstruction/Intestinal
Diversion categories. A list of procedures/CPT codes for which this automated system is in place is attached. In general,
the RC for Urology discourages residents and fellows from manually unbundling procedures, since cases that have been
designated as appropriate will automatically populate the relevant categories.
There are two exceptions when manual unbundling of surgical cases may be appropriate:
(1) When a single case has several unrelated portions that serve as meaningful educational experiences in more than
one category. For example, in the case of a combined partial nephrectomy (50240) and ureteroneocystotomy (50780),
a resident may appropriately unbundle this case, logging the partial nephrectomy and ureteroneocystotomy
separately.
(2) When two residents each complete one side of a bilateral procedure (orchidopexy, ureteral reimplant, nephrectomy),
each resident may appropriately record the case as Surgeon.
We hope that this clarification will help to standardize case recording across programs and make case logging less
burdensome.
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Date: February 2013
RE: ACGME Memo - Case recording of robotic and urologic ultrasound cases
In an effort to match the degree of resident involvement in robotic surgical cases with the resident role
recorded in operative case logs, the Urology Residency Review Committee (RRC) wishes to clarify the roles of
surgeon and assistant in robotic-assisted cases. In robotic cases, the resident typically fulfills one of two
operative roles: bedside assistant or console surgeon. Because the critical steps of robotic surgery are
executed by the console surgeon, residents should only log their role as surgeon if they act as console
surgeon for some portion of the case. Because robotic cases require a unique set of skills that are gained
through stepwise learning, residents are not expected to complete the majority of critical steps of a given
robotic case to qualify as surgeon. It is expected that over the course of their training, residents will develop
the skills necessary to perform progressively greater proportions of robotic cases. When residents serve solely
as the bedside assistant, such cases should be logged as assistant. For the situation in which two residents
complete some portion of the case at the console, only one resident may log the case as surgeon. We have
included some examples of appropriate case logging to further clarify these changes.
To reflect current standards of practice, the Urology RRC has broadened the index category for “laparoscopy,”
which will now be named “laparoscopic/robotic surgery.” Case minimums for this index category will remain
unchanged at 20, but there will be no specified case minimums for robotic surgery. For robotic cases, both
surgeon and assistant roles will be given index case credit for the “laparoscopic/robotic surgery” index
category.
In order to define the current resident experience in performing urologic ultrasound procedures and to track this
experience over time, the RRC also requested that residents begin logging these cases starting July 1, 2012.
Ultrasound cases include commonly performed procedures like transrectal ultrasound (TRUS) and less
common procedures such as renal, pelvic, scrotal and penile ultrasound cases. While TRUS for prostate
biopsy will remain an index case with a minimum number required (25), there will be no minimum number of
cases required for other ultrasound procedures. We ask that residents use one of the CPT codes specific
below when logging these procedures.
We hope that these changes will reinforce the emerging importance of training in robotic surgery and help to
define the current experience in ultrasound for graduating chief residents.
Examples for Correct Coding of Robotic Surgery Cases (July 2012)
Example A: A resident (1) assists in placement of robotic ports for a robotic-assisted laparoscopic
prostatectomy. She then serves as the bedside assistant, while the attending surgeon operates at the console for
the entire case. She helps to remove the specimen and close port sites at the end of the case.
Resident
1
CPT Code
55866
Procedures
Laparoscopic/Robotic Radical
Prostatectomy
Role
Assistant
Index Credit?
Yes
Note: The resident did not complete any steps on the console, so she can only log the role of “assistant” for the
case. However, she will receive index case credit towards her minimum case requirement (20) for
“laparoscopic/robotic surgery.”
Example B: A junior resident (1) assists in placement of robotic ports for a robotic-assisted laparoscopic
prostatectomy. He then serves as the bedside assistant for the case. The senior resident (2) dissects the
seminal vesicles, divides the endopelvic fascia and completes a portion of the anastomotic sutures, while the
attending surgeon completes the majority of the case.
Resident
1
CPT Code
55866
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Procedures
Laparoscopic/Robotic Radical
Role
Assistant
Index Credit?
Yes
2
55866
Prostatectomy
Laparoscopic/Robotic Radical
Prostatectomy
Surgeon
Yes
Note: Resident 1 did not complete any steps on the console, so he can only log the role of “assistant” for the
case. Resident 2 operated on the console for a portion of the case and may log the case as “surgeon” even
though he did not complete the majority of the case. Both residents will receive index case credit towards the
minimum case requirement (20) for “laparoscopic/robotic surgery.”
Example C: A junior resident (1) assists in placement of robotic ports for a robotic-assisted laparoscopic
prostatectomy. He then scrubs out to complete the seminal vesicle dissection at the console, then returns to his
role as bedside assistant. The chief resident (2) then completes a number of steps at the console, under the
supervision of the attending surgeon.
Resident
1
2
CPT Code
55866
55866
Procedures
Laparoscopic/Robotic Radical
Prostatectomy
Laparoscopic/Robotic Radical
Prostatectomy
Role
Assistant
Index Credit?
Yes
Surgeon
Yes
Note: Although both residents operated on the console for a portion of the case, only one resident may log the
case as “surgeon.” Since resident 2 completed more of the case at the console, resident 1 should log the case as
“assistant,” index case credit towards the minimum case requirement (20) for “laparoscopic/robotic surgery.”
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Surgical procedure case logs for graduating residents will also be reported categorically, organized into “core
domains” as follows:
general urology
endourology/stone disease
laparoscopic surgery
reconstructive surgery
oncology
pediatric urology (minor and major)
Index Categories, Minimum Numbers, and Common CPT Codes for Urology Residents
(As Prepared by ACGME Residency Review Committee for Urology)
Index Category
ADULT UROLOGY
General Urology
Transurethral resection
Transrectal ultrasound-guided prostate
biopsy
Scrotal/inguinal surgery
Urodynamics (participate and interpret)
Endourology/Stone Disease
Shock wave lithotripsy
Ureteroscopy
Percutaneous renal procedures
Laparoscopy
Reconstruction
Male
Penile/incontinence
Urethra
Female
Intestinal diversion
Oncology
Pelvic
Prostate
Bladder
Retroperitoneal
Kidney
PEDIATRIC UROLOGY
Minor
Endoscopy
Hydrocele/hernia
Orchiopexy
Major
Hypospadias
Ureter
Required
Minimum Number
National
Averages
200
100
25
385
172
84
40
10
100
10
40
10
20
60
15
10
5
15
8
100
40
25
8
40
30
99
28
266
30
187
46
132
168
66
51
14
48
34
240
136
102
31
104
93
30
5
10
10
15
5
5
121
36
31
46
75
38
24
In order to be recorded as Surgeon, a resident must be present for all critical portions of the case and must perform a
significant number of the critical steps of the procedure. Any lesser involvement while a first assistant should be coded as
Assistant. In general, only one resident should record any procedure for credit—activity as “second assistant”
should not be recorded. When a senior resident acts as a Teaching Assistant, directing and overseeing the major
portions of the case, while the supervising staff physician functions as an assistant or observer, a second resident may then
also record the case for credit as Surgeon. If two residents each do one side of a bilateral procedure (e.g., orchidopexy,
ureteral reimplant, nephrectomy), each resident may record the procedure as Surgeon.
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Logging Ultrasound Procedures
To define the current resident experience in performing urologic ultrasound procedures and to track this experience over
time, the Urology Review Committee would like residents to log these cases starting July 1, 2012. Ultrasound cases
include commonly performed procedures such as transrectal ultrasound (TRUS) with prostate biopsy, and non-TRUS
biopsy procedures such as renal, pelvic, scrotal and penile ultrasound cases. The Review
Committee is particularly interested in tracking resident involvement in non-TRUS biopsy ultrasound procedures. While
TRUS-prostate biopsy will remain an index case with a minimum number required (25), there will be no minimum number
of cases required for nonprostate ultrasound procedures. We ask that residents use one of the following CPT codes when
logging these procedures:
Category
Scrotal
Renal
Retroperitoneal, limited (kidney only)
Retroperitoneal, complete (both kidney and bladder)
Transplant kidney ultrasound
US guidance, intraoperative (e.g., during partial nephrectomy)
US guidance, parenchymal ablation (e.g., ablation of renal mass)
Pelvic
Residual urine measurement
Limited (bladder OR prostate/SVs)
Complete (bladder AND prostate/SVs; in females, must note uterus, adnexa and
endometrium)
Prostate
Transrectal ultrasound (TRUS)
TRUS-guidance for needle placement (TRUS biopsy)
Prostate volume study for brachytherapy
Prostate Cryotherapy (includes US guidance and monitoring)
Penile
Duplex, complete
Duplex, limited or follow-up
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CPT code
76870
76775
76770
76776
76998
76940
51798
76857
76856
76872
76942
76873
55873
93980
93981
RESOURCES
The University of Oklahoma Department of Urology is responsible for assessing the availability of resources for urology
resident education.
Residents are provided with clinical facilities containing state-of-the-art equipment to perform diagnostic and therapeutic
procedures.
Equipment to perform the following procedures is available: flexible cystoscopy, ureteroscopy, percutaneous endoscopy,
percutaneous renal access, extracorporeal shock wave lithotripsy, ultrasonography and biopsy, fluoroscopy, laparoscopy,
laser therapy, robotics, brachytherapy, cryotherapy and microscopy.
Urodynamic evaluation equipment is present in four clinics, the VAMC clinic, the OUPB clinic, the pediatric urology clinic and
the resident clinic located in the PPOB.
Video imaging is available to allow adequate supervision and education during endoscopic procedures.
A DaVinci surgical platform and simulation model is available in the Presby operating room for resident use.
Residents have available for their use a urology library equipped with audio visual resources, textbooks, journals.
Resident office space and call room are equipped with up to date computer equipment including printers and a scanner.
A sufficient number and variety of inpatient and ambulatory adult and pediatric patients with urologic disease will be available
for resident education.
Residents have full and ready access to specialty-specific and other appropriate reference material in print or electronic
format. Electronic medical literature databases with search capabilities will be available.
RESOURCES RESEARCH LABORATORY
Dr. Robert Hurst
Dr. Hurst’s Adult Urology Lab laboratory facilities are located within the College of Medicine, OUHSC, and occupy
8 laboratory rooms, totaling approximately 1900 ft2 in the Biomedical Sciences Building (BMSB).
Special facilities include a Beckman PF2D 2-dimensional chromatography system for proteomics, real-time PCR
for gene expression studies, a microtome and facilities for both conventional and immunostaining of slides from
both paraffin-embedded and flash-frozen material. Also included are facilities for mouse and rat experiments and
fluorescence imaging for tumor xenograft studies plus fluorescence and light microscopy with image capture and
facilities for RNA and DNA isolation.
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Dr. H-K Lin
Facilities: Dr. H-K Lin has laboratory space consisting of 3,000 sq. ft. located in 800 Research Parkway on the
University of Oklahoma Health Sciences Center campus. The laboratory is fully equipped with all standard
laboratory safety features and general supplies (i.e. glass ware, hot plates, refrigerators, freezers, surgical
dissection instruments, biological safety cabinets, balances). The following equipment is also available including
electrophoretic systems, power supplies, gel driers, clinical centrifuges, microfuges, a hybridization over, cell
culture incubators, UV crosslinker, and a Beckman UV/Vis scanning spectrophotometer.
Animal: The Department of Urology has full access privileges to the Oklahoma University Laboratory Animal
Research Center located in the Biomedical Sciences Building and 800 Research Parkway. These are fully
approved AAALAC animal holding facilities with full veterinary staff and technologist supports. Fully equipped
operating room facilities are available for our small animal studies.
Major Equipment
Olympus BX-51 microscope equipped with fluorescence and bright field microscopy
Olympus research grade inverted microscope IX-51 with fluorescence attachment
Beckman DU640 UV/Vis spectrophometer
Bio-Tek µQUANT universal microplate spectrophometer
Bio-Tek FLx800 microplate fluorescence reader
MJ Research PTC-200 DNA Engine with in situ block
Bio-Rad protein IEF cells
Core facilities include a Perceptive Biosystems MALDITOF system with full data collection and analysis and a
Synthetic and Analytical Laboratory for synthesis and purification of peptides and oligonucleotides as well as full
sequencing facilities for both nucleic acids and proteins. These include gel densitometry analysis equipment and
other techniques for nucleic acid and protein analysis. The Department of Microbiology and Immunology also
performs large-scale nucleic acid and protein sequencing for a reasonable fee. Core facilities include a dark room,
walk-in warm room, central glassware washing and sterilization, liquid scintillation counter, ultracentrifuge, gamma
counter, flow cytometer, confocal image facility, 3-D image analysis with live digital imaging center to name a few
of the core facilities available.
CLINIC RESOURCES
General Pediatric Urology Clinic
The pediatric urology clinic is housed in a spacious 6800 square foot facility. Patients are seen Monday through
Friday 8a.m. to 5p.m. The general staff is diverse and includes personal service representatives, medical
assistant, registered nurse, and two pediatric nurse practitioners. Full time attending physicians, residents and
fellow physicians are available and “on-call” 24/7 for any pediatric emergencies.
The environment is professional and both kid and family friendly in appearance and decorative theme. There are 7
patient exam rooms as well as a large cystoscopy and video urodynamics suite. These areas include adjoining
instrument sterilization (autoclave) and cleaning facility. The rooms are all equipped with the latest technology
and equipment including flat screen TV/DVD units. Local and conscious sedation procedures can also be
performed safely in these areas. The clinic also includes a laboratory, ultrasound, research, and biofeedback area.
Patient bathrooms are equipped with uroflowmetry units and age appropriate sized toilets.
Renal transplant and myelomeningocele clinics are held twice monthly at another specialty location within the
hospital. The clinic has full access to the radiology department which includes MRI, CT, nuclear, ultrasound,
fluoroscopy studies. All surgical evaluations, consents, and scheduling can be completed through the clinic. We
have full hospital admission privileges for any complex or urgent medical problems.
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Adult Urology Clinics
An adult urology clinic is located at the OU Physicians Building on the OUHSC campus. There are 10 examining
rooms, 1 clinic manager, 1 nurse manager/R.N., four medical assistants, and four administrative clerks to assist in
patient flow. There is approximately 6,000 sq. ft. allocated to the urology clinic at this facility. In addition, there is a
large procedure room where ultrasound, fluoroscopy, bladder scan, cystoscopy and urodynamic equipment is
located. Multiple other urologic procedures including TRUS biopsies, sacral neuromodulation capacity and neural
stimulation procedures are also performed in the procedure room. Additional diagnostic testing facilities are
located within the building and results are obtained quickly for patient convenience.
A 2nd adult urology clinic is located at the Presbyterian Professional Building, which is adjacent to the Presbyterian
Tower (Hospital). The clinic area is approximately 4,000 sq. ft. and includes 9 examining rooms, 1 procedure
room, reception area and waiting room. The general urology clinic is held on Thursdays 8-4:30. On Mondays a
procedure clinic is held from 8-4:30. Cystoscopies, TRUS biopsies, urodynamics, fluoroscopy, ultrasound, bladder
scan and other simple procedures are performed on this day. Ancillary personnel include a clinic supervisor and a
registered nurse assigned to urology as well as other clinic nurses assigned as needed to facilitate clinic flow.
There is also an administrative clerk assigned to the clinic. Ultrasound equipment for biopsies and scans are
available at this facility as is a cysto table, bladder scan and uroflow equipment.
A 3rd adult urology clinic is located at the Presbyterian Professional Building. This clinic treats inmates within the
Oklahoma State Department of Corrections. The clinic area is approximately 2,000 sq. ft. This clinic is held on
Fridays 1-3:00pm. There is one registered nurse and in this clinic and there is limited equipment.
A 4th adult urology clinic is located at the Veteran’s Affairs Medical Center. This clinic treats veterans and the clinic
area is approximately 4,000 square feet. This clinic has four examination rooms, one cystoscopy suite, one
procedure suite and one urodynamics suite. A general urology clinic is held on Tuesdays from 8-4:30. Postoperative patients are seen on Thursdays and a procedures clinic is held on Fridays which includes vasectomies
and specialized testing using penile Doppler. In addition, there is a large procedure room where ultrasound,
fluoroscopy, bladder scan, cystoscopy and urodynamic equipment is located. Multiple other urologic procedures
including TRUS biopsies, sacral neuromodulation capacity and neural stimulation procedures are also performed
in the procedure room. Ancillary personnel include one PA, two RNs, one NA and one clerk.
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BLOCK DIAGRAM
PGY1
4 months
Pre-Urol
Teams 1 and 2
PGY2
URO-1
PGY3
URO-2
PGY4
URO-3
PGY5
URO-4
8 months
4 months
Teams 1 and 2
Presbyterian Tower
VA Medical Center
8 months
4 months
Teams 1 and 2
Presbyterian Tower
The Children’s Hospital
4 months
4 months
4 months
OU Medical Center
Transplantation Service
VA Medical Center
The Children’s Hospital
12 months
Teams 1 and 2
Presbyterian Tower
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DIDACTIC CONFERENCES
All urology residents and faculty are expected to participate in all educational and didactic conferences. Urological imaging,
urological pathology, journal review and combined morbidity and mortality for all participating sites are covered in the
didactic conferences. A yearly conference schedule is given early in the year to ensure adequate time for the resident to
research and prepare his/her required educational presentations.
Department of Urology Resident Educational Conferences
July 1, 2011, Updated June 28, 2013
All urology residents and faculty are expected to participate in all educational and didactic conferences. Urological
imaging, urological pathology, journal review and combined morbidity and mortality for all participating sites are covered in
the didactic conferences. A yearly conference schedule is given early in the year to ensure adequate time for the resident
to research and prepare his/her required educational presentations.
Evaluations of the core competencies required in the presentations are completed by faculty attending the
presentations, entered into the MEDHUB using Forms 18, 19, 20, 21, 22, 23, 24, 25, 31, 32, 33 and 34 and become a part
of the resident’s portfolio.
Evaluation of Residents by Faculty/Fellows
Conference Presenter Evaluation Form
Female Urology and Urodynamics Conference Evaluation Form
Journal Club Participation Evaluation Form
Morbidity and Mortality Conference Evaluation Form
Pathology Conference Evaluation Form
Case Presentations – Junior Receiver
Case Presentations – Chief Presenter
Transplant Conference Evaluation Form
Mock Boards Evaluation of PGY4
Mock Boards Evaluation of PGY5
Minimally Invasive and Endoscopic Workshop for Residents Performance Rating Form
Urologic Reconstruction, Urinary Incontinence, POP and ED Workshop for Residents Performance Rating Form
Evaluation of Conference/Presenter by Residents/Fellow
Teaching Activity Evaluation by Residents
Minimally Invasive and Endoscopic Workshop Resident Evaluation of Participating Faculty Form
Minimally Invasive and Endoscopic Workshop Resident Evaluation of Workshop Form
Urologic Reconstruction, Urinary Incontinence, POP and ED Workshop Resident Evaluation of Participating Faculty Form
Urologic Reconstruction, Urinary Incontinence, POP and ED Workshop Resident Evaluation of Workshop Form
Attendance of Urology Educational Conferences is mandatory by all residents, fellows and faculty
OUHSC DEPARTMENT OF UROLOGY RESIDENCY/FELLOW ORIENTATION
This orientation conference is mandatory attendance by all urology residents, fellows and faculty.
residency/fellowship coordinator is also in attendance.
The
During this orientation, the Program Director gives information regarding not only the department requirements but also
requirements of the OUHSC College of Medicine, OU Medical Center, VA Medical Center, the AUA, the ACGME and the
ABU.
Department of Urology policies and procedures are discussed, i.e., duty hours, call, travel reimbursement, vacations.
Residents are provided with information regarding each rotation’s goals and objectives and where they can get
information at any time (Medhub).
The following items which are mandatory by the ACGME will be discussed:
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Urology Faculty and their Roles
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Length of Urology Residency Program
Residency Objectives
Urology Residency Line of Supervision
Residency Goals – All Years
Residency Requirements – Clinical
Residency Requirements – Personal
Residency Requirements – Self Study
Residency Requirements – Surgical
Residency Requirements – Scholarly Activities
Residency Requirements – Promotion
Residency Requirements - Administrative
Commitment of Faculty
Commitment of Residents
Social Networking
Urology Residency Conferences In-House
Evaluations – Resident/Faculty
Residency Objectives by Year – Located in Medhub
Oklahoma Licensing Requirements
Patient Handover/Duty Hours
Resident Vacations
Resident Call Schedules
Duty Hours
Mandatory for all Urology Residents In-Service Examination
Mock Boards
Urology Workshops
INDICATIONS/IMAGING/IVP CONFERENCE – Every Friday, 6am, Urology Library, WP3140
The Indications/Imaging/IVP Conference is held on Friday mornings. Chief residents for each service - The Children’s
Hospital, Presbyterian Tower, Transplant and the VA Medical Center Urology Services meet to review and discuss the
surgical cases for the next week. A list of all cases to be performed the following week will be provided.
Residents present laboratory, clinical, and diagnostic findings that support surgical intervention and each case is
discussed in depth with the faculty attendings. All data is formally reported and is available for review and subsequent
discussion.
Upper level residents present more complex cases and lower level residents present cases of less complexity. Each
resident is expected to be familiar with all cases that will be performed at their hospital the following week.
Special attention will be placed on cases which are scheduled from resident clinic, inpatient setting and the VA Hospital.
Residents are not responsible for specific details on private cases of which they have limited access to documentation.
Radiologic imaging for each specific case will be reviewed in detail and education in radiologic imaging, pathologic finding
in oncology cases will be focused on.
Both upper and lower level residents should have done the necessary reading in order to support their decision to perform
surgery.
VAMC SURGICAL CASE ASSIGNMENT AND PATHOLOGY REVIEW CONFERENCE – Every Thursday, 6am, VAMC
Urology Conference room, 4th floor
The VAMC Surgical Case Assignment and Pathology Review Conference is held every Thursday.

Purpose
o Review of pathology and discussion of treatment options
o Recognize and discuss available research protocols, if any, for patients
o Timely scheduling of surgical procedures when appropriate
Page 14
VA residents, faculty and PA meet to review and discuss the surgical cases for the next week. A list of all cases to be
performed the following week will be provided.
Residents present laboratory, clinical, and diagnostic findings that support surgical intervention and each case is
discussed in depth with the faculty attendings. All data is formally reported and is available for review and subsequent
discussion.
Upper level residents present more complex cases and lower level residents present cases of less complexity. Each
resident is expected to be familiar with all cases that will be performed at their hospital the following week.
Radiologic imaging for each specific case will be reviewed in detail and education in radiologic imaging, pathologic finding
in oncology cases will be focused on.
Both upper and lower level residents should have done the necessary reading in order to support their decision to perform
surgery.
UROLOGY GRAND ROUNDS – Friday, 7am, Urology Library, WP3140
Controversial topics in:
Core domains:
voiding dysfunction
female urology
reconstruction
oncology
calculus disease
pediatrics
reproductive and sexual dysfunction
Core techniques:
endo-urology
minimally-invasive intra-abdominal and pelvic surgical techniques (e.g., laparoscopy/robotics)
major flank and pelvic surgery
perineal and genital surgery
urologic imaging including fluoroscopy, interventional radiology, and ultrasound
microsurgery
Other topics as required by ACGME:
bioethics
biostatistics
epidemiology
geriatrics
infectious disease
renovascular disease
renal transplantation
trauma
plastic surgery
medical oncology
PowerPoint presentations by PGY4, 5 and fellows.
There will be two presentations of 20 minutes with an additional 10 minutes for questions and comments.
Resident presenters must include applicable urologic imaging, pathology and literature references as part of the
presentations.
The resident has to be prepared by discussing the topic in advance with the assigned faculty member. Both names must
be listed on the title slide of the PowerPoint presentation.
Page 15
An electronic version of the presentation must be uploaded into Medhub and emailed to Beverly Shipman, Program
Coordinator for saving in the Scholarly Activities Directory for future use. (Non-compliance of this requirement will result in
an unprofessional evaluation)
Presentations are evaluated by faculty, upper level residents and fellows using the Conference Presentation Evaluation
Form through the College of Medicine’s MEDHUB online evaluation system.
CHIEF CASE PRESENTATIONS – Friday, 7am, Urology Library, WP3140
Chief case presentations are presented on Friday morning in conjunction with the urology grand rounds. Up to three
upper level residents are selected at random by a faculty member on the morning of the presentation. The upper level
residents will present the case to a lower level resident of their choosing.
PGY4, 5 and fellows are responsible for having one urological case available. The presenting resident has to use
PowerPoint, preferable in Mock Oral Boards format and has to include radiologic imaging and pathologic findings. They
are to be able to provide a description of the surgical technique.
An electronic version of the presentation must be uploaded into Medhub and emailed to Beverly Shipman, Program
Coordinator for saving in the Scholarly Activities Directory for future use. (Non-compliance of this requirement will result in
an unprofessional evaluation)
Presentations are evaluated by faculty, upper level residents and fellows using the Chief Case Presentations Evaluation
Forms through the College of Medicine’s MEDHUB online evaluation system. Both the chief and junior residents will be
evaluated on their performance.
MORTALITY AND MORBIDITY CONFERENCE – 4th Friday, 7am, Urology Library, WP3140
The chief residents for each service including transplant present at the Mortality and Morbidity Conference. This
conference is structured to review all hospital complications in a group setting. Core competencies and evidence based
medicine outcome results are a part of the discussion. Variances that have not been resolved at the time of the initial
presentation are carried over for discussion at the next conference so adequate followup and outcomes are tracked.
Case numbers, procedures, etc. are cited for each hospital and the variance/complication are discussed using the
following schema:
Case Identifier:
Present Case: What happened? (PC)
Emphasize problem: Why did it happen? (PBLI)
Discuss case: What change could have prevented the problem?(IC)
Presented current data and references on topic (MK)
State lesson(s) learned and has the change resulted in an improvement in patient care? (PC)
UROSUBSPECIALTY/CAMPBELL’S CLUB CONFERENCES – Monday, 5pm, Urology Library, WP3140
PGY2 and 3 urology residents present at the UroSubspecialty Conferences on Mondays. The UroSubspecialty and
Campbell’s Club conferences are based on the ACGME core curriculum but also include subspecialty topics and consist
of preplanned, in-depth PowerPoint presentations involving specific chapters in the Journal of Urology, AUA Updates,
SASP, Campbell’s, Gillenwater’s and RCSG with each set of conferences devoted to a specific urologic topic listed below.
Residents/fellows give presentations that include pathology slides (relevant to the pathology section of the In-Service
examinations), evidence based treatment options, study results, and literature references. Presentation skills of all
residents are evaluated by faculty.
o
o
o
o
o
o
o
voiding dysfunction
female urology
reconstruction
oncology
calculus disease
pediatrics
reproductive and sexual dysfunction
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o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
endourology
minimally-invasive intra-abdominal and pelvic surgical techniques (e.g., laparoscopy/robotics)
major flank and pelvic surgery
perineal and genital surgery
urologic imaging including fluoroscopy, interventional radiology, and ultrasound
bioethics (presented by Dr. William Reiner)
radiation safety (training received as PGY1 from Radiation Safety for radiation badge)
biostatistics (presented by Dr. Amy Wisniewski)
epidemiology
geriatrics
infectious disease
renovascular disease
renal transplantation
trauma
plastic surgery
medical oncology
patient safety, IPM online module
quality of care, IPM online module
sleep and fatigue (presented by Dr. Gennady Slobodov)
disruptive behavior (presented by Dr. Gennady Slobodov)
Presentations are evaluated by faculty, upper level residents and fellows using the Morbidity and Mortality Conference
Evaluation Form through the College of Medicine’s MEDHUB online evaluation system.
FEMALE UROLOGY AND URODYNAMICS CONFERENCE – Thursday, 12noon, VAMC
The Female Urology and Urodynamics Conference is held once weekly on a Thursday. References for this conference
are contained in Female Urology 3rd Edition (FU), Urogynecology & Female Pelvic Reconstructive Surgery (UG) and Adult
Urodynamics (AU). The faculty member who facilitates this conference is Gennady Slobodov. This conference is
attended by ALL PGY2 urology residents. The PGY2 urology residents are given a list of chapters to read prior to the
conference by date.
This conference is a face to face discussion between the PGY2 urology residents and Dr. Slobodov. The residents are
required to have read the assigned topics for that week and be able to discuss them.
The PGY2 urology residents, with the help of Dr. Slobodov, interpret urodynamic studies at the VAMC urology clinic and
the resident clinic at the PPOB for the previous week.
Presentations are evaluated by Dr. Gennady Slobodov using the Female Urology and Urodynamics Conference
Evaluation Form through the College of Medicine’s MEDHUB online evaluation system.
PRESBYTERIAN TOWER SELF STUDY SASP – 7:30-8:00am, Presbyterian Tower
This is a self-study to review ten questions out of the AUA Self-Assessment Study Program. The questions to review
have been provided on the monthly conference schedule. A discussion is held between the Presbyterian resident team
and Dr. Slobodov prior to the start of the clinic.
The administrative chief is responsible for ensuring all Presby team residents have the assigned SASP questions.
Feedback is given at the end of the conference by Dr. Slobodov.
UROPATHOLOGY – Monday, 6 times per year, 4:00pm, Lawson Center
We are in the process of revising this conference with Dr. Barbara Bane of pathology. It will be held six times per year.
The conference will consist of three to four urologic cases. The residents are to provide the names to Dr. Bane at least
ten days prior to the conference in order for the pathologic slides to be pulled.
Page 17
Slides will be viewed and discussed.
Resident knowledge and participation are evaluated by Dr. Gennady Slobodov using the Pathology Conference
Evaluation Form through the College of Medicine’s MEDHUB online evaluation system.
URORADIOLOGY – Monday, 6 times per year, 4:00pm, Lawson Center
We are in the process of revising this conference with radiology. It will be held six times per year.
The conference will consist of three to four urologic cases. The residents are to provide the names to the radiologist at
least ten days prior to the conference in order for the CT/MRI/URS to be pulled.
will be viewed and discussed.
Resident knowledge and participation are evaluated by Dr. Gennady Slobodov using the Radiology Conference
Evaluation Form through the College of Medicine’s MEDHUB online evaluation system
JOURNAL CLUB/EVIDENCE BASED REVIEWS IN UROLOGY (EBRU) - Monday, 6 times per year, 5:00pm, Urology
Library, WP3140
Journal club is held with the purpose of introducing residents to current literature and also serving as an instructional
exercise for the residents to evaluate and critically assess literature.
This conference is based on the
AUA’s Evidence Based Reviews in Urology (EBRU). The residents are provided with the reading material at least two
weeks prior to the conference.
Resident knowledge and participation are evaluated by Dr. Gennady Slobodov using the Journal Club Evaluation Form
through the College of Medicine’s MEDHUB online evaluation system.
PEDIATRIC UROLOGY INDICATIONS CONFERENCE – Tuesday, 6am, Pediatric Urology Clinic
The Pediatric Indications Conference is held on Tuesday mornings as a preconference for the Indications Conference
which is held on Friday mornings. Pediatric urology fellows, residents and faculty for The Children’s Hospital meet to
review and discuss the surgical cases for the next week. A list of all cases to be performed the following week will be
provided.
Residents present laboratory, clinical, and diagnostic findings that support surgical intervention and each case is
discussed in depth with the faculty attendings. All data is formally reported and is available for review and subsequent
discussion.
Upper level residents present more complex cases and lower level residents present cases of less complexity. Each
resident is expected to be familiar with all cases that will be performed at their hospital the following week.
Radiologic imaging for each specific case will be reviewed in detail and education in radiologic imaging, pathologic finding
in oncology cases will be focused on.
Both upper and lower level residents should have done the necessary reading in order to support their decision to perform
surgery.
PEDIATRIC DIDACTIC UROLOGY CONFERENCES – Each Tuesday, 12:45pm, Pediatric Urology Clinic
The Pediatric Urology didactic conference is a one hour conference held each Tuesday at 12:45 pm.
Dr. Donald B. Halverstadt is the faculty in charge of this conference and acts as moderator to challenge assumptions
based on his personal experience of 45 years in pediatric urology.
The conference is designed to encourage the junior resident to review and present sixteen one hour reviews which
encompass the entire breadth of current knowledge and information in pediatric urology. The subjects are assigned
flexibly to correspond to cases in which the resident is participating at the bedside or in the clinic.
Page 18
Dr. Halverstadt evaluates the residents on:






How complete the information presented is
How current the information is
The resident’s interpretation of controversial areas
Dedication of the resident to learning as opposed to simply presenting
Appropriateness to current patients in the hospital or clinic
Sources
Residents are evaluated by Dr. Halverstadt using the Conference Presentation Evaluation Form through the College of
Medicine’s MEDHUB online evaluation system.
DEPARTMENTAL GRADUATE MEDICAL EDUCATION COMMITTEE (GMEC) – Fridays, every three months or more
often as needed, 7am, Urology Library, WP3140
The purpose of this meeting is for the self-evaluation and continued improvement of the urology residency program.
Meetings are held no less than every 3 months. Faculty members of the departmental GMEC and the urology resident
representative attend the meeting. Concerns of the residents are addressed. Concerns from faculty regarding the
educational experiences, technology available and progress on individual resident growth and development are
discussed. Documentation of these meetings is a part of the departmental portfolio.
TRANSPLANT – Tuesdays, 12noon, Oklahoma Transplant Center Conference Room
The urology resident on the transplant rotation attends these conferences.
New Didactic activities will address the core competencies of medical knowledge, with the residents gaining
knowledge of evolving biomedical, clinical epidemiological and social behavioral sciences as it applies to renal
transplantation; immunology and pharmacology; and renovascular disease.
The resident will have a scheduled weekly reading assignment which will then be discussed and evaluated by Dr.
Puneet Sindhwani.
Renovascular disease and renal transplantation presentations during urology grand rounds will be given by the
resident twice during their four month rotation.
The other didactic conferences will include:
Monthly transplant journal club
Bi-weekly patient selection and listing committee meeting
Monthly kidney transplant M&M conference
Resident knowledge is evaluated by Dr. Puneet Sindhwani using the Transplant Conference Evaluation Form through the
College of Medicine’s MEDHUB online evaluation system.
MOCK ORAL BOARDS
The mock oral boards are an annual experiential learning activity created to simulate Part 2 of the American Board of
Urology. This gives residents the chance to experience what the oral examination board examination is like. PGY4/5
Residents must develop skills to departmentalize their knowledge and verbally convey that knowledge within a set time
limit. The situational time limit provides added stress forcing focus on the task at hand in a stressful situation. Additionally
performing a clinical examination (history, physical, appropriate laboratory and radiologic investigation) a differential
diagnosis and an assessment and management plan in an organized manner within a set time frame mimics not only the
boards but also situational practice of urology after graduation.
Schedule Permitting - MINIMALLY INVASIVE AND ENDOSCOPIC WORKSHOP – Saturday, 1x yearly, 8am to
12noon, CSETC, mandatory attendance by all residents and fellows
Page 19
Stations are provided for the following skills:
Flexible Cystoscopy
TURP/BT Bipolar Techniques
Ureteroscopy
Laparoscopy Hand-Eye Coordination Skills
Residents are evaluated by faculty and upper level residents using the ACMI/AMS Skills Workshop Performance Rating of
Residents in the online Medhub evaluation system:
Schedule Permitting - UROLOGIC RECONSTRUCTION, URINARY INCONTINENCE, PELVIC ORGAN PROLAPSE
AND ERECTILE DYSFUNCTION WORKSHOP SPONSORED BY AMS - Saturday, 1x yearly, 8am to 12noon, CSETC,
mandatory attendance by all residents and fellows
Stations are provided for the following skills:
Pelvic Organ Prolapse
Stress Urinary Incontinence for Male and Female
Erectile Dysfunction
Residents are evaluated by faculty and upper level residents using the ACMI/AMS Skills Workshop Performance Rating of
Residents in the online Medhub evaluation system:
UROLOGIC EMERGENCIES - Saturday, 1x yearly, 8am to 12noon, WP3140, mandatory attendance by all residents
and faculty
Schedule Permitting - ROBOTICS SKILLS PROGRESSION – Monday after OR closed, 2x yearly, Time TBD, Presby
OR, mandatory attendance by all residents and faculty
Robotic Skills Olympiad Workshop, Presby Tower, pre and post survey.
Residents perform designated tasks on the DaVinci Surgical Platform Training Module. Times are recorded and residents
are re-assessed in two months to record robotic skills progression.
The Science of Tissue Management Workshop, Saturday, 1x yearly, 8am to 12noon, CSETC, mandatory
attendance by all residents and fellows
1. Science of Tissue Management-Energy (1 hour to 1 hour 20min with hands-on)
 What is Energy?
 Importance of Tissue Management
o Tissue Dynamics
o Human and Environment Considerations
 Mechanics of Hemostasis
 History of Energy in Surgery
 Technology
o Electrosurgical Principles
o Traditional Bipolar
o Advanced Bipolar
o Ultrasonic Principles
Page 20

Discussion and Hands-On (EnSeal and Harmonic- Vessel Sealing Trainer with Porcine
Carotid Arteries)
2. Science of Tissue Management-Stapling (1 hour to 1 hour 20 min with hands-on)
 Components of Tissue Management
 Origins of Surgical Stapling
 Tissue Dynamics
 Human Factors
 Technology of Surgical Staplers
 Discussion and Hands-On (Open and Endoscopic Staplers with Porcine Stomach)
3. Suturing and Knot Tying (30-40 min)
 Open and laparoscopic suturing
4. Hemostasis Agents (20 min)
 General Hemostasis and Hemostasis Cascade
 Topical Hemostasis Products
 Advanced Hemostasis Products
Page 21
MENTORING
Each resident is asked to select a faculty mentor at the beginning of their residency. This faculty mentor will continue
mentoring them throughout their residency. The resident is also assigned an upper level resident who will mentor them
through their PGY-3 year. This mentor is not only someone they can seek advice from regarding their urology residency but
also seek information on a personal level, community level, etc.
Mentoring
A mentor is more than just a teacher and is not merely a cheerleader.
A mentor is someone to whom you can turn for objective, honest advice.
A mentor will not dictate what you should do.
A mentor will provide guidance, help you work on your weaknesses and allow you to accomplish your goals
Each resident was asked to select a faculty mentor. This faculty mentor will continue mentoring them throughout
their residency.
PGY1, 2 and 3 residents are also assigned an upper level resident who will mentor them through their PGY-3 year.
This mentor is not only someone they can seek advice from regarding their urology residency but also seek
information on a personal level, community level, etc.
Each mentor needs to make themselves available to meet at least once every rotation and more often if needed.
Your participation in this important part of urology residency education is very important and is very much
appreciated.
Page 22
REVIEW OF PROGRAM GOALS AND OBJECTIVES
The goals and objectives for urology residency program are reviewed at least annually by the Urology GME Faculty.
Changes in these goals and objectives are made based on outcome measures such as resident performance on in-service
examinations, graduate board exam scores and feedback from graduating residents. Changes are also dictated by new
technologies and the need to incorporate new scientific discoveries.
CORE COMPETENCIES
Residents will be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health. (Patient Care)
Residents will demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral
sciences, as well as the application of this knowledge to patient care. (Medical Knowledge)
Residents will demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific
evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (PracticeBased Learning and Improvement)
Residents will demonstrate interpersonal and communication skills that result in the effective exchange of information and
collaboration with patients, their families, and health professionals. (Interpersonal and Communication Skills)
Residents will demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
(Professionalism)
Residents will demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as
the ability to call effectively on other resources in the system to provide optimal health care. (Systems-Based Practice)
MOONLIGHTING
Urology residents are prohibited from participating in moonlighting activities.
REQUIREMENTS, ALL YEARS OF UROLOGY RESIDENCY
 Annual Health Screening, email reminder
 Annual On-Line HIPAA Training, email reminder
 Annual On-Line Safety Hazard Training, email reminder
 Annual On-Line Sexual Harassment Training, email reminder
 Bi-Annual BLS Certification, check your BLS card for expiration date
 Initial Institutional Review Board (IRB) online training and attend the in-house educational training on human
participant protection in Research to be completed as PGY1. This is required for participation in all research
projects.
 Bi-Annual On-Line IRB Research Recertification, email reminder
 Introduction to the Practice of Medicine (IPM) completion, on-line training, all core competencies
o Patient Safety and Quality of Health Care to be completed annually
 Training on the Centricity Electronic Medical Records (EMR) System as a PGY1
 BLS (VAMC), online then skills assessment
Page 23
SUPERVISION/GRADED AUTHORITY AND RESPONSIBILITY/WHEN TO NOTIFY UPPER LEVELS – Updated
September 20, 2011
Definition of Supervision Levels
Level 1 - Direct Supervision
o The supervising physician/chief resident/fellow is physically present with the resident and patient.
o PGY1 residents will always been under Level 1 – Direct Supervision.
Level 2 - Indirect Supervision
o Direct supervision is immediately available.
 The supervising physician/chief resident/fellow is physically within the confines of the site of patient
care and immediately available to provide Direct Supervision
o Direct supervision is available.
 The supervising physician/chief resident/fellow is not physically present within the confines of the
site of patient care but is immediately available via phone and is available to provide Direct
Supervision.
Level 3 – Oversight Supervision
o The supervising physician is available to provide review of procedures and encounters with feedback
provided after care is delivered.
When to Notify Upper Level Residents and Attendings
The attending or upper level resident must be notified by the resident on call in a timely manner.
When to Notify Attendings
 All admissions
 All consultations of complex patients
 Significant changes in status of inpatients
 ICU transfers
 DNR
 Any patients going to OR
 Any intraoperative consultations
 All transfer requests, i.e., emergency room, outside hospitals
When to Notify Upper Level Residents PGY2/3 to PGY4/5
 All of above – plus
 Any admissions
 Any consultations
 Any floor procedures
Page 24
EVALUATION
Instruments for evaluation
Evaluations will be completed no less than at the end of each rotation and entered into the online Medhub evaluation
system by faculty and residents and ancillary staff (360).
Clinical (Competency or Curriculum) Committee






Page 25
Committee established for residents to present their portfolio for progression to next
level including graduation vs extra time in program to fulfill requirements for
graduation vs non-renewal of contracts for next PG year
Committee members:
o Slobodov, Presbyterian Tower (non-voting member)
o Kropp, Children’s Hospital (voting member)
o Palmer, Children’s Hospital (voting member)
o Wisniewski, scholarly activities (voting member)
o Ash Bowen, Edmond Medical Center (voting member)
o Puneet Sindhwani, VAMC (voting member)
Voting members make their recommendations to Dr. Slobodov, Program Director
o Dr. Slobodov makes final decisions
Bi-annual meeting with each resident
Program Coordinator to have present:
o Evaluations to be reviewed with resident
 Faculty evaluations
 Peer evaluations
 360 evaluations
o In-Service scores
o Prior Committed actions
o Resident completion rate of evaluations
During meeting residents are to present their portfolios to Committee:
o In-Service scores to be reviewed
 <40% requires structured study plan (remediation vs FOC???)
 2nd time of <30% put on academic probation
o Surgical logs (within 10% of peer)
 It is the responsibility of each resident to monitor their case log volume
in relation to their peers to ensure even case distribution
 If case volume is <10% of their peers then promotion to next level will
be held off until case logs are caught up.
 Example: If TURP cases are low, it is resident’s responsibility to adjust
their schedule when cases are assigned during Indications Conference.
Resident needs to go to the attending for assistance.
o Resident to provide up to date CV
o Scholarly activity update since last report
 Requirement for progression to PGY5
 2 publications as 1st author
 2 presentations at national meetings
o CD with publications, presentations, databases since last report
 Presentations are to be current in Medhub
 Abstracts, manuscripts, etc., to be current in Medhub portfolio section
o
o
o
o
o
o
o

Professionalism
 Certificate of completion of AUA ethics for urology module
 Completion of IPM
 AUA robotics training requirements
Evidence of educating lower level residents or medical students, if any.
Quality improvement projects, if any
 Identification of quality issues
Service on College of Medicine or OU Medical Center committees
Awards
Ongoing research or quality improvement projects and timeline for completion
Self evaluations
Criteria for not promoting residents to next level including graduation
o <30% on inservice exam after completing remediation the year prior
o Did not complete 2 publications and 2 presentations at national meetings
o Problems in professionalism
o Falls 10% below other peers will prompt being held back until case volume is
caught up
o Underperforming in any 2 competencies will result in additional time in same
PG year
o Per Dr. Zubialde – GME will pay for extra time resident has to spend
Residents are evaluated using the following forms

PGY1/Pre-Urology 4-Month Presbyterian Rotation



PGY2/URO1 Presbyterian Tower Rotation
PGY2/URO1 Private Adult Clinic OUPB
PGY2/URO1 VAMC Clinic Portion



PGY3/URO2 Presbyterian Tower Rotation
PGY3/URO2 Children’s Hospital Rotation Evaluation
PGY3/URO2 DVAMC Rotation


PGY4/URO3 Presbyterian Tower Rotation
PGY4/URO3 Transplant Rotation Evaluation


PGY5/URO4 Presbyterian Tower Rotation
PGY5/URO4 DVAMC Rotation




Evaluation of Resident Performance in a Clinic Setting
Observed Patient Encounter Rating Form
Operative Performance Rating Form
Global Resident Competency Rating Form









Conference Presenter Evaluation Form
Female Urology & Urodynamics Conference Evaluation Form
Case Presentations – Junior Resident Receiver
Case Presentations – Presenting Resident
Journal Club Participation
Pathology Conference Participation
Transplant Conference
Morbidity and Mortality Conference Evaluation
360 Rating Form
Page 26





360 Peer Rating Form
General Observations – Comments
Memo for Record
On Call Activity/Patient Handover Log – Evaluation of Resident Compliance
Evaluation of Residents at the end of Rotation




Minimally Invasive and Endoscopic Workshop for Residents Performance Rating Form
Mock Board Evaluation of PGY4
Mock Board Evaluation of PGY5
Urologic Reconstruction, Urinary Incontinence, POP and ED Workshop for residents Performance Rating Form
At the end of the rotation, residents are required to enter evaluations into the online Medhub evaluation system on the
following:
 Evaluation of Faculty
 Urology Program Rotation Evaluation Form
At the end of the residency, residents are required to evaluate the residency program and faculty using the online
Medhub evaluation system on the following:
 Graduating Resident Evaluation of Program and Faculty Form
At the end of the residency year (or more often if necessary), faculty are required to evaluate the residency program
using the anonymous online Medhub evaluation system on the following:
 Urology Faculty Confidential Survey/Evaluation of the Urology Program
Residents are also given the opportunity to evaluate learning activities such as Mock Boards, Urologic Reconstruction,
Urinary Incontinence, POP and ED Workshop, Minimally Invasive and Endourology Workshop, Urologic Emergencies
Workshop and the Robotics Skills Set Workshop.
 Teaching Activity Evaluation by Residents
 Minimally Invasive and Endoscopic Workshop Resident Evaluation of Participating Faculty
 Minimally invasive and Endoscopic Workshop Resident Evaluation of Workshop
 Urologic Reconstruction, Urinary Incontinence, POP and ED Workshop Resident Evaluation of Participating Faculty
 Urologic Reconstruction, Urinary Incontinence, POP and ED Workshop Resident Evaluation of Workshop
Page 27
Effective March 2013, ACGME implemented the Urology Milestones.
The Milestones are designed only for use in evaluations of resident physicians in the context of their participation in
ACGME-accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the
development of the resident physician in key dimensions of the elements of physician competency in a specialty or
subspecialty. A copy of the complete set of milestones has been uploaded into Medhub under Orientation 2013 – 2014
Resources/Documents.
By the end of the PGY1 year, the resident will have mastered Level 1 of the ACGME milestones before progressing to the
PGY2 year.
During the PGY2 year, the resident will continue to master Level 1 of the ACGME milestones and work toward mastering
Level 2 of the ACGME milestones.
By the end of the PGY3 year, the resident will continue mastery of Levels 1 and 2 of the ACGME milestones and will have
progressed towards mastery of the Level 3 ACGME milestones.
By the end of the PGY4 year, the resident will continue mastery of Levels 1, 2 and 3 of the ACGME milestones and will
have progressed towards mastery of the Level 4 ACGME milestones.
During the PGY5 (chief) year, the resident will have shown continued mastery of the Levels 1, 2 and 3 of the ACGME
milestones. During this year, the resident will progress towards mastery of Level 4 of the ACGME milestones with the goal
of mastering Level 5.
It is understood that not all PGY5 residents will graduate with a mastery of Level 5 of the ACGME milestones.
Page 28
PC1 Gathers Information by Interviewing the Patient or Surrogate and Performing a Physical Examination
Level 1
Level 2
Level 3
Level 4
Level 5
Acquires general history Acquires accurate and
Obtains relevant
Role models gathering
Highly efficient at
from patient and is able
relevant history from the historical subtleties that
subtle and reliable
gathering information,
to elicit genitourinary
patient in an efficiently
inform and prioritize
information from the
including history and
complaints.
customized, prioritized,
both differential
patient for junior
physical exam.
and hypothesis-driven
diagnoses
members of the health
Performs an accurate
fashion for genitourinary and diagnostic plans,
care team, particularly
general physical
complaints.
including sensitive,
for sensitive aspects
Examination.
complicated, and
of genitourinary
Performs an accurate
detailed information that conditions.
physical examination
may not often be
that is appropriately
volunteered by the
Routinely identifies
targeted to a patient’s
patient.
subtle or unusual
genitourinary complaints
physical findings
and medical condition.
Identifies common
pertinent to
genitourinary exam
genitourinary conditions.
findings routinely, but
inconsistently is able to
identify subtle physical
exam findings.
PC2 Uses Diagnostic Tests and Procedures, Including Performance and Interpretation of Imaging Studies
Level 1
Level 2
Level 3
Level 4
Level 5
Selects and performs
Selects and performs
Selects appropriate
Consistently uses
Uses and performs
appropriate diagnostic
appropriate diagnostic
routine diagnostic tests
routine and advanced
routine and advanced
tests and/or imaging
tests and/or imaging
based on patient’s
diagnostic tests and
diagnostic tests in an
procedures for general
procedures based on
genitourinary
imaging procedures in a efficient fashion
complaints.
patient’s genitourinary
complaints and medical
judicious fashion based
based on patient’s
complaints and medical
condition.
on patient’s
genitourinary
condition.
genitourinary
complaints and
Familiar with indications complaints
medical condition.
for advanced diagnostic and medical condition.
tests and/or procedures.
Makes appropriate
Makes appropriate
clinical decisions
clinical decisions based
based on common and
on common diagnostic
advanced diagnostic
test results.
test results.
Applies results of
advanced diagnostic
testing with supervision.
Selects and performs
imaging studies based
on patient’s
genitourinary complaint
and medical condition.
Page 29
PC3 Generates a Differential Diagnosis
Level 1
Level 2
Creates a differential
Creates a differential
diagnosis for general
diagnosis that includes
complaints from
common causes of
patient’s history and
urologic complaints.
physical.
Level 3
Creates a differential
diagnosis that includes
common and
uncommon causes of
urologic complaints.
Prioritizes potential
causes of patient
complaint using
information-gathering
skills.
Level 4
Creates a differential
diagnosis that includes
common and
uncommon
causes of urologic
complaints.
Level 5
Creates a differential
diagnosis that
includes common,
uncommon, and
rare causes of urologic
complaints.
Rapidly generates
differential and strategy
to finalize diagnosis.
Rapidly generates
differential and
strategy to finalize
diagnosis for multiple
urologic complaints.
PC4 Develops a Patient Care Plan, Including Medical, Surgical, and/or Radiologic Interventions. Counsels Preoperative
Patients Regarding Treatment Options. Discusses Risks, Benefits, and Alternatives (Informed Consent Process). Counsels
Patients Regarding Potential Short- and Long-Term Impact of Interventions on Quantity and Quality of Life, as Applicable.
Adapts Initial Plan as Subacute or Chronic Condition Evolves
Level 1
Level 2
Level 3
Level 4
Level 5
Develops rudimentary
Develops plan for
Develops plan for more
Develops plan for
Routinely and efficiently
plan for routine clinical
routine clinical problem
complex clinical
complex clinical
develops plan for
problem.
with defined treatment
problem in otherwise
problem in patient with
complex clinical
options in otherwise
healthy patient.
multiple comorbid
problem in patient with
Understands basic
healthy patient.
conditions.
multiple comorbid
elements of informed
Counsels patients for
Conditions.
consent.
Counsels patient for
routine, intermediateCounsels patients for
routine, lower risk
risk urologic
complex, higher risk
Counsels patients for
Interventions.
interventions.
urologic interventions,
complex, higher isk
with potential impact on
urologic interventions,
quantity and/or quality
with potential impact on
of life.
quantity and/or quality
of life.
PC5 Performs Intraoperative and Postoperative Management of Patients, Including Recognition and Treatment of
Physiologic Alterations and Complications
Level 1
Level 2
Level 3
Level 4
Level 5
Identifies alterations in
Identifies common
Identifies and manages
Identifies and manages
Efficiently identifies and
normal physiology.
intraoperative and
less common
common and
manages common and
postoperative
intraoperative and
uncommon
uncommon
alterations and
postoperative
intraoperative and
intraoperative and
Complications.
alterations and
postoperative
postoperative
complications.
physiologic alterations
physiologic alterations
Manages common
and complications.
and complications.
complications, with
Identifies and manages
appropriate helpcommon later
seeking behavior as
complications of
necessary.
urologic interventions.
Page 30
PC6 Performs Open Surgical Procedures
Level 1
Level 2
Closes incisions for
Creates and closes
routine urologic
surgical wounds for
procedures under
routine urologic
direct supervision (as
Procedures.
defined in the Program
Requirements).
Performs routine
urologic procedures
appropriate for level
of education.
Level 3
Plans, creates, and
closes surgical wounds
for routine urologic
procedures.
Level 4
Plans, creates, and
closes surgical wounds
for routine and complex
urologic procedures.
Manipulates, repairs,
and excises (as
necessary) internal
structures with
appropriate instrument
selection and technique
for routine urologic
procedures.
Manipulates, repairs,
and/or excises (as
necessary) internal
structures with
appropriate instrument
selection for majority
urologic procedures.
Level 5
Manipulates, repairs,
and/or excises (as
necessary) internal
structures with
appropriate instrument
selection for majority
routine and complex
urologic procedures.
Demonstrates capacity
to perform surgical
procedures
independently.
PC7 Performs Endoscopic Procedures of the Upper and Lower Urinary Tract
Level 1
Level 2
Level 3
Level 4
Obtains access and
Obtains access and
Obtains access to
Obtains access to
performs examination of performs examination
bladder, ureter, and
bladder, ureter, and
bladder in a female
of bladder and ureter for kidney, as appropriate
kidney for routine and
under direct supervision routine cases.
for level of education.
complex cases.
(as defined in the
Program
Manipulates endoscopic Manipulates endoscopic
Requirements).
equipment with
equipment with
appropriate instrument
appropriate instrument
selection and correct
selection and correct
force, speed, depth, and force, speed, depth, and
distance for routine
distance for majority
transurethral and
transurethral and
ureteroscopic cases, as ureteroscopic and
appropriate for level of
percutaneous cases.
education.
Performs routine
transurethral,
ureteroscopic, and
percutaneous
procedures with
independence.
PC8 Performs Laparoscopic/Robot-Assisted Surgical Procedures
Level 1
Level 2
Level 3
Manipulates
Manipulates
Obtains access and
laparoscopic equipment laparoscopic equipment insufflates abdomen for
as assistant for routine
with correct force,
routine cases.
cases without robotic
speed, depth, and
assistance under direct
distance as assistant for Manipulates
supervision (as defined
routine cases.
laparoscopic equipment
in the Program
with appropriate
Requirements).
instrument selection
and correct force,
speed, depth, and
distance for a portion of
routine cases, as
appropriate for level of
education.
Page 31
Level 4
Manipulates
laparoscopic and/or
robotic equipment with
appropriate instrument
selection and correct
force, speed, depth,
and distance for routine
cases.
Performs routine
laparoscopic
procedures
with independence.
Level 5
Manipulates endoscopic
equipment with
appropriate instrument
selection and correct
force, speed, depth, and
distance for majority
routine and complex
transurethral and
ureteroscopic and
percutaneous cases.
Obtains percutaneous
renal access.
Level 5
Manipulates
laparoscopic and/or
robotic equipment with
appropriate instrument
selection and correct
force, speed, depth,
and distance for most
routine and complex
cases.
PC9 Performs Office-Based Procedures
Level 1
Level 2
Performs routine
Obtains access to
outpatient procedures
bladder for routine office
under direct supervision procedures.
(as defined in the
Program
Requirements).
Level 3
Manipulates endoscopic
and office surgical
equipment with correct
force, speed, depth, and
distance for routine
procedures.
Level 4
Manipulates endoscopic
and office surgical
equipment with correct
force, speed, depth, and
distance for routine and
complex procedures.
Level 5
Performs complex
diagnostic and
therapeutic outpatient
procedures.
Demonstrates capacity
to teach and supervise
performance of officebased procedures.
Interprets office-based
ultrasound of the
kidney, bladder, and
genitalia.
Performs routine officebased procedures with
Independence.
SBP1 Works Effectively Within and Across Health Delivery Systems
Level 1
Level 2
Level 3
Describes basic levels
Knows unique roles of
Manages and
of systems of care.
and services provided
coordinates care and
by local health care
care transitions across
Identifies the types of
delivery systems and
multiple delivery
health care providers
how to access these
systems, including
within a health care
resources for patient
ambulatory, subacute,
delivery system.
care.
acute, rehabilitation,
and skilled nursing.
Knows and appreciates
the roles of a variety of
Advocates for quality
health care providers,
patient care and optimal
including consultants,
patient care systems.
therapists, nurses,
home care workers,
pharmacists, and social
workers.
Advocates for quality
patient care.
Level 4
Discusses nonpharmacologic and
nonprocedural patient
resources (eg, physical
therapy, social work,
alternative medicine
providers, chaplains)
with patients and
families.
Demonstrates how to
lead a health care team
by using the skills and
coordinating the
activities of
interprofessional team
members (physician
extenders/mid-levels,
nurses, medical
students, allied health
workers, etc.).
Negotiates patientcentered care among
multiple care providers.
Page 32
Level 5
Is adept at systems
thinking.
Capably leads the
health care team,
understanding personal
role as leader.
Contributes
meaningfully to
interprofessional teams.
SBP2 Incorporates Cost Awareness and Risk-Benefit Analysis into Patient Care
Level 1
Level 2
Level 3
Level 4
Recognizes the concept Knows common
Identifies the role of
Demonstrates the
of risk/benefit analysis
socioeconomic barriers
various health care
incorporation of cost
associated with
that impact patient care. stakeholders (health
awareness and riskobtaining and providing
care systems, hospitals, benefit principles into
health care.
Describes how costinsurance carriers,
complex clinical
benefit analysis is
health care providers,
scenarios.
Identifies basic
applied to patient care.
etc) and their varied
laboratory and
impact on the cost of
Minimizes unnecessary
radiographic tests that
Knows relative costs of
and access to health
care by ordering
are commonly
frequently used
care.
appropriate laboratory
performed, recognizing
diagnostic and
tests and radiographic
that each is associated
therapeutic
Demonstrates the
studies.
with specific costs.
interventions, such as
incorporation of cost
CT versus magnetic
awareness and riskUses essential
resonance imaging
benefit principles into
equipment with
(MRI) scans, and the
standard clinical
efficiency in the OR.
extent and ways they
judgments and decision
contribute to diagnostic
making.
accuracy and positive
patient outcomes.
SBP3 Works in Interprofessional Teams to Enhance Patient Safety
Level 1
Level 2
Level 3
Recognizes teamwork
Identifies, reflects upon, Dialogues with care
and communication
and learns from critical
team members to
failure in health care
incidents such as near
identify risk for and
as leading cause of
misses and preventable prevention of medical
preventable patient
medical errors.
errors.
harm.
Recognizes health
Understands methods
Identifies critical
system factors that
for analysis and
incidents, such as near
increase the risk for
correction of systems
misses and preventable error, including medical
errors.
medical errors.
device design, flawed
processes, easily
Applies structured
confusable medications, communication
barriers to optimal
techniques and tools,
patient care, and
such as Situationcompeting interests
Backgroundof different
Assessmentstakeholders.
Recommendation
(SBAR), during
Describes the value and handoffs and changes
use of techniques and
in patient condition.
tools for preventing
adverse events,
Leads briefings and
including checklists,
executes basic
briefings, and structured teamwork techniques
communication and
designed to prevent
teamwork protocols.
adverse events (such
as those in Crew
Resource Management
[CRM]).
Page 33
Level 4
Leads team analysis of
the effectiveness of
techniques applied to
prevent errors.
Partners with other
health care
professionals to identify,
propose, and implement
improvement
opportunities within the
system.
Uses specialized
principles and
techniques to study
potential sources and
causes of errors.
Level 5
Consistently
incorporates cost
awareness and riskbenefit principles into all
clinical scenarios.
Masterfully uses
common and highly
specialized equipment
within the OR.
Level 5
Develops and evaluates
communication and
teamwork techniques
designed to prevent
medical errors.
Uses advanced
specialized techniques
to study potential
sources and causes of
errors.
Coordinates and/or
leads system quality
improvement studies
and implementation
interventions.
SBP4 Uses Technology to Accomplish Safe Health Care Delivery
Level 1
Level 2
Level 3
Explains the role of the
As is applicable in the
Efficiently uses
electronic health record
institution, uses the
information systems for
(EHR) and
EHR to order tests,
patient care, including
computerized physician
medications, and
literature review (see
order entry (CPOE) in
document notes, and
also ‘‘Practice-Based
prevention of medical
responds to alerts.
Learning and
errors.
Improvement’’ [PBLI]).
Recognizes the risks
and limitations added
Demonstrates
by EHRs.
medication
reconciliation for
patients by using a
variety of strategies.
Level 4
Contributes to reduction
of risks of automation
and computerized
systems by reporting
system problems.
Uses decision support
systems in EHR (as
applicable in the
institution).
Level 5
Judges safety of
computer and device
interfaces by using
Heuristics.
Recommends systems
redesign for faculty
computerized
processes.
Critiques decision
support systems.
Consistently
demonstrates safe
practices to minimize
risks and limitations
added by EHRs.
PBLI1 Improves via Feedback and Self-assessment
Level 1
Level 2
Level 3
Accepts feedback from
Responds welcomingly
Maintains awareness of
faculty members and
and productively to
the situation and
senior residents
feedback from all
responds to situational
positively.
members of the health
needs.
care team, including
faculty members, peer
Demonstrates selfresidents, students,
reflection.
nurses, allied health
workers, and patients
and their advocates.
Level 4
Actively responds to
and uses feedback
from all members of
the health care team.
Reflects on feedback in
developing plans for
Improvement.
PBLI2 Learns and Improves by Asking and Answering Clinical Questions From a Patient Scenario
Level 1
Level 2
Level 3
Level 4
Recognizes general
Identifies specific
Formulates focused
Distinguishes different
information deficits
information needs
clinical questions for
types of clinical
(background
(background
questions that relate to
questions aside from
information) as they
information) as they
therapy.
therapy (ie, prognosis,
become apparent in
emerge in patient care
diagnosis, costclinical encounters.
Activities.
effectiveness).
PBLI3 Acquires the Best Evidence
Level 1
Level 2
Performs unsystematic
Uses medical
searches for research
information systems to
findings with little
find medical information
discrimination of the
but lacks ability to
quality of the resource.
discriminate resources
and search efficiently.
Page 34
Level 3
Effectively and
efficiently searches
National Library of
Medicine database for
original clinical research
articles.
Level 5
Calibrates selfassessment with
feedback and other
external data.
Level 4
Effectively and
efficiently searches
evidence-based
summary medical
information resources
(preappraised evidence)
and filters to enhance
search.
Level 5
Sets up an information
system to stay current
with the current best
evidence on select
topics.
Level 5
Demonstrates
information mastery by
effectively and
efficiently tapping into a
variety of information
resources.
PBLI4 Appraises the Evidence for Validity, Impact, and Applicability
Level 1
Level 2
Level 3
Demonstrates a basic
Demonstrates an
Assesses the impact
understanding of the
understanding of main
and applicability of
‘‘hierarchy of evidence’’
types of study design
results from a variety of
concept.
for clinical research.
study designs.
Understands how bias
and confounding are
minimized at higher
levels of the ‘‘hierarchy
of evidence’’.
Understands the basic
concepts underlying
hypothesis testing.
PBLI5 Applies the Evidence to Decision Making for Individual Patients
Level 1
Level 2
Level 3
Uses research evidence Determines whether
Seeks to integrate the
to guide clinical decision clinical evidence from a
entire body of evidence
making for individual
single study can be
for a clinical question in
patients.
generalized to an
reaching a clinical
individual patient.
decision.
PBLI6 Improves the Quality of Care for a Panel of Patients
Level 1
Level 2
Level 3
Demonstrates general
Demonstrates
Engages in team-based
appreciation of the need commitment to
quality improvement
to constantly improve
providing high-quality
interventions.
quality and safety.
care in clinic by raising
specific quality and
safety issues.
PBLI7 Participates in the Education of Other Team Members
Level 1
Level 2
Level 3
Fully participates in
Attends and participates Informally teaches
required didactic
actively in teaching
fellow residents,
activities.
conferences.
medical students, and
other health care
Teaches medical
professionals.
students.
Level 4
Appraises studies of
harm, diagnosis, and
prognosis for validity,
impact, and
applicability.
Demonstrates a
thorough understanding
of study design and
hypothesis testing.
Level 4
Assesses the clinical
context, the patient’s
values and preferences,
and the quality of
evidence to reach a
clinical decision.
Level 5
Applies a framework for
making clinical
recommendations,
based on the quality of
evidence and
anticipated ratio of
benefit to harm.
Level 4
Identifies areas in his or
her own practice and
local system that can be
changed to improve the
processes and
outcomes of care.
Level 5
Internalizes
commitment to
continuous quality and
safety improvement.
Level 4
Organizes didactic
educational activities,
including determination
of educational content.
Level 5
Takes responsibility for
education for residents
at all levels of
education.
Formally teaches fellow
residents, medical
students, and other
health care
professionals.
Mentors junior
colleagues and other
team members.
Page 35
Level 5
Appraises systematic
reviews, clinical practice
guidelines, and costeffectiveness studies for
validity, impact, and
applicability.
ICS1 Communicates Effectively With Patients and Families With Diverse Socioeconomic and Cultural Backgrounds

Medical Interviewing (also see PC)

Counseling and Education (also see PC)

Hospitalization Updates

Delivering Bad News

Informing About Medical Error
Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates adequate Exhibits most of the
Consistently and
Consistently and
Is capable of effective
skills of listening
basic communication
capably exhibits basic
capably exhibits basic
communication in the
without interrupting,
skills during medical
communication skills in
communication skills in
most challenging and
ensuring his or her
interviews, counseling
nonstressful situations
a variety of contexts.
emotionally charged
message was
and education, and
and in some stressful,
situations, and invites
understood, and allows
hospitalization updates
challenging situations,
Consistently, capably,
participation from all
an opportunity for
when the patient
for example, time
and confidently delivers
stakeholders.
questions.
condition is nonacute or stressed, when patient’s bad news to the family
life-threatening.
condition is acute or
about complications and
Demonstrates
lifethreatening, or when
death, and informs them
sensitivity to patients’
the patient is mentally
of a medical error that
Cultures.
impaired.
caused harm.
Can capably deliver bad
news to the patient or
family, related to
condition severity.
Role models effective
communication to junior
colleagues.
ICS2 Effectively Counsels, Educates, and Obtains Informed Consent (see PC)
Level 1
Level 2
Level 3
Level 4
Provides limited
Exhibits most patientConsistently and
Provides patientinformation, minimal
centered basic skills
capably performs
centered counseling in
therapeutic advocacy,
above, but consistently
patient-centered skills
cases of acute and
and generic risk and
checks for patient
while counseling and
probable terminal
benefit analysis.
understanding and
obtaining informed
illness.
invites questions.
consent across a
diverse set of situations
Gaps may be present in involving serious illness.
condition-specific
information related to
Condition-specific
risks, benefits, and
information related to
treatment options.
risks, benefits, and
treatment options is
mostly complete and
accurate.
Level 5
Demonstrates highly
proficient counseling
behaviors that are
carefully personalized
and participatory.
These behaviors allow
predictive
recommendations with
high resolution of the
anticipated benefits and
possible risks and
complications.
ICS3 Communicates Effectively With Physicians, Other Health Professionals, and Health-Related Agencies

Writing Diagnostic Reports

Referral (Oral and Written)

Consultations (Oral and Written)

Medical Records
Level 1
Level 2
Level 3
Level 4
Level 5
Orally communicates
Exhibits skills in some
Capably and
Anticipates and
Capably disseminates
and documents
cases.
consistently delivers
prevents poor team
cogent information of an
information of a basic
complete, key, and
communication and
essential nature in a
nature regarding a
May include
timely information
effectively manages
fashion that leads to
patient’s urologic
nonessential
organized in
conflicts arising from
efficient resolution of
problem.
information and may fail accordance with
less skilled residents.
urologic patient care
to deliver information on established protocols
issues.
time.
and standards.
Page 36
ICS4 Communicates Effectively During Care Transitions and Consultations With Fellow Residents
Level 1
Level 2
Level 3
Level 4
Demonstrates ability to
Capably uses one form
Demonstrates most
Consistently and
summarize and transfer of communication to
components but
capably demonstrates
key information about
transfer key information, inconsistency and
all handover
patient issues when
invites questions, and
lapses may occur in
components across a
transferring care.
seeks advice for
time-stressed or
range of situations.
challenging situations.
otherwise challenging
situations.
Level 5
Always transfers care in
a manner that is
thorough, personal, and
anticipatory by using a
checklist that clearly
delineates responsibility
and invites questions
and feedback.
ICS5 Works Effectively as a Member or Leader of a Health Care Team or Other Professional Group (also see SBP3)

OR Team

Clinical Team (Office, Inpatient, or Outpatient/Clinic)

Professional Work Groups and Committees (eg, Quality Improvement, Research)
Level 1
Level 2
Level 3
Level 4
Level 5
Communicates and
Consistently engages in Follows communication
Demonstrates good
Leads by example
listens with sensitivity
basic communication
protocols for updating
team leadership skills,
and fosters continuous
and respect for all
and interpersonal
members on patient
including providing
collaborative
members of the health
behaviors that facilitate
status, and expresses
direction, inviting and
communication in any
care team.
effective teamwork,
himself or herself in an
using input, providing
situation.
including timely sharing
objective,
feedback, creating a
of information, treating
straightforward way in
positive team climate,
team members
situations of
managing conflict, and
respectfully, being
disagreement and
using briefing protocols
approachable and
conflict.
that facilitate safe care.
cooperative.
Recognizes duality of
roles in that at times he
or she must be able to
step into a leadership
role when chief resident
is indisposed/
unavailable, while at
other times must act as
basic team member,
despite more advanced
knowledge base.
P1 Demonstrates Adherence to Ethical Principles
Level 1
Level 2
Working under
Occasionally may be
supervising physician,
inclined to take on tasks
recognizes examples of beyond own ability but
limiting task selection
generally asks for help
among more senior
when needed.
residents.
Level 3
Usually conveys
discomfort with
unfamiliar tasks and will
decline to proceed
independently when not
supervised.
Level 4
Never takes on tasks
beyond own ability and
reliably asks for help
when needed.
Always knows when to
refer patients and does
not hesitate to do so.
Very comfortable
working with more
senior colleagues to
refine skills.
Page 37
Level 5
Demonstrates the ability
and willingness to point
out to peers and
trainees concerns
regarding appropriate
task selection.
P2 Demonstrates Compassion, Integrity, and Respect for Others
Level 1
Level 2
Level 3
Working under
Works well with others
Almost always viewed
supervising physician,
but on occasion may
as a team player, but
recognizes and reflects
not follow through on
under conditions of high
in writing on both
stated commitments.
workload may not follow
positive and negative
through on stated
witnessed examples of
Occasionally displays
commitments.
compassion, integrity,
lapses in respectfulness
and respect for others.
and compassion.
Occasionally displays
lapses in respectfulness
and compassion in
difficult, stressful, highly
demanding situations.
Level 4
Is a strong team leader
who always puts patient
needs above his or her
Own.
Is always respectful and
Considerate.
Consistently able to
deal appropriately with
patient and family
emotions.
Level 5
Demonstrates the ability
and willingness to point
out to peers and
trainees concerns
regarding observed
behaviors that are not
within the URO-4
standard for
compassion, integrity,
and respect for others.
Consistently honest and
responsive to other
members of the health
care team.
P3 Demonstrates Responsiveness to Patient Needs That Supersede Self-interest
Level 1
Level 2
Level 3
Level 4
Working under
Usually follows through
Is consistently prompt
Always follows through
supervising physician,
with patient care
and responsive, even
with obligations to
recognizes and can
obligations, but
when not personally
patient care Is proactive
reflect in writing on both occasionally needs to
convenient.
in reminding junior
positive and negative
be reminded of the
residents of importance
witnessed examples of
importance of prompt
Almost always
of prompt
being responsive to
responsiveness in
completes tasks on time responsiveness in
patient needs that
checking patient data
and usually accepts
patient care.
supersede self-interest.
and initiating patient
responsibilities willingly.
assessment, even when
Always accepts
not personally
feedback willingly.
convenient.
Tasks are always
completed in a careful
and thorough manner.
P4 Demonstrates Respect for Patient Privacy and Autonomy
Level 1
Level 2
Level 3
Working under
Has occasional minor
Has rare lapses in
supervising physician,
lapses in patient
patient confidentiality.
recognizes and can
confidentiality.
reflect in writing on both
Almost always mindful
positive and negative
Infrequently reof patient privacy
witnessed examples of
discusses clinical
concerns.
respect for patient
cases in common areas.
privacy and autonomy.
Level 4
Has no lapses in patient
confidentiality.
Reminds junior
residents of importance
of maintaining patient
confidentiality at all
times.
Always able to
recognize and honor
patient privacy
concerns.
Page 38
Level 5
Demonstrates the ability
and willingness to point
out to peers and
trainees concerns
regarding observed
behaviors that are not
within the URO-4
standard for being
responsive to patient
needs that supersede
self-interest.
Level 5
Demonstrates the ability
and willingness to point
out to peers and
trainees concerns
regarding observed
behaviors that are not
within the URO-4
standard for maintaining
respect for patient
privacy and autonomy.
P5 Demonstrates Accountability to Patients, Society, and the Profession
Level 1
Level 2
Level 3
While working under
Is usually responsive to
Consistently takes
supervising physician,
criticism and
responsibility for actions
demonstrates
understands importance and behavior.
awareness of the
of compliance and
importance of record
improvement.
Is able to admit
completion and
mistakes in most cases.
participates in these
Periodically falls behind
responsibilities as part
in completion of medical Almost always
of a team.
records or Surgical
completes medical
Logs during times of
records and Surgical
heavy clinical
Logs on time.
responsibility.
Level 4
Mentors and supports
junior residents in
completion of such
responsibilities.
Admits mistakes readily.
Always recognizes
conflicts of interest.
Level 5
Demonstrates ability to
function in an oversight
capacity in the clinical
practice environment
with regard to medical
staff compliance
matters related to
documentation and
medical records
completion.
Consistent in timely
completion of medical
records and Surgical
Logs.
P6 Demonstrates Sensitivity and Responsiveness to Diverse Populations, Including Diversity in Gender, Age, Culture,
Race, Religion, Disabilities, and Sexual Orientation
Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates reflective Usually sensitive to
Almost always
Always sensitive to
Demonstrates ability to
thinking, through written cultural and other
demonstrates sensitivity cultural and other
critique residents and
portfolio entries,
patient diversity
to patient diversity
patient diversity
peers with regard to
regarding specific
matters, but
matters and usually
matters.
observed diversity and
patient experiences that occasionally needs to
recognizes ethical
cultural sensitivity
raise cultural and
be reminded by senior
dilemmas related to
Anticipates complex
issues or concerns.
diversity issues.
colleagues to be more
cultural differences.
needs of diverse patient
aware of the needs of
groups and leads team
diverse patient groups.
effort in demonstrating
sensitivity and
responsiveness.
Never discriminates in
providing care.
MK Demonstrates Level-Appropriate Competency in Core Domainsa as Indicated by Performance on the American Board of
Surgery In-Training Examination (ABSITE) and AUA Resident ISE
Level 1
Level 2
Level 3
Level 4
Level 5
Achievement of a
Achievement of a
Achievement of a
Achievement of a
Achievement of a
percentage correct
percentage correct
percentage correct
minimum percentage
minimum percentage
score of 26 to 35 on the score of 36 to 45 on the score of 46 to 55 on the correct score of 56 to 65 correct score of 65 on
AUA Resident ISE.
AUA Resident ISE.
AUA Resident .ISE
on the AUA Resident
the AUA Resident ISE.
ISE.
URO-1 only:
Achievement of a
percentage correct
score of 26 to 40 on
the ABSITE.
a
Core Domains: Female Pelvic Medicine, Neurogenic Bladder and Incontinence, BPH and Voiding Dysfunction, Reconstruction, Calculus Disease,
Fistulae, Adrenal Disease, Transplantation, Pediatrics, Reproductive and Sexual Dysfunction, Uroradiology and Radiation Safety, Biostatistics and
Epidemiology, Infectious Disease, Hypertension and Renovascular Disease, Renal, Trauma, Medical Oncology, Anatomy, Physiology, Geriatrics,
Infections, and Uropathology.
Page 39
Summative Evaluations
The program director provides a summative evaluation for each resident upon completion of the program. This evaluation
becomes part of the resident’s permanent record maintained by the institution, and is accessible for review by the resident
in accordance with institutional policy.
This evaluation includes documentation of the resident’s performance during the final period of education and verifies that
the resident has demonstrated sufficient competence to enter practice independently as of the date of completion.
EVALUATION – MEDICAL KNOWLEDGE
The yearly AUA In-Service examination will be used as one means of medical knowledge. A score of less than 40% will
prompt remediation plan including a structured study program.
Page 40
SCHOLARLY ACTIVITIES
The curriculum advances residents’ knowledge of the basic principles of research, including how research is conducted,
evaluated, explained to patients, and applied to patient care. Residents participate in scholarly activity. Documentation of
resident performance of scholarly activity is demonstrated by manuscript preparation, lectures, teaching activities,
abstracts and active performance of research or participation in clinical studies and reviews.
By the end of the PGY-4 year, each resident is expected to have fulfilled the following scholarly activity requirements:
 Two presentations at National urological meetings
 Two publications as first author in peer-reviewed journals
EDUCATIONAL RESOURCES for SELF STUDY: (P, PBL, MK)
 Wieder’s Pocket Guide to Urology
 Journal of Urology
 AUA Updates
 AUA Online Access
 Campbell’s Urology
 Smith’s Urology
 Self-Assessment Study Program (SASP)
 Online resources including OUHSC Library’s Online access
 OUHSC Library full access to EJournals and EBooks
Page 41
TRANSITION OF CARE AND HANDOVER PROCESS/DUTY HOURS – updated 09/20/2011
The Department of Urology Residency Program is committed to and assumes full responsibility for promoting patient safety
and resident well-being and in providing a supportive educational environment.
The learning objectives of this program will not be compromised by excessive reliance on residents to fulfill service
obligations.
Didactic and clinical education has priority in the allotment of residents’ time and energy.
Duty hour assignments reflect that faculty and residents collectively have responsibility for the safety and welfare of patients.
All urology residents adhere to the ACGME mandated duty hours policy. Urology residents take home call.
•
•
•
•
•
PGY-1: no call while on urology rotation
PGY-2: home call – 1st call, all services
PGY-3: home call – 1st call, all services
PGY-4: home call – 2nd call, all services
PGY-4 TX resident: home call – 2nd call, not to exceed q3 to ensure compliance with ACGME TOAD requirements, all
services
PGY-5: home call – 2nd call, all services
Pediatric fellow: 3rd call, home call, pediatric urology only
Endourology fellow: TBD
•
•
•
Service Team to On Call – Junior/Upper Level Residents/Attendings

At 5:00 pm during weekdays, on call residents and attendings will receive a list of all patients and consults on the
urology service to include Team 1 (DJC), Team 2 (GS), VAMC, CHO and Transplant.


A printed list of all patients is to be given to the on call resident. The on call resident will then give these lists (five) to
Beverly Shipman, Resident Coordinator, the next day. This can be accomplished by fax, email, scan or in person.

If on call team has specific studies pending that he/she needs to check, detailed instructions will be provided on how
to handle results on these lists.

If on call team has procedures that are pending in OR or on the floor, specific instructions will be provided in these
lists.

Since the same attending is on call during the day and night, there will be no disruption of continuity of care (as the
attendings are always available/present to help).
On Call (night) Team to Each Service
A detailed email will be sent out to the following:
All urology residents
All urology clinical attendings
Resident coordinator
Glenn Sulley, adult clinic coordinator
Stephanie Harding, pediatric clinic coordinator
Roger Timm, VA urology clinic coordinator
Steve Roe, adult urology resident clinic coordinator
Mani Vijayan, transplant clinical director
summarizing the night’s events by 7:00 am. This information is to ensure proper patient handoffs, proper coverage of clinics
and OR and to ensure appropriate ACGME guidelines for resident sleep. (P, IC, PBLI)


Email will include:
For all phone calls, consults, patients seen in ER or on the floor, the following information is required:
Page 42













Date and Time
# Consults
Hospital
Patient Name
Patient Medical Record #
Events that Occurred
o Action Taken
Pending Items
Patient Phone Calls (#, time, name)
Reason for Phone Call
o Action Taken
Attending physician will already be familiar with the night’s events and will ensure no disruption in continuity of care.
Amount of time spent in hospital seeing patients – to include time arrived at patient and time left patient
The total amount (# of hours) of uninterrupted sleep the resident had
If procedures are performed
o Last name of the patient
o What was performed
o Which urology service
o If the patient was admitted
Weekends


During weekends, the handover will occur at 7:00 am on Saturday and Sunday from on call team to the primary team.
The primary team will do handover by 10:00 am at the latest to an on call team.
Handovers q 4 Month During Service Changes


A list of all patients and consults will be provided for each service to an incoming team.
Each patient will be rounded on by the outgoing and incoming team at each hospital on the pm rounds.
DUTY HOURS – In addition to the ACGME mandated duty hours, the following rules are set.
 Unless the residents on call are called into the hospitals, no residents are to report earlier than 5am.

PGY1/2 residents – if they report at 5am, they are to leave by 7pm. No exceptions.

PGY3/4/5 and fellows – if not out by 7pm, schedules will be adjusted to provide 10 hours rest.
Page 43
PGY-1/Pre-Urology Rotation (4 month – Urology), Teams 1 and 2 Presbyterian Tower
As part of the PGY-1/pre-urology year, the resident will rotate for four months with the busy Presbyterian Tower Teams 1 and
2 urology resident team participating in the care of inpatient and outpatient urological problems with Level 1 supervision.
During the PGY-1 urology year, the resident is expected to complete both the online and in-house IRB educational training
on human participant protection. They will also be trained in OUMC’s electronic medical record system of Meditech as well
as the OUPB medical record system of Centricity EMR. During this year, the resident will be introduced to the six core
competencies (PC, IC, MK, PBLI, P, SBP) with emphasis on integrating them into the team approach to the diagnosis and
treatment of urologic conditions.
Goals
 Learn basic diagnostic and treatment strategies for patients with urologic problems (PC, MK, P)
 Gain basic understanding of the principles of evidence-based urology treatment parameters (MK, PC)
 Acquire basic surgical skills including manual dexterity, proper handling of surgical instruments, and knot tying
proficiency (MK, PC)
 Introduction to the team approach to clinical care with emphasis on the basic principles of coordinating patient care within
a standard and complex health care system (PC, P, IC, SBP, PBLI)
 Gain awareness of the resources available in the health care system that will allow optimal coordination of patient care
(PBLI, SBP)
Evaluations – Appendix 3
Evaluations are done at the end of the rotation by supervising faculty, residents and ancillary staff and entered into MEDHUB
(College of Medicine sponsored resident tracking program) using Form(s) 1, 14, 15, 16, 17, 18, 20, 22, 23, 25, 26, 27, 30, 31,
and 34. A review of all evaluations done on the resident during that rotation are also reviewed by the Program Director at
this time.
On Call Activities
PGY-1 urology residents while on the 4 month urology service, do not take call activities of any kind.
Supervision - Graded Authority and Responsibility:
All PGY1 residents will be supervised at a Level 1 in every resident activity. Supervising faculty physicians will delegate
progressive portions of patient care to PGY1 residents, as appropriate, at a Level 1. Progressive authority and responsibility
will be given based on direct observation and medical knowledge.
Block Diagram - PGY-1/Pre-Urology
PGY1
4 months
Pre-Uro
Presby, Team1, Team 2, OUPB Adult Clinic
Page 44
Mon am:
Mon pm:
Mon 5-7pm:
Tues am:
Tues pm:
Wed am:
Wed pm:
Thurs am:
Thurs pm:
Fri 6-8am:
Fri am:
Fri 1-3pm:

Morning Rounds with Attending
Operating Room/Clinic
Operating Room/Clinic
Evening Rounds with Attending
Morning Rounds with Attending
Operating Room/Clinic
Operating Room/Clinic
Evening Rounds with Attending
Morning Rounds with Attending
SASP Self Study
Operating Room/Clinic
Operating Room/Clinic
Evening Rounds with Attending
Urology Educational Conference
Morning Rounds with Attending
Operating RoomClinic
PPOB DOC Clinic
Evening Rounds with Attending
PGY-1/Pre-Urology Pre-Operative Evaluation Experience
Performance of this setting will be evaluated by faculty using Form 15 which is self-generated by the faculty in
Medhub. (PC, IC, MK, P, SBP, PBL)
o
o
o
o
o
o
o
o
o
o

Morning Rounds with Attending
Operating Room/Clinic
Operating Room/Clinic
Evening Rounds with Attending
Urology Educational Conference
Resident will recognize how to collaborate with the team and other services to provide care to pre-operative and
post-operative patients that is compassionate, appropriate and effective in standard clinical scenarios.
Resident will identify steps to ensure the patient is ready for surgery in pre-operative area in standard clinical
scenarios.
Resident will learn and identify the correct ordering of necessary labs and imaging prior to surgical intervention in
standard clinical scenarios.
Resident will learn how to identify and take steps to prevent reason for surgical cancellation in standard clinical
scenarios.
Resident will learn how to recognize appropriate documentation has been done, correct surgical site is marked and
other services are notified (if necessary) in standard clinical scenarios.
Resident will learn how to document discussion with patients undergoing standard surgical procedures.
Resident will learn the importance of identifying areas of self-improvement in area of pre-operative management in
standard clinical scenarios. (PBL)
If resident identified areas of pre-operative management that need improvement, he/she will discuss the quality
improvement issue with the team, i.e., correct pre-operative antibiotics, stoppage of blood thinners, cardiac
clearance in standard clinical scenarios.
Resident will learn how to work within the multi-professional team in outpatient surgery setting in a standard clinical
scenario.
Resident will learn how to identify factors that lead to surgery delay, unnecessary patient waiting or <24 hour
cancellation in standard clinical scenarios.
PGY-1/Pre-Urology Operating Room Experience
Page 45
Performance of these cases will be evaluated by faculty using Form 16 which is self-generated by the faculty in
Medhub. (PC, IC, MK, P, SBP, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
Resident will learn and be able to describe the clinical details of each standard clinical scenario.
Resident will learn how to identify and describe the findings on all relevant imaging in standard clinical scenarios.
Resident will be prepared for all cases by reading level specific articles, textbooks, surgical atlases and prior
operative notes and be able to effectively communicate this information.
Resident will learn basic instrumentation, materials needed, patient positioning and anesthesia needed to complete
standard cases.
Resident will read and be able to discuss prior to coming to OR the applicable pages from the AUA Handbook on
Laparoscopic Fundamentals and the AUA Handbook on Robotics.
Resident will learn and be able to describe cost awareness in standard scenarios.
Resident will learn how to work within the interprofessional OR team; scrub tech, circulator, IMS, anesthesiologists,
anesthesia resident, nurse anesthetists, attending surgeon, upper level surgeon.
Resident will learn how to identify system errors and describe it to the team in standard clinical scenarios.
Resident will learn and demonstrate the correct dictation of operative reports as required by attending physician
within 24 hours of completion of operation in standard clinical scenarios. These reports will be reviewed by
attending physician.
Resident will start learning how to bill and the required documentation in standard clinical scenarios.
Resident will learn how to effectively communicate with other members of Presbyterian team in order to provide
information about case details.
Resident will take responsibility for entering all cases performed into ACGME surgery log online system within one
week of case completion.
Resident will participate in the education of medical students.
Page 46

PGY-1/Pre-Urology Operating Room – Technical
Performance of these cases will be evaluated by faculty using the Form 16 which is self-generated by the
faculty in Medhub. (PC, MK, PBL)
Resident will perform as an assistant with Level 1 supervision:
o Transurethral resection cases (TURP, TURBT)
o Scrotal and inguinal surgery
o Stent placement (retrograde approach)
o Ureteroscopy (upper and lower)
o Cystoscopy
o Endourology/Stone Removal
o Extracorporeal Shock Wave Lithotripsy (ESWL)
Resident will also assist and perform with Level 1 supervision:
o Laparoscopy
o Male and female reconstruction
o Intestinal diversion
o Oncology cases including prostate, bladder, kidney, retroperitoneum.
o Renal Transplantation
Page 47
PGY1 Presbyterian Resident Clinic,
Performance of the following goals will be evaluated by faculty using the Form 14 by the faculty in Medhub. (PC,
IC, MK, P, SBP, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Resident will prepare for each sub-specialty clinic by reading applicable material and will be able to discuss.
Resident will learn the basics of direct patient care including initial evaluation, establishment of diagnosis, selection
of therapy and management of complications in standard clinical scenarios.
Resident will learn accuracy in medical billing including selecting appropriate E&M code, selecting appropriate
diagnosis.
Resident will learn how and be able to perform history and physical examination in a standard clinical scenario.
Resident will learn how to develop and discuss differential diagnosis and plan of care in standard clinic scenarios.
Resident will learn and be able to discuss how to effectively schedule patient for surgery in standard clinic
scenarios. This will include:
 Resident-patient discussion
 Risk/benefit assessment and communication
 Post-operative expectations
Resident will learn all the steps that need to be taken in order for patient to go from clinic to inpatient/outpatient
surgery
Resident will learn how to self-improve by identifying deficiencies in patient care. (PBLI)
Resident will participate in and be able to explain evidence based practice and will learn how to investigate sources
of information easily identifiable.
Resident will learn recognition in identifying quality improvement issues and bring them to attention of faculty and
upper level residents in standard clinical scenarios.
Resident will learn to practice cost awareness in standard scenarios. (SBP)
Resident will learn and recognize how to work effectively within interprofessional team of nurses, clinic manager,
clerks, schedulers, other residents and attendings in standard clinical scenarios. (SBP, P, IC)
Resident will learn efficiency in obtaining access and using EMR in the appropriate and correct manner. (SBP, IC)
Resident will learn how to communicate in clear and concise language when describing a standard clinical scenario.
(IC, MK)
Resident will learn and demonstrate proficiency in documentation of standard patient visits and will ensure that all
the needed information is included in the note. (IC, MK, SBP)
Resident will perform (Level 1 supervision) clinic procedures during clinic visits under standard circumstances.
Performance of these procedures will be evaluated by faculty using the Form 16 which is self-generated by the
faculty in Medhub. (PC, MK, PBL)
o
Resident will observe and will start performing with Level 1 supervision:
 Cystoscopy
 TRUS
 Prostate biopsy
 Stent removal
 UDY procedure and interpretation
 Cystogram
 Nephrostogram
 Nephrostomy tube change
 Renal ultrasound
 Pelvic ultrasound
o
Resident will learn and apply Clinical Ethics for urologist module
(http://www.auanet.org/eforms/cme/modules.cfm?ID=407) (http://www.auanet.org/content/guidelines-and-qualitycare/code-of-ethics/ethics.pdf) in standard clinical scenarios.
o
Resident will learn and perform dictations describing clinic procedures within 24 hours of service performed.
Page 48
PGY1 Rounding, In-Patient Work, Consults (Level 1 supervision)
Performance of these objectives will be evaluated by faculty using the Form 15 in Medhub.
Description: During rotation on Presbyterian Hospital, resident will participate in all aspects of inpatient care,
including consults. (PC, IC, MK, P, SBP, PBL)
Resident will:
o Have dedicated experience in evaluation and management of inpatient GU disease (PC)
o Perform standard history and physical examination with emphasis on GU system and GU complaint (PC)
o Learn and be able to describe diagnostic and therapeutic treatment options in standard clinical scenarios (PC, MK,
ICS)
o Work with other urology faculty, residents and medical students to coordinate care delivery provided by consult
team in standard clinical scenarios (IC, SBP, P)
o Learn and communicate findings from rounds or consults, including recommendations to requesting physicians (IC,
SBP)
o Learn and communicate results of tests, pathology results, intra-operative findings to patients and family in standard
clinical scenarios (IC, P)
o Review literature on disease processes encountered in patients. Based on literature and knowledge, the resident
will be able to describe patient care in standard clinical scenarios (PC, MK, PBL)
o Learn and be able to describe basic urology to medical students and other services requesting consults (IC, P, MK)
o Learn how to work effectively with other health care providers, including social workers, case managers, nurses,
pharmacists to optimize resources available to patients (IC, P, SBP, MK)
o Learn and be able to perform required documentation in order to provide accurate and useful information to other
team members, consulting teams, billing department (IC, P)
o Learn to practice cost awareness in standard clinical inpatient scenarios (SBP)
o Learn how to perform dictations including discharge summaries, admission notes, operative notes and consults
within 24 hours of service performed standard clinical inpatient scenarios
The resident on this rotation is expected to attend and participate in the following education activities:
Monday
Urologic Subspecialty Conference 5pm
Journal Club/Chapter Review 5pm
UroPathology (6x yr, 3 cases each) 4pm
Friday
Indications/Imaging/IVP Conference 6am
Urology Grand Rounds (two presentations) 7am
Chief Case Presentations (three presentations) 7am
Morbidity and Mortality Conference 7am
Page 49
PGY-2 (URO-1)
This PGY-2/URO-1 resident year is structured so that 8 months are spent at Presbyterian Tower participating in the PPOB
and DOC clinic and in inpatient and outpatient surgeries and consults; 4 months are spent at the Veteran’s Affairs Medical
Center Urology erectile dysfunction and procedures clinic.
This urology resident year provides continued exposure to the six core competencies (PC, IC, MK, PBLI, P, SBP) with
emphasis on integrating them into the team approach in the diagnosis and treatment of urologic conditions.
Successful completion of one year in an ACGME-approved general surgery pre-urology residency year is required prior to
being promoted to this urology resident year.
PGY-2 urology residents do not participate in the yearly Mock Oral Board Examinations.
Goals
 Continue to learn learn basic diagnostic and treatment strategies for patients with urologic problems (PC, MK, P)
 Continue to gain basic understanding of the principles of evidence-based urology treatment parameters (MK, PC)
 Continue to acquire basic surgical skills including manual dexterity, proper handling of surgical instruments, and knot
tying proficiency (MK, PC)
 Continue to learn the team approach to clinical care with emphasis on the basic principles of coordinating patient care
within a standard and complex health care system (PC, P, IC, SBP, PBLI)
 Continue to gain awareness of the resources available in the health care system that will allow optimal coordination of
patient care (PBLI, SBP)
Evaluations – Appendix 3
Evaluations are done at the end of the rotation by supervising faculty, residents and ancillary staff and entered into
MEDHUB (College of Medicine sponsored resident tracking program) using Form(s) 2, 3, 4, 5, 14, 15, 16, 17, 18, 19, 20, 22,
23, 25, 26, 27, 29, 30, 31 and 34. A review of all evaluations done on the resident during that rotation are also reviewed by
the Program Director at this time.
On Call Activities
PGY-2 urology residents take at home 1st call with Level 1 and 2 supervision.
Supervision - Graded Authority and Responsibility:
At all times, the PGY-2 urology resident, whether involved in patient care or clinical research activities, will be supervised by
qualified faculty and/or senior residents/fellows at a Level 1 Supervision level. Progressive authority and responsibility will
be given based on direct observation and medical knowledge.
Page 50
BLOCK DIAGRAM
PGY2
URO-1
8 months
4 months
Teams 1 and 2
Mon am: PT OR
Mon pm: PPOB Clinic
Mon 5-7pm: Urology Educational Conference
VAMC
Mon: Clinic/OR
Mon 5-7pm: Urology Educational Conference
Tue: PT OR
Tue: Clinic/OR
Wed: PT OR
Wed: Clinic/OR
Thurs: SASP Self Study, Female Urology
Conference, PPOB Clinic Urodynamics (perform
and interpretation)
Thurs 6am: VAMC Surgical Case Assignment and
Pathology Review Conference
Thurs: OR/Clinic
Fri 6-8am: Urology Educational Conference
Fri am: PT OR
Fri 1-3pm: PPOB DOC Clinic
Fri 6-8am: Urology Educational Conference
Page 51
Fri: VAMC Clinic – ED and Procedures Clinics, OR as
required
PGY2/URO1 PRESBYTERIAN TOWER TEAMS 1 AND 2 ROTATION

PGY2/URO1 Presbyterian Resident Pre-Operative Evaluation Experience
Performance of this setting will be evaluated by faculty using the Form 15 which is self-generated by the faculty
in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o

Resident will apply knowledge learned as a PGY1 and collaborate with the team and other services to provide care
to pre-operative and post-operative patients that is compassionate, appropriate and effective in standard clinical
scenarios.
Resident will apply knowledge learned as a PGY1and ensure the patient is ready for surgery in pre-operative area
in standard clinical scenarios.
Resident will identify the correct ordering of necessary labs and imaging prior to surgical intervention in standard
clinical scenarios.
Resident will identify and take steps to prevent reason for surgical cancellation in standard clinical scenarios.
Resident will ensure appropriate documentation has been done, correct surgical site is marked and other services
are notified (if necessary) in standard clinical scenarios.
Resident will know how to document discussion with patients undergoing standard surgical procedures.
Resident will continue to learn the importance of identifying areas of self-improvement in area of pre-operative
management in standard clinical scenarios.
If resident identified areas of pre-operative management that need improvement, he/she will discuss the quality
improvement issue with the team, i.e., correct pre-operative antibiotics, stoppage of blood thinners, cardiac
clearance in standard clinical scenarios.
Resident will work within the multi-professional team in outpatient surgery setting in a standard clinical scenario.
Resident will identify factors that lead to surgery delay, unnecessary patient waiting or <24 hour cancellation in
standard clinical scenarios.
PGY2/URO1 Presbyterian Resident Operating Room Experience
Performance of these cases will be evaluated by faculty using the Form 16 which is self-generated by the
faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
Resident will be able to describe the clinical details of each standard clinical scenario.
Resident will be able to identify and describe the findings on all relevant imaging in standard clinical scenarios.
Resident will be prepared for all cases by reading level specific articles, textbooks, surgical atlases and prior
operative notes and be able to effectively communicate this information.
Resident will continue to learn basic instrumentation, materials needed, patient positioning and anesthesia needed
to complete standard cases.
Resident will read and be able to discuss prior to coming to OR the applicable pages from the AUA Handbook on
Laparoscopic Fundamentals and the AUA Handbook on Robotics.
Resident will continue to learn and be able to apply cost awareness in standard scenarios.
Resident will start applying how to work within the interprofessional OR team; scrub tech, circulator, IMS,
anesthesiologists, anesthesia resident, nurse anesthetists, attending surgeon, upper level surgeon.
Resident will be able to identify system errors and describe it to the team in standard clinical scenarios.
Resident will be able to demonstrate the correct dictation of operative reports as required by attending physician
within 24 hours of completion of operation in standard clinical scenarios. These reports will be reviewed by
attending physician.
Resident will start applying how to bill and the required documentation in standard clinical scenarios.
Resident will continue the process of learning how to effectively communicate with other members of Presbyterian
team in order to provide information about case details.
Resident will take responsibility for entering all cases performed into ACGME surgery log online system within one
week of case completion.
Resident will participate in the education of medical students.
Page 52
PGY2/URO1 Presbyterian Teams 1 and 2 Resident Operating Room – Technical
Performance of these cases will be evaluated by faculty using the Form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)
Resident will perform as an assistant with Level 1 supervision:

Transurethral resection cases (TURP, TURBT)

Scrotal and inguinal surgery

Stent placement (retrograde approach)

Ureteroscopy (upper and lower)

Cystoscopy

Endourology/Stone Removal

Extracorporeal Shock Wave Lithotripsy (ESWL)
Resident will also assist and perform with Level 1 supervision:

Laparoscopy

Male and female reconstruction

Intestinal diversion

Oncology cases including prostate, bladder, kidney, retroperitoneum.

Renal Transplantation
PGY2/URO1 Teams 1 and 2 Resident Clinic
Performance of the following goals will be evaluated by faculty using the Form 14 by the faculty in Medhub. (PC, MK,
SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Resident will prepare for each sub-specialty clinic by reading applicable material and will be able to discuss.
Resident will continue to learn the basics of and be able to perform direct patient care including initial evaluation,
establishment of diagnosis, selection of therapy and management of complications in standard clinical scenarios.
Resident will continue to learn and recognize accuracy in medical billing including selecting appropriate E&M code,
selecting appropriate diagnosis.
Resident will be able to perform a history and physical examination in a standard clinical scenario.
Resident will continue to refine how to develop and discuss differential diagnosis and plan of care in standard clinic
scenarios.
Resident will continue to learn and be able to discuss how to effectively schedule patient for surgery in standard
clinic scenarios. During this year, the PGY2 resident will begin to schedule with Level 1 supervision. This will
include:
 Resident-patient discussion
 Risk/benefit assessment and communication
 Post-operative expectations
Resident will continue to learn and be able to demonstrate all the steps that need to be taken in order for patient to
go from clinic to inpatient/outpatient surgery
Resident will continue the learning process of how to self-improve by identifying deficiencies in patient care. (PBLI)
Resident will participate in and be able to explain evidence based practice and will continue to learn how to
investigate sources of information easily identifiable.
Resident will continue to learn recognition in identifying quality improvement issues and bring them to attention of
faculty and upper level residents in standard clinical scenarios.
Resident will begin practicing cost awareness in standard scenarios. (SBP)
Resident will continue the learning process of how to work effectively within interprofessional team of nurses, clinic
manager, clerks, schedulers, other residents and attendings in standard clinical scenarios. (SBP, P, IC)
Resident will continue to refine their knowledge and skills in using EMR in the appropriate and correct manner.
(SBP, IC)
Resident will continue their learning of how to communicate in clear and concise language when describing a
standard clinical scenario. (IC, MK)
Resident will demonstrate proficiency in documentation of standard patient visits and will ensure that all the needed
information is included in the note. (IC, MK, SBP)
Resident will perform (Level 1 supervision progressing to Level 2 supervision) clinic procedures during clinic visits
under standard circumstances.
Page 53
PGY2 Resident performance of these clinic procedures will be evaluated by faculty using the Form 16 which is
self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
Resident will start performing with Level 1 supervision:
 Cystoscopy
 TRUS
 Prostate biopsy
 Stent removal
 UDY procedure and interpretation
 Cystogram
 Nephrostogram
 Nephrostomy tube change
 Renal ultrasound
 Pelvic ultrasound
o
Resident will apply Clinical Ethics for urologist module in standard clinical scenarios.
o
Resident will be able to perform dictations describing clinic procedures within 24 hours of service performed.
PGY2/URO1 Presbyterian Teams 1 and 2 Resident Rounding, In-Patient Work, Consults (Level 1 supervision)
Performance of these objectives will be evaluated by faculty using the Form 15 in Medhub.
Description: During rotation on Presbyterian Hospital Teams 1 and 2, resident will participate in all aspects of
inpatient care, including consults. (PC, MK, SBP, IC, P, PBL)
Resident will:
o Have dedicated experience in evaluation and management of inpatient GU disease (PC)
o Perform standard history and physical examination with emphasis on GU system and GU complaint (PC)
o Continue to learn and be able to describe diagnostic and therapeutic treatment options in standard clinical
scenarios (PC, MK, ICS)
o Work with other urology faculty, residents and medical students to coordinate care delivery provided by consult
team in standard clinical scenarios (IC, SBP, P)
o Continue the learning process and be able to discuss the findings from rounds or consults, including
recommendations to requesting physicians (IC, SBP)
o Continue to learn and be able to communicate results of tests, pathology results, intra-operative findings to patients
and family in standard clinical scenarios (IC, P)
o Review literature on disease processes encountered in patients. Based on literature and knowledge, the resident
will be able to describe patient care in standard clinical scenarios (PC, MK, PBL)
o Further learn and be able to describe basic urology to medical students and other services requesting consults (IC,
P, MK)
o Continue learning how to work effectively with other health care providers, including social workers, case managers,
nurses, pharmacists to optimize resources available to patients (IC, P, SBP, MK)
o Be able to perform required documentation in order to provide accurate and useful information to other team
members, consulting teams, billing department (IC, P)
o Will continue the learning of and be able to practice cost awareness in standard clinical inpatient scenarios (SBP)
o Will continue to learn what is required and be able to perform dictations including discharge summaries, admission
notes, operative notes and consults within 24 hours of service performed standard clinical inpatient scenarios
The resident on this rotation is expected to attend and participate in the following education activities:
Monday
Urologic Subspecialty Conference 5pm
Journal Club/Chapter Review 5pm
UroPathology (6x yr, 3 cases each) 4pm
Thursday
Female Urology and Urodynamics Conference, 10am
Friday
Indications/Imaging/IVP Conference 6am
Urology Grand Rounds (two presentations) 7am
Chief Case Presentations (three presentations) 7am
Morbidity and Mortality Conference 7am
Page 54
PGY2/URO1 DVAMC Rotation (4 months)
Pre-Operative Evaluation Experience
Performance of this setting will be evaluated by faculty using the Form 15 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)










Resident will provide care to pre-operative and post-operative patients that is compassionate, appropriate and
effective in a standard clinical scenario.
Resident will learn how to ensure that patient is ready for surgery in pre-operative area.
Resident will learn and obtain proficiency in ordering necessary labs and imaging prior to surgical intervention.
Resident will learn how to identify reason for surgical cancellation.
Resident will learn how to ensure appropriate documentation has been done, surgical site is marked and other
services are notified (if necessary).
Resident will work on self-improvement in area of pre-operative management and educate PGY1 residents.
(PBL)
If resident identified areas of pre-operative management that need improvement, he/she will discuss this quality
improvement issue with the team, i.e., correct pre-operative antibiotics, stoppage of blood thinners, cardiac
clearance.
Resident will know how to work within the multi-professional team in outpatient surgery setting.
Resident will identify factors that lead to surgery delay, unnecessary patient waiting or <24 hour cancellation.
Resident will document any pre-operative discussions with patients.
Operating Room Experience
Performance of this setting will be evaluated by faculty using the Form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)













Resident is expected to know all of the clinical details of each case in standard clinical scenarios.
Resident is expected to know findings on all relevant imaging.
Resident will learn how to prepare for all cases by reading articles, textbooks, surgical atlases and prior
operative notes.
Resident will know basic instrumentation, materials needed, patient positioning and anesthesia needed to
complete the case.
Resident must read prior to coming to OR the applicable pages from Laparoscopic and Robotic Fundamentals
and AUA Handbook or Robotics.
Resident will know and practice in standard scenarios cost awareness.
Resident will know and work within the interprofessional OR team; scrub tech, circulator, IMS,
anesthesiologists, anesthesia resident, nurse anesthetists, attending surgeon, upper level surgeon.
Resident will identify system errors and bring it to attention of the team.
Resident will dictate operative reports as required by attending physician within 24 hours of completion of
operation. These reports will be reviewed by attending physician.
Resident will start learning about billing and about required documentation.
Resident will learn how to efficiently communicate with other members of VAMC team in order to provide
information about case details.
Resident will take responsibility for entering all cases performed into ACGME surgery log online system within
one week of case completion.
Resident will participate in the education of PGY1 residents and medical students.
Page 55
Operating Room – Technical
Performance of these cases will be evaluated by faculty using the form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)
Resident will perform, and by the end of PGY2 year, become proficient in:
 Transurethral resection cases (TURP, TURBT)
 Scrotal and inguinal surgery
 Stent placement (retrograde approach)
 Ureteroscopy (upper and lower)
 Endourology/Stone Removal
 Extracorporeal Shock Wave Lithotripsy (ESWL)
Resident will also assist and perform in:
 Laparoscopy
 Male and female reconstruction
 Intestinal diversion
 Oncology cases including prostate, bladder, kidney, retroperitoneum.
PGY2/URO1 VAMC Clinic
Performance of the following goals will be evaluated by faculty using the form 14 by the faculty in Medhub. (PC,
MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Resident will prepare for each sub-specialty clinic by reading applicable material.
Resident will become proficient in direct patient care including initial evaluation, establishment of diagnosis, selection of
therapy and management of complications.
Resident will gain confidence/improve accuracy in medical billing including selecting appropriate E&M code, selecting
appropriate diagnosis.
Resident will know how and will perform history and physical examination.
Resident will gain ability to develop differential diagnosis and plan of care in standard clinic scenarios.
Resident will gain ability to schedule patient for surgery in standard clinic scenarios. This will include:
 Resident-patient discussion
 Risk/benefit assessment and communication
 Post-operative expectations
Resident will know all the steps that need to be taken in order for patient to go from clinic to inpatient/outpatient surgery
Resident will work on self-improvement by identifying deficiencies in patient care. (PBLI)
Resident will participate in evidence based practice and will know sources of information easily identifiable.
Resident will participate in identifying quality improvement issues and bring them to attention of faculty and upper level
residents.
Resident will practice cost awareness in standard clinical scenarios (vs complex PGY 4/5) (SBP)
Resident will work effectively within interprofessional team of nurses, clinic manager, clerks, schedulers, other residents
and attendings. (SBP, P, IC)
Resident will become proficient in obtaining access and using the DVAMC’s electronic medical record system. (SBP, IC)
Resident will become proficient in communicating using clear and concise language when describing a clinical scenario.
(IC, MK)
Resident will become proficient in documentation of patient visits and will ensure that all the needed information is
included in the note. (IC, MK, SBP)
Resident will become proficient in performing clinic procedures and supervising clinic visits under standard
circumstances.
Resident will develop and be able to demonstrate skills in office (outpatient clinic) urology. (PC, IC, MK, PBLI, P, SBP)
Resident will learn and be able to discuss the understanding of mituritional and erectile physiologies and the medical
and surgical treatment options for each condition. (MK, PC)
Resident will learn and assume responsibility for the urodynamic and the erectile dysfunction laboratories. (PC, IC, MK,
PBLI, P, SBP)
Resident will gain knowledge and be able to demonstrate skills in the treatment of prostatism. (MK, PC)
Resident will learn and be able to discuss the evaluation and treatment process of impotence. (MK, PC)
Resident will gain knowledge/experience and be able to demonstrate proficiency in office endoscopy skills including
office urosonography and radiography, vasectomy, prostate biopsy, urodynamics and penile Doppler and ultrasound.
(PC, IC, MK, PBLI, P, SBP)
Page 56
o
Resident will learn to perform and document consultations for other services. (PC, IC, MK, PBLI, P, SBP)
Performance of these clinic procedures will be evaluated by faculty using the form 16 which is self-generated by
the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o Cystoscopy
o TRUS
o Prostate biopsy
o Stent removal
o UDY procedure and interpretation
o Cystogram
o Nephrostogram
o Nephrostomy tube change
o Renal ultrasound
o Pelvic ultrasound
Resident will use Clinical Ethics for urologist module in standard clinical scenarios.
Page 57
PGY2/URO1 VAMC Rounding, In-Patient Work, Consults
Performance of these cases will be evaluated by faculty using the form 15 by the faculty in Medhub. (PC, MK, SBP,
IC, P, PBL)
Description: During rotation on the VAMC rotation, resident will participate in all aspects of inpatient care,
including consults.
Resident will:
o
o
o
o
o
o
o
o
o
o
o
Have dedicated experience in evaluation and management of inpatient GU disease (PC)
Perform comprehensive history and physical examination with emphasis on GU system and GU complaint (PC)
Make decisions on diagnostic and therapeutic treatment options in standard clinical scenarios (PC, MK, ICS)
Work with other urology residents/medical students to coordinate care delivery provided by consult team in standard
clinical scenarios (IC, SBP, P)
Communicate finding from rounds or consults, including recommendations to requesting physicians (IC, SBP)
Communicate results of tests, pathology results, intra-operative findings to patients and family in standard clinical
scenarios (IC, P)
Review literature on disease processes encountered in patients. Based on literature and your new knowledge,
optimize patient care in standard clinical scenario (PC, MK, PBL)
Teach basic urology to medical students, PGY1 and PGY2 urology residents, other services requesting consults (IC,
P, MK)
Work effectively with other health care providers, including social workers, case managers, nurses, pharmacists to
optimize resources available to patients (IC, P, SBP, MK)
Perform all required documentation in order to provide good information to other team members, consulting teams,
billing department (IC, P)
Practice cost awareness in standard inpatient scenarios (SBP)
Resident will participate in the following weekly educational activities:
Monday
Urologic Subspecialty Conference 5pm
Journal Club/Chapter Review 5pm
UroPathology (6x yr, 3 cases each) 4pm
Friday
Indications/Imaging/IVP Conference 6am
Urology Grand Rounds (two presentations) 7am
Chief Case Presentations (three presentations) 7am
Morbidity and Mortality Conference 7am
Page 58
PGY-3/URO-2
This PGY-3/URO-2 resident year is structured so that 8 months are spent at Presbyterian Tower Teams 1 and 2
participating in the PPOB and DOC clinic and in inpatient and outpatient surgeries; 4 months are spent at the Children’s
Hospital of Oklahoma participating in pediatric urology clinics and in inpatient and outpatient surgeries.
This urology resident year provides continued exposure to the six core competencies (PC, IC, MK, PBLI, P, SBP) with
emphasis on integrating them into the team approach in the diagnosis and treatment of urologic conditions.
Successful completion of PGY-2/URO-1 residency year is required prior to being promoted to this urology resident year.
PGY-3/URO-2 urology residents do not participate in the yearly Mock Oral Board Examinations.
Goals
 Continue the learning of diagnostic and treatment strategies for patients with urologic problems in standard, advancing to
complex clinical scenarios (PC, MK, P)
 Continue to gain understanding of the principles of evidence-based urology treatment parameters in standard, advancing
to complex clinical scenarios (MK, PC)
 Continue acquiring basic and progress to learning of advanced surgical skills including manual dexterity, proper handling
of surgical instruments, and knot tying proficiency in standard, advancing to complex clinical scenarios (MK, PC)
 Continue to learn and implement the team approach to clinical care with emphasis on the basic principles of coordinating
patient care within a standard and complex health care system in standard, advancing to complex clinical scenarios (PC,
P, IC, SBP, PBLI)
 Gain awareness of the resources available in the health care system that will allow optimal coordination of patient care in
standard, advancing to complex clinical scenarios (PBLI, SBP)
Evaluations – Appendix 3
Evaluations are done at the end of the rotation by supervising faculty, residents and ancillary staff and entered into MEDHUB
(College of Medicine sponsored resident tracking program) using Form(s) 6, 7, 8,14, 15, 16, 17, 18, 20, 22, 23, 25, 26, 27,
28, 29, 30, 31 and 34 . A review of all evaluations done on the resident during that rotation are also reviewed by the
Program Director at this time.
On Call Activities
PGY-3 urology residents take at home 1st call with Level 2 supervision.
Supervision - Graded Authority and Responsibility:
The PGY-3 urology resident, whether involved in patient care or clinical research activities, will be supervised by qualified
faculty and/or senior residents/fellows at a Level 1 Supervision level. Progressive authority and responsibility will be given
based on direct observation and medical knowledge.
Page 59
BLOCK DIAGRAM
PGY3/
URO-2
8 months
4 months
Teams 1 and 2
The Children’s Hospital
Mon: PT OR/Clinic
Monday
AM Rounds with Attending
DF OR
BK Clinic
Mon 5-7pm: Urology Educational
Conference
5-7pm Educ Conf
PM Rounds with Attending
Tue: PT OR/Clinic
Tuesday
6-6:30am Peds Urol Ind Conf
AM Rounds with Attending
DF Clinic
BK OR
12-1pm Ped Urol Topic Educ Conf
PM Rounds with Attending
Wed: PT OR/Clinic
Wednesday
AM Rounds with Attending
DF OR
PM Rounds with Attending
Thurs: PT OR/Clinic
Thursday
AM Rounds with Attending
BK OR
DF OR Robotics (every other week)
1-3pm MM Clinic (1st/2nd week)
PM Rounds with Attending
Fri 6-8am: Urology Educational
Conference
Friday
AM Rounds with Attending
6-8am Educ Conf
Fri am: PT OR/Clinic
7:15-7:45am Ped Uro-Rad Conf (2nd
Fr of month)
Fri 1-3pm: PPOB DOC Clinic
DF OR (every other week)
Page 60
PGY3/URO2 PRESBY SERVICE TEAMS 1 AND 2 ROTATION (4 MONTHS)
Pre-Operative Evaluation Experience
Performance of this setting will be evaluated by faculty using the Form 15 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)










Resident will provide care to pre-operative and post-operative patients that is compassionate, appropriate and
effective in a standard clinical scenario.
Resident will learn how to ensure that patient is ready for surgery in pre-operative area.
Resident will learn and obtain proficiency in ordering necessary labs and imaging prior to surgical intervention.
Resident will learn how to identify reason for surgical cancellation.
Resident will learn how to ensure appropriate documentation has been done, surgical site is marked and other
services are notified (if necessary).
Resident will work on self-improvement in area of pre-operative management and educate PGY1 and PGY2
residents. (PBL)
If resident identified areas of pre-operative management that need improvement, he/she will discuss this quality
improvement issue with the team, i.e., correct pre-operative antibiotics, stoppage of blood thinners, cardiac
clearance.
Resident will know how to work within the multi-professional team in outpatient surgery setting.
Resident will identify factors that lead to surgery delay, unnecessary patient waiting or <24 hour cancellation.
Resident will document any pre-operative discussions with patients.
Operating Room Experience
Performance of this setting will be evaluated by faculty using the Form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)













Resident is expected to know all of the clinical details of each case in standard and complex clinical scenarios.
Resident is expected to know findings on all relevant imaging.
Resident will learn how to prepare for all cases by reading articles, textbooks, surgical atlases and prior
operative notes.
Resident will know basic instrumentation, materials needed, patient positioning and anesthesia needed to
complete the case.
Resident must read prior to coming to OR the applicable pages from Laparoscopic and Robotic Fundamentals
and AUA Handbook or Robotics.
Resident will know and practice in standard scenarios cost awareness.
Resident will know and work within the interprofessional OR team; scrub tech, circulator, IMS,
anesthesiologists, anesthesia resident, nurse anesthetists, attending surgeon, upper level surgeon.
Resident will identify system errors and bring it to attention of the team.
Resident will dictate operative reports as required by attending physician within 24 hours of completion of
operation. These reports will be reviewed by attending physician.
Resident will start learning about billing and about required documentation.
Resident will learn how to efficiently communicate with other members of Presbyterian team in order to provide
information about case details.
Resident will take responsibility for entering all cases performed into ACGME surgery log online system within
one week of case completion.
Resident will participate in the education of PGY1 and PGY2 residents and medical students.
Page 61
Operating Room – Technical
Performance of these cases will be evaluated by faculty using the Form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)
Resident will perform, and by the end of PGY3 year, become proficient in:
1. Transurethral resection cases (TURP, TURBT)
2. Scrotal and inguinal surgery
3. Stent placement (retrograde approach)
4. Ureteroscopy (upper and lower)
5. Endourology/Stone Removal
6. Extracorporeal Shock Wave Lithotripsy (ESWL)
Resident will also assist and perform in:
1. Laparoscopy
2. Male and female reconstruction
3. Intestinal diversion
4. Oncology cases including prostate, bladder, kidney, retroperitoneum.
5. Renal Transplantation
Page 62
PGY3/URO2 Presby Teams 1 and 2 Resident Clinic
Performance of the following goals will be evaluated by faculty using the Form 14 by the faculty in Medhub. (PC, MK,
SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Resident will prepare for each sub-specialty clinic by reading applicable material.
Resident will become proficient in direct patient care including initial evaluation, establishment of diagnosis, selection of
therapy and management of complications.
Resident will gain confidence/improve accuracy in medical billing including selecting appropriate E&M code, selecting
appropriate diagnosis.
Resident will know how and will perform history and physical examination.
Resident will gain ability to develop differential diagnosis and plan of care in standard clinic scenarios.
Resident will gain ability to schedule patient for surgery in standard clinic scenarios. This will include:
 Resident-patient discussion
 Risk/benefit assessment and communication
 Post-operative expectations
Resident will know all the steps that need to be taken in order for patient to go from clinic to inpatient/outpatient surgery
Resident will work on self-improvement by identifying deficiencies in patient care. (PBLI)
Resident will participate in evidence based practice and will know sources of information easily identifiable.
Resident will participate in identifying quality improvement issues and bring them to attention of faculty and upper level
residents.
Resident will practice cost awareness in standard clinical scenarios (vs complex PGY 4/5) (SBP)
Resident will work effectively within interprofessional team of nurses, clinic manager, clerks, schedulers, other residents
and attendings. (SBP, P, IC)
Resident will become proficient in obtaining access and using EMR (SBP, IC)
Resident will become proficient in communicating using clear and concise language when describing a clinical scenario.
(IC, MK)
Resident will become proficient in documentation of patient visits and will ensure that all the needed information is
included in the note. (IC, MK, SBP)
Resident will become proficient in performing clinic procedures and supervising clinic visits under standard
circumstances.
Performance of these clinic procedures will be evaluated by faculty using the Form 16 which is self-generated by the
faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
Cystoscopy
o
TRUS
o
Prostate biopsy
o
Stent removal
o
UDY procedure and interpretation
o
Cystogram
o
Nephrostogram
o
Nephrostomy tube change
o
Renal ultrasound
o
Pelvic ultrasound
Resident will use Clinical Ethics for urologist module in standard clinical scenarios.
Page 63
PGY3/URO2 Presby Teams 1 and 2 Rounding, In-Patient Work, Consults
Performance of these cases will be evaluated by faculty using the Form 15 by the faculty in Medhub. (PC, MK, SBP,
IC, P, PBL)
Description: During rotation on Presbyterian Hospital, resident will participate in all aspects of inpatient care,
including consults.
Resident will:
o
o
o
o
o
o
o
o
o
o
o
Have dedicated experience in evaluation and management of inpatient GU disease (PC)
Perform comprehensive history and physical examination with emphasis on GU system and GU complaint (PC)
Make decisions on diagnostic and therapeutic treatment options in standard clinical scenarios (PC, MK, ICS)
Work with other urology residents/medical students to coordinate care delivery provided by consult team in standard
clinical scenarios (IC, SBP, P)
Communicate finding from rounds or consults, including recommendations to requesting physicians (IC, SBP)
Communicate results of tests, pathology results, intra-operative findings to patients and family in standard clinical
scenarios (IC, P)
Review literature on disease processes encountered in patients. Based on literature and your new knowledge, optimize
patient care in standard clinical scenario (PC, MK, PBL)
Teach basic urology to medical students, PGY1 and PGY2 urology residents, other services requesting consults (IC, P,
MK)
Work effectively with other health care providers, including social workers, case managers, nurses, pharmacists to
optimize resources available to patients (IC, P, SBP, MK)
Perform all required documentation in order to provide good information to other team members, consulting teams,
billing department (IC, P)
Practice cost awareness in standard inpatient scenarios (SBP)
Resident will participate in the following weekly educational activities:
Monday
Urologic Subspecialty Conference 5pm
Journal Club/Chapter Review 5pm
UroPathology (6x yr, 3 cases each) 4pm
Friday
Indications/Imaging/IVP Conference 6am
Urology Grand Rounds (two presentations) 7am
Chief Case Presentations (three presentations) 7am
Morbidity and Mortality Conference 7am
Page 64
PGY3/URO2 The Children’s Hospital of Oklahoma Rotation (4 months)
This is the initial resident exposure to pediatric urology from routine clinic consultations and follow up visits, ER and
inpatient consultations, inpatient and outpatient primary care, preoperative evaluation/workup, perioperative care,
postoperative care and follow-up, including NICU, PICU, and subspecialty care at a regional tertiary care Children’s
hospital. (PC, IC, MK, PBLI, P, SBP)
Graded Authority and Responsibility:
At all times, the PGY3/URO2 urology resident, whether involved in patient care or clinical/basic science research activities,
will be supervised by qualified faculty and/or senior residents/fellows/instructors at a Level 1 Supervision level with
progression toward Level 2 Supervision.
Supervising faculty physicians will delegate graded progressive authority and responsibility of portions of patient care to
PGY3/URO2 residents, as appropriate based on direct knowledge of the skills of the resident.
Pre-Operative Evaluation Experience
Performance of this setting will be evaluated by faculty using the Form 15 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)

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
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Resident will provide care to pre-operative and post-operative patients that is compassionate, appropriate and
effective in standard clinical scenarios.
Resident learn the steps necessary to ensure the patient is ready for surgery in pre-operative area in standard
clinical scenarios.
Resident will learn and be able to identify the steps to prevent surgical cancellation in standard clinical scenarios.
Resident will learn and ensure that appropriate documentation is done, correct surgical site is marked and other
services are notified (if necessary) in standard clinical scenarios.
Resident will demonstrate self-improvement in the area of pre-operative management and will educate medical
students in same.
If resident identifies areas of pre-operative management that need improvement, he/she will discuss the quality
improvement issue with the team, i.e., correct pre-operative antibiotics, stoppage of blood thinners, cardiac
clearance, etc., in standard clinical scenarios.
Resident will show the ability to work within the multi-professional team in outpatient surgery setting in a standard
clinical scenario.
Resident will learn and be able to identify the factors that lead to surgery delay, unnecessary patient waiting or <24
hour cancellation in standard clinical scenarios.
Resident will learn proper documentation of pre-operative discussions with patients.
Resident will learn the appropriate management for pre-operative inpatient bowel preparations, when necessary.
Operating Room Experience
Performance of this setting will be evaluated by faculty using the Form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)

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Resident will learn and be able to describe the clinical details in standard clinical scenarios.
Resident will learn and be able to identify and describe findings on all relevant imaging in standard clinical
scenarios.
Resident will prepare for cases by reading level specific articles, textbooks, surgical atlases and prior operative
notes and will be able to effectively communicate this information.
Resident will learn and be able to demonstrate knowledge of basic instrumentation, materials needed, patient
positioning and anesthesia needed to complete standard cases.
Resident will learn and demonstrate the ability to practice cost awareness in standard clinical scenarios.
Resident will learn to work effectively within the interprofessional OR team, scrub techs, circulators, IMS,
anesthesiologists, anesthesia residents, nurse anesthetists, attending surgeons and upper level surgeons.
Resident will learn and be able to identify system errors and describe them to the team in standard clinical
scenarios.
Resident will learn and be able to demonstrate the correct dictation of operative reports as required by attending
physician within 24 hours of completion of operation in standard clinical scenarios. These reports will be reviewed
by attending physician.
Page 65
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Resident will learn and demonstrate a knowledge of how to bill and the required documentation in standard clinical
scenarios.
Resident will learn to communicate effectively with other members of the Children’s team in order to provide
information about case details in standard clinical scenarios.
Resident will show responsibility for entering all cases performed into the ACGME surgery log online system within
one week of case completion.
Resident will effectively participate in the education of medical students.
Operating Room – Technical
Performance of these cases will be evaluated by faculty using the Form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)

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Endourology
o Cystourethroscopy
o Ureteral catheterization for stent/RPG
Scrotal/Inguinal
o Hernia/hydrocele
o Orchiopexy (scrotal, inguinal, laparoscopic)
Urodynamics
o Basic video urodynamics
Bladder/Ureteral
o Subureteric injection
o Urinary diversion (vesicostomy, ureterostomy)
o Ureterocele excision
o Ureteroureterostomy
o Ureteroneocystostomy (extravesical, common sheath, tapering)
Endourology/Stones
o Urethral valve ablation
o Shock wave lithotripsy
o Ureteroscopy percutaneous nephrolithotomy
o Ureterocele puncture/incision
Major Abdominal/Reconstructive
o Enterocystoplasty
o Nephrectomy (total/partial)
o Appendico-vesicostomy (appendix, Monti, Casale techniques)
o Pyeloplasty (open/laparoscopic/robotic-assisted)
Penile
o Circumcision
o Penoplasty (Chordee)
o Scrotoplasty
o Meatotomy
o Meatoplasty distal hypospadias
Scrotal/Inguinal
o Varicocelectomy (subinguinal, microscopic, laparoscopic)
Urodynamics
o Advanced video urodynamics
Educational Goals to be read from AUA Core Curriculum for Resident Education

Resident will demonstrate having studied the following curriculum:
o Congenital Anomalies: cryptorchidism, hypospadias, testicular torsion, hydrocele/hernia, varicocele
o Obstructive Uropathy: UPJ obstruction, duplicated system anomalies (ureterocele, ectopic ureters,
megaureters)
o Oncology: Wilm’s tumor, Neuroblastoma
o Hydronephrosis
o Embryology
o Fluid and electrolyte management of neonates and pediatric patients
o Neonatal emergencies
Page 66
o
Urinary Tract Infections: UTI, dysfunctional elimination, VUR
PGY3/URO2 Pediatric Urology Clinic
Performance of the following goals will be evaluated by faculty using the Form 14 by the faculty in Medhub. (PC,
MK, SBP, IC, P, PBL)
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Resident will be prepared for each pediatric sub-specialty clinic by reading applicable material and will be able to
discuss.
Resident will learn and demonstrate a proficiency in the basics of direct patient care including initial evaluation,
establishment of diagnosis, selection of therapy and management of complications in standard clinical scenarios.
Resident will learn and demonstrate an accuracy in medical billing including selecting appropriate E&M code and
selecting appropriate diagnosis.
Resident will learn and perform history and physical examinations in standard clinical scenarios.
Resident will learn and demonstrate knowledge and be able to discuss differential diagnosis and plan of care in a
standard clinical scenario.
Resident will learn and be able to discuss how to effectively schedule patient for surgery in standard clinical
scenarios. This will include:
o Resident-patient-family discussion
o Risk/benefit assessment and communication
o Post-operative expectations
Resident will learn and perform the steps necessary in order for patient to go from clinic to inpatient/outpatient
surgery.
Resident will learn and demonstrate the ability for self-improvement by identifying deficiencies in patient care.
Resident will learn and participate in and be able to explain evidence based practice and be able to describe
sources of information.
Resident will learn to recognize and identify quality improvement issues in standard clinical scenarios and, if
applicable during this rotation, bring them to the attention of faculty and upper level residents.
Resident will learn to practice cost awareness in standard clinical scenarios.
Resident will work effectively within the interprofessional team of nurses, clinic managers, clerks, schedulers, other
residents and attendings in standard clinical scenarios.
Resident will improve their knowledge and skills in using EMR in the appropriate and correct manner.
Resident will learn to communicate in clear and concise language when describing a standard clinical scenario.
Resident will learn and demonstrate a proficiency in documenting of standard patient visits and ensure that all the
information needed is included in the note.
Resident will perform, with level 1 supervision, clinic procedures during clinic visits under standard circumstances.
Performance of these clinic procedures will be evaluated by faculty using the Form 16 which is self-generated by
the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o


Meatotomy
Lysis of penile adhesions
Urodynamics
Renal ultrasound
Bladder ultrasound
Resident will use Clinical Ethics for urologist module in standard clinical scenarios.
Resident will perform dictations describing clinic procedures within 24 hours of service performed.
PGY3/URO2 Children’s Rounding, In-Patient Work, Consults
Performance of these cases will be evaluated by faculty using the Form 15 by the faculty in Medhub. (PC, MK, SBP,
IC, P, PBL)
Description: During rotation on the Children’s Pediatric Urology service, resident will participate in all aspects of
inpatient care, including consults.
Page 67
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

Resident will have a dedicated experience in the evaluation and management of inpatient pediatric GU disease.
Resident will learn and be able to perform a comprehensive history and physical examination with emphasis on the
pediatric GU system and pediatric GU complaint.
Resident will learn and be able to describe diagnostic and therapeutic treatment options in standard clinical
scenarios.
Resident will work effectively with other urology residents, faculty and medical students to coordinate care delivery
provided by consult team in standard clinical scenarios.
Resident will learn and be able to communicate findings from rounds or consults, including recommendations, to
requesting physicians in standard clinical scenarios.
Resident will learn and be able to communicate results of tests, pathology results, intra-operative findings to
patients and family in standard clinical scenarios.
Resident will learn and be able to describe patient care in standard clinical scenarios based on his/her research and
review of literature on disease processes encountered in patients.
Resident will learn and be able to describe basic pediatric urology to medical students and other services
requesting consults.
Resident will work effectively with other health care providers, including social workers, case managers, nurses,
pharmacists to optimize resources available to patients.
Resident will learn and perform required documentation and provide accurate and useful information to other team
members, consulting teams, billing department.
Resident will practice cost awareness in standard clinical inpatient scenarios.
Resident will learn to accurately perform dictations, including discharge summaries, admission notes, operative
notes and consults within 24 hours of service performed in standard clinical inpatient scenarios.
Resident will round with PGY4/URO3 Children’s pediatric urology resident on inpatient pediatric urology patients
and consulted patients. This will include checkout and/or rounds with Fellow/Attending.
Resident will learn to triage and manage inpatient consultations and check out to the PGY4/URO3 and
fellow/attending in a timely fashion.
Other Requirements



Resident will learn and demonstrate the ability to successfully take handover from on-call resident regarding on-call
activities related to the Children’s Pediatric Urology service. (Evaluation Form 29)
Resident will prepare indications for future surgical patients including imaging, previous operative notes or records
and other intricacies of pre-operative preparation.
Resident will prepare and present weekly pediatric urology educational presentation to Dr. Halverstadt and medical
students on service.
The resident on this rotation is expected to attend and participate in the following educational activities:
 Pediatric Uro/Radiology Conference
 Urologic Subspecialty Conference
 Pediatric Urology Conference
 Journal Club/EBRU
 UroPathology Conference
 Indications/Imaging/IVP Conference
 Urology Grand Rounds
 Chief Case Presentations
 Morbidity and Mortality Conference
Page 68
PGY-4/URO-3 Rotation
This PGY-4/URO-3 resident year is structured so that 4 months are spent at Children’s Hospital in inpatient and outpatient
surgeries, 4 months are spent at the Veteran’s Affairs Medical Center and 4 months are spent on the OUMC Transplant
Service.
This urology resident year provides continued exposure to the six core competencies (PC, IC, MK, PBLI, P, SBP) with
emphasis on integrating them into the team approach in the diagnosis and treatment of urologic conditions.
Successful completion of PGY-3/URO-2 residency year is required prior to being promoted to this urology resident year.
PGY-4 urology residents do participate in the yearly Mock Oral Board Examinations.
Goals
 Provide and teach lower level residents, basic diagnostic and treatment strategies for patients with urologic problems
(PC, MK, P)
 Practice and teach lower level residents, basic understanding of the principles of evidence-based urology treatment
parameters (MK, PC)
 Practice and mentor to lower level residents, basic surgical skills including manual dexterity, proper handling of surgical
instruments, and knot tying proficiency (MK, PC)
 Work effectively and teach to lower level residents, the team approach to clinical care with emphasis on the basic
principles of coordinating patient care within a standard and complex health care system (PC, P, IC, SBP, PBLI)
 Demonstrate the knowledge and teach to lower level residents, the resources available in the health care system that will
allow optimal coordination of patient care (PBLI, SBP)
Evaluations – Appendix 3
Evaluations are done at the end of the rotation by supervising faculty, residents and ancillary staff and entered into MEDHUB
(College of Medicine sponsored resident tracking program) using Form(s) 9, 10, 11, 14, 15, 16, 17, 18, 21, 22, 23, 24, 25, 26,
27, 28, 30, 31, 32, 33 and 34. A review of all evaluations done on the resident during that rotation are also reviewed by the
Program Director at this time.
On Call Activities
PGY-4 urology residents take at home 2nd call with Level 2 and Level 3 supervision.
Supervision - Graded Authority and Responsibility:
The PGY-4 urology resident, whether involved in patient care or clinical research activities, will be supervised by qualified
faculty and/or senior residents/fellows at a Level 1, 2 and 3 supervision level. Progressive authority and responsibility will be
given based on direct observation and medical knowledge.
Page 69
BLOCK DIAGRAM
PGY4/
URO3
4 months
4 months
4 months
The Children’s Hospital
Transplant Service
VAMC
Monday
AM Rounds with Attending
DF OR
BK Clinic
BP OR/Clinic
5-7pm Educ Conf
PM Rounds with Attending
Mon: OR with Dr Sindhwani
Mon: Clinic/OR
Tuesday
6-6:30am Peds Urol Ind Conf
AM Rounds with Attending
DF Clinic
BK OR
BP OR
12-1pm Ped Urol Topic Educ Conf
PM Rounds with Attending
Tue: Private Clinic with Dr
Sindhwani
Tue: Clinic/OR
Wednesday
AM Rounds with Attending
DF OR
BP Clinic
PM Rounds with Attending
Wed: Transplant Clinic with Dr
Sindhwani
Wed: Clinic/OR
Mon 5-7pm: Urology Educational Mon 5-7pm: Urology Educational
Conference
Conference
Thursday
Thurs: Transplant Clinic with Dr
AM Rounds with Attending
Sindhwani
BK OR
DF OR Robotics (every other week)
BP OR/Clinic
1-3pm MM Clinic (1st/2nd week)
PM Rounds with Attending
Thurs 6am: VAMC Surgical Case
Assignment and Pathology
Review Conference
Thurs: OR/Clinic
Friday
AM Rounds with Attending
6-8am Educ Conf
Fri 6-8am: Urology Educational
Conference
Fri 6-8am: Urology Educational
Conference
Fri: Private Clinic with Dr
Sindhwani
Fri: VAMC Clinic – ED and
Procedures Clinics, OR as required
7:15-7:45am Ped Uro-Rad Conf (2
Fr of month)
DF OR (every other week)
BK OR/Clinic
BP OR/Clinic
Page 70
nd
PGY4/URO3 VAMC Service Rotation (4 months)

Pre-Operative Evaluation Experience
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 153 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o

Resident will collaborate with the team and other services to provide care to pre-operative and post-operative
patients that is compassionate, appropriate and effective in standard and complex clinical scenarios.
Resident will mentor the team to ensure the patient is ready for surgery in pre-operative area in simple and complex
clinical scenarios.
Resident will identify and ensure the correct ordering of necessary labs and imaging prior to surgical intervention in
standard and complex clinical scenarios.
Resident will be aware and take steps to prevent reason for surgical cancellation in standard and complex clinical
scenarios.
Resident will mentor lower level residents to ensure correct surgical site is marked and other services are notified (if
necessary) in standard and complex clinical scenarios.
Resident will document complex discussion with patients undergoing major surgical procedures.
Resident will lead quality improvement education personally for the team and of PGY 1, 2, 3 and 4 residents on selfimprovement in area of pre-operative management in standard and complex clinical scenarios. (PBL)
If resident identified areas of pre-operative management that need improvement, he/she will mentor and lead
discussion with lower level residents on quality improvement issue with the team, i.e., correct pre-operative
antibiotics, stoppage of blood thinners, cardiac clearance in standard and complex clinical scenarios.
Resident will facilitate the effective working within the multi-professional team in outpatient surgery setting in a
standard and complex clinical scenario.
Resident will anticipate and take necessary steps to prevent factors that lead to surgery delay, unnecessary patient
waiting or <24 hour cancellation in standard and complex clinical scenarios.
Resident will document any pre-operative discussions with patients in standard and complex clinical scenarios.
Operating Room Experience
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 16 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
Resident will know and facilitate the learning of lower level residents in all of the clinical details in standard and
complex clinical scenarios.
Resident will know and facilitate the learning of lower level residents in the findings on all relevant imaging in
standard and complex clinical scenarios.
Resident will be prepared for all cases by reading articles, textbooks, surgical atlases and prior operative notes and
be able to effectively communicate this information in a teaching format to lower level residents and medical
students in standard and complex clinical scenarios.
Resident will know and be able to facilitate discussion with lower level residents in instrumentation, materials
needed, patient positioning and anesthesia needed to complete the case in standard and complex clinical
scenarios.
Resident will have read and be able to describe prior to coming to OR the applicable pages from Laparoscopic and
Robotic Fundamentals and AUA Handbook on Robotics in complex clinical scenarios and will promote investigation
of self to others to improve patient care.
Resident will practice and be able to mentor lower level residents in standard and complex scenarios cost
awareness.
Resident will know and lead work within the interprofessional OR team; scrub tech, circulator, IMS,
anesthesiologists, anesthesia resident, nurse anesthetists, attending surgeon, upper level surgeon.
Resident will know system errors and will bring it to the attention of the team in complex clinical scenarios.
Resident will assess and ensure correct dictation by lower level residents of operative reports as required by
attending physician within 24 hours of completion of operation in standard and complex clinical scenarios. These
reports will be reviewed by attending physician.
Resident will know and mentor the lower level residents in billing and of required documentation in standard and
complex clinical scenarios.
Resident will effectively communicate with other members of Presbyterian team in order to provide information
about case details.
Resident will take responsibility for entering all cases performed into ACGME surgery log online system within one
week of case completion and will serve as a mentor to lower level residents to ensure correct entry of their cases.
Page 71
o
Resident will participate in the education of PGY1, PGY2, PGY3 and PGY4 residents and medical students.
Operating Room – Technical
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 16 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
Resident will perform and become proficient in general urology and endourology:
 Transurethral resection cases (TURP, TURBT)
 Scrotal and inguinal surgery
 Stent placement (retrograde approach)
 Ureteroscopy (upper and lower)
 Laparoscopy
 Male and female reconstruction
 Intestinal diversion
 Oncology cases including prostate, bladder, kidney, retroperitoneum
Page 72
PGY4 VAMC Clinic
Performance of the following goals and teaching and supervising of lower level residents will be evaluated by
faculty using the form 14 by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Resident will prepare for each sub-specialty clinic by reading applicable material and will be able to facilitate and
lead discussion with lower level residents.
Resident will be proficient in direct patient care including initial evaluation, establishment of diagnosis, selection of
therapy and management of complications in standard and complex clinical scenarios.
Resident will demonstrate accuracy in medical billing including selecting appropriate E&M code, selecting
appropriate diagnosis.
Resident will perform history and physical examination and lead in a consultative and teaching role for lower level
residents.
Resident will develop differential diagnosis and plan of care in standard and complex clinic scenarios.
Resident will effectively schedule patient for surgery in standard and complex clinic scenarios. This will include:
 Resident-patient discussion
 Risk/benefit assessment and communication
 Post-operative expectations
Resident will take all the steps in order for patient to go from clinic to inpatient/outpatient surgery
Resident will facilitate the understanding and learning in lower level residents in self-improvement by teaching them
how to identify deficiencies in patient care. (PBLI)
Resident will know evidence based practice and will know sources of information easily identifiable and will mentor
lower level residents.
Resident will identify quality improvement issues and bring them to attention of faculty in standard and complex
clinical scenarios.
Resident will practice cost awareness in standard and complex scenarios. (SBP)
Resident will work effectively within interprofessional team of nurses, clinic manager, clerks, schedulers, other
residents and attendings in standard and complex clinical scenarios. (SBP, P, IC)
Resident will be proficient in obtaining access and using the DVAMC’s electronic medical records system and will
mentor lower level residents in the appropriate and correct use of the same. (SBP, IC)
Resident will communicate clear and concise language when describing a standard and complex clinical scenario.
(IC, MK)
Resident will be proficient in documentation of standard and complex patient visits and will ensure that all the
needed information is included in the note. (IC, MK, SBP)
Resident will perform, teach and supervise lower level residents in office (outpatient clinic) urology in standard and
complex clinical scenarios.
Resident will demonstrate a knowledge of and discuss micturitional and erectile physiologies and the medical and
surgical treatment options for each condition to lower level residents.
Resident will demonstrate knowledge and facilitate in the learning of lower level residents in the treatment of
prostatism.
Resident will demonstrate knowledge in the evaluation and treatment process of impotence and facilitate in the
learning of lower level residents.
Resident will mentor lower level residents in performing and documenting consultations for other services in
standard and complex clinical scenarios.
Resident will perform clinic procedures and will supervise lower level residents in clinic visits under standard and
complex circumstances.
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 16 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)







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
Cystoscopy
TRUS
Prostate biopsy
Stent removal
UDY procedure and interpretation
Cystogram
Nephrostogram
Nephrostomy tube change
Renal ultrasound
Page 73
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

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


Pelvic ultrasound
Office Urosonography
Office Radiography
Vasectomy
Prostate Biopsy
Urodynamics
Penile Doppler
Penile Ultrasound
Resident will use Clinical Ethics for urologist module in standard and complex clinical scenarios and will facilitate the
education of clinical ethics in lower level residents.
Resident will ensure dictations describing clinic procedures are performed within 24 hours of service performed by lower
level residents.
Page 74
PGY4 Rounding, In-Patient Work, Consults, VAMC
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 15 by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
Description: During rotation on Presbyterian Hospital, resident will participate in and supervise, teach and
evaluate lower level residents in all aspects of inpatient care, including consults, with proper level of supervision.
Resident will:
o
o
o
o
o
o
o
o
o
o
o
o
Provide and mentor lower level residents in evaluation and management of inpatient GU disease in standard and
complex clinical scenarios (PC)
Perform comprehensive history and physical examination with emphasis on GU system and GU complaint in
standard and complex clinical scenarios (PC)
Leads in decisions on diagnostic and therapeutic treatment options in standard and complex clinical scenarios (PC,
MK, ICS)
Work with other urology residents and medical students to coordinate care delivery provided by consult team in
standard and complex clinical scenarios (IC, SBP, P)
Communicate finding from rounds or consults, including recommendations to requesting physicians (IC, SBP)
Communicate results of tests, pathology results, intra-operative findings to patients and family in standard and
complex clinical scenarios (IC, P)
Review literature on disease processes encountered in patients. Based on literature and knowledge, facilitate
patient care in standard and complex clinical scenarios (PC, MK, PBL)
Teach basic urology to medical students, PGY1, PGY2, PGY3 and PGY4 urology residents, other services
requesting consults (IC, P, MK)
Work effectively with other health care providers, including social workers, case managers, nurses, pharmacists to
optimize resources available to patients (IC, P, SBP, MK)
Perform all required documentation in order to provide accurate and useful information to other team members,
consulting teams, billing department (IC, P)
Practice cost awareness in standard and complex clinical inpatient scenarios (SBP)
Perform dictations including discharge summaries, admission notes, operative notes and consults within 24 hours of
service performed in standard and complex clinical inpatient scenarios.
The resident on this rotation is expected to attend and participate in the following education activities:
 Monday, Urology Educational Conference
 Friday, Urology Educational Conference
 Yearly In-Service Examination
 Yearly Mock Board Oral Examination
Page 75
PGY4/URO-3 The Children’s Hospital at OU Medical Center, 4 months
This rotation allows the PGY4/URO3 resident to act as a chief of service resident in pediatric urology and cover routine clinic
consultations and follow up visits, ER and inpatient consultations, inpatient and outpatient primary care, preoperative
evaluation/workup, perioperative care, postoperative care and follow-up, including NICU, PICU, and subspecialty care at a
regional tertiary care Children’s hospital. (PC, IC, MK, PBLI, P, SBP)
At all times, the PGY4/URO3 urology resident, whether involved in patient care or clinical/basic science research activities,
will be supervised by qualified faculty and/or senior residents/fellows at a Level 1 Supervision level with progression toward
Level 2 Supervision.
Graded Authority and Responsibility:
Supervising faculty physicians will delegate graded progressive authority and responsibility of portions of patient care to
PGY4 residents, as appropriate, based on direct knowledge of the skills of the resident.
Pre-Operative Evaluation Experience
Performance of these cases will be evaluated by faculty using the form 15 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)











Resident will provide care to pre-operative and post-operative patients that is compassionate, appropriate and
effective in standard and complex clinical scenarios and will facilitate in the learning of lower level residents.
Resident will ensure that patients are ready for surgery in pre-operative area in standard and complex scenarios.
Resident will demonstrate knowledge in identifying the correct ordering of necessary labs and imaging prior to
surgical intervention in standard and complex clinical scenarios and will be a mentor to lower level residents in same.
Resident will be identify the steps to prevent surgical cancellation in standard and complex clinical scenarios.
Resident will ensure that appropriate documentation is done and correct by lower level residents, that correct
surgical site has been marked and other services are notified (if necessary) in standard and complex clinical
scenarios.
Resident will demonstrate self-improvement in the area of pre-operative management and will educate medical
students and lower level residents in standard and complex clinical scenarios.
If resident identified areas of pre-operative management that needed improvement, he/she will be able to facilitate a
discussion of the quality improvement issue with the team, i.e., correct pre-operative antibiotics, stoppage of blood
thinners, cardiac clearance, etc., in standard and complex clinical scenarios.
Resident will work within the multi-professional team in outpatient surgery setting in a standard and complex clinical
scenario.
Resident will identify and facilitate the learning of such in lower level residents factors that lead to surgery delay,
unnecessary patient waiting or <24 hour cancellation in standard and complex clinical scenarios.
Resident will show proper documentation of pre-operative discussions with patients and will mentor lower level
residents in same in standard and complex clinical scenarios.
Resident will appropriately manage pre-operative inpatient bowel preparations when necessary and will facilitate the
learning of lower level residents.
Operating Room Experience
Performance of these cases will be evaluated by faculty using the form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)
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Resident will be able to describe and facilitate discussion with lower level residents in the details of standard and
complex clinical scenarios.
Resident will be able to identify and describe findings on all relevant imaging in standard and complex clinical
scenarios and act as a mentor to lower level residents in same.
Resident will be prepared for cases by reading level specific articles, textbooks, surgical atlases and prior operative
notes and will be able to effectively communicate this information.
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Resident will demonstrate a knowledge of instrumentation, materials needed, patient positioning and anesthesia
needed to complete standard and complex clinical cases and will serve as a teacher to lower level residents in same.
Resident will practice and act as a mentor to lower level residents cost awareness in standard and complex clinical
scenarios.
Resident will work effectively within the interperofessional OR team, scrub techs, circulators, IMS, anesthesiologists,
anesthesia residents, nurse anesthetists, attending surgeons and upper level residents.
Resident will identify system errors and lead discussion with lower level residents to the team in standard and
complex clinical scenarios.
Resident will demonstrate the correct dictation of operative reports as required by attending physician within 24
hours of completion of operation in standard and complex clinical scenarios. These reports will be reviewed by
attending physician. Resident will also act as a leader in the teaching of lower level residents in this also.
Resident will demonstrate a knowledge of how to bill and the required documentation in standard and complex
clinical scenarios and will ensure the lower level residents have a beginning knowledge.
Resident will communicate effectively with other members of the Children’s team in order to provide information
about case details.
Resident will show responsibility for entering all cases performed into the ACGME surgery log online system within
one week of case completion.
Resident will participate in the education of medical students and lower level residents.
Operating Room – Technical
Performance of these cases will be evaluated by faculty using the form 16 which is self-generated by the faculty in
Medhub. (PC, MK, SBP, IC, P, PBL)
Level 1 progressing to Level 2 supervision
 Endourology
o Cystourethroscopy
o Ureteral catheterization for stent/RPG
 Scrotal/Inguinal
o Hernia/hydrocele
o Orchiopexy (scrotal, inguinal, laparoscopic)
 Urodynamics
o Basic video urodynamics
o
Level 1 supervision (Exposure to the following procedures)
 Bladder/Ureteral
o Subureteric injection
o Urinary diversion (Vesicostomy, Ureterostomy)
o Ureterocele excision
o Ureteroureterostomy
o Ureteroneocystostomy (Extravesical, common sheath, tapering)
 Endourology/Stones
o Urethral valve ablation
o Shock wave lithotripsy
o Ureteroscopy Percutaneous Nephrolithotomy
o Ureterocele puncture/incision
 Major Abdominal/Reconstructive
o Enterocystoplasty
o Nephrectomy (total/partial)
o Appendico-vesicostomy (appendix, Monti, Casale techniques)
o Antegrade continent enema (open/laparoscopic)
o Pyeloplasty (open/laparoscopic/robotic-assisted)
 Penile
o Circumcision
o Penoplasty (chordee)
o Scrotoplasty
o Meatotomy
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o Meatoplasty distal hypospadias
Scrotal/Inguinal
o Varicocelectomy (subinguinal, microscopic, laparoscopic)
Urodynamics
o Advanced video urodynamics
Educational goals to be read from AUA Core Curriculum for Resident Education. Resident will demonstrate having
read the following curriculum:
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Congenital Anomalies
o Cryptorchidism
o Hypospadias
o Testicular torsion
o Hydrocele/hernia
o Varicocele
Obstructive Uropathy
o UPJ Obstruction
o Duplicated system anomalies
 Ureterocele
 Ectopic ureters
 Megaureters
Oncology
o Wilm’s Tumor
o Neuroblastoma
Hydronephrosis
Embryology
Fluid and Electrolyte Management of Neonates and Pediatric Patients
Neonatal Emergencies
Urinary Tract Infections
o UTI
o Dysfunctional elimination
o VUR
PGY4/URO3 Pediatric Urology Clinic
Performance of the following goals will be evaluated by faculty using the form 14 by the faculty in Medhub. (PC,
MK, SBP, IC, P, PBL)
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Resident will be prepared for each pediatric simple and complex sub-specialty clinic by reading applicable material
and will lead discussion with lower level residents
Resident will show proficiency in leading lower level residents in the basics of direct patient care including initial
evaluation, establishment of diagnosis, selection of therapy and management of complications in standard and
complex clinical scenarios.
Resident will demonstrate an accuracy and mentor lower level residents in medical billing including selecting
appropriate E&M code and selecting appropriate diagnosis.
Resident will perform and teach lower level residents in performing history and physical examination in a standard
and complex clinical scenario.
Resident will show knowledge and lead in discussion in differential diagnosis and plan of care in a standard and
complex clinical scenario.
Resident will continue to learn and facilitate in the learning of lower level residents in how to effectively schedule
patient for surgery in standard and complex clinical scenarios. This will include:
o Resident-patient-family discussion
o Risk/benefit assessment and communication
o Post-operative expectations
Resident will perform and teach lower level residents the steps that need to be taken in order for patient to go from
clinic to inpatient/outpatient surgery.
Resident will demonstrate an ability and mentor lower level residents to self-improve by identifying deficiencies in
patient care.
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Resident will participate in and will lead discussion with lower level residents in explaining evidence based practice
and will be able to describe sources of information.
Resident will recognize and identify quality improvement issues in standard and complex clinical scenarios and, if
applicable during this rotation, bring them to the attention of faculty, upper and lower level residents.
Resident will practice cost awareness in standard and complex scenarios and serve as a mentor to lower level
residents in the same.
Resident will work effectively within the interprofessional team of nurses, clinic managers, clerks, schedulers, other
residents and attendings in standard and complex clinical scenarios.
Resident will demonstrate knowledge and skills in using EMR in the appropriate and correct manner and will
facilitate the learning of lower level residents.
Resident will communicate in clear and concise language when describing a standard and complex clinical
scenario.
Resident will demonstrate a proficiency in documentation of standard and complex patient visits and will ensure that
all of the needed information is included in the note.
Resident will perform with Level 1 supervision clinic procedures during clinic visits under standard and complex
circumstances.
Performance of these clinic procedures will be evaluated by faculty using the form 16 which is self-generated by
the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
 Meatotomy
 Lysis of penile adhesions
 Urodynamics
 Renal ultrasound
 Bladder ultrasound
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Resident will access the AUA Clinical Ethics for Urologists Module and will apply it in standard and complex clinical
scenarios.
Resident will perform dictations describing clinic procedures within 24 hours of service performed.
PGY4/URO3 Children’s Hospital Rounding, In-Patient Work, Consults
Performance of these objectives will be evaluated by faculty using the form 15 by the faculty in Medhub. (PC, MK,
SBP, IC, P, PBL)
Description: During rotation at the Children’s Hospital, resident will participate and supervise lower level residents
in all aspects of inpatient care, including consults.
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Resident will have a dedicated experience in the evaluation and management of inpatient pediatric GU disease and
will facilitate in the learning of lower level residents and medical students.
Resident will perform and teach lower level residents how to perform a comprehensive history examination with
emphasis on the pediatric GU system and pediatric GU complaint.
Resident will be able to describe diagnostic and therapeutic treatment options in standard and complex clinical
scenarios and facilitate the learning of lower level residents in the same.
Resident will work with other urology faculty, residents and medical students to coordinate care delivery provided by
consult team in standard and complex clinical scenarios.
Resident will communicate findings from rounds or consults, including recommendations, to requesting physicians.
Resident will communicate results of tests, pathology results, intra-operative findings to patients and family in
standard and complex clinical scenarios and will mentor lower level residents in their learning.
Resident will describe patient care in standard and complex clinical scenarios based on his/her research and review
of literature on disease processes encountered in patients and will mentor lower level residents in the same.
Resident will describe pediatric urology to medical students and lower level residents and other services requesting
consults.
Resident will work effectively with other health care providers, including social workers, case managers, nurses,
pharmacists to optimize resources available to patients.
Resident will perform, and ensure performance of lower level residents, the required documentation and accurate
and useful information to other team members, consulting teams and billing department.
Resident will practice cost awareness in standard and complex clinical inpatient scenarios.
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Resident will perform, and ensure performance of lower level residents, dictations including discharge summaries,
admission notes, operative notes and consults within 24 hours of service performed in standard and complex
clinical inpatient scenarios.
Resident will round with pediatric urology lower level residents and attendings on inpatient pediatric urology patients
and consultant patients. This will include checkout.
Resident will triage and manage inpatient consultations and checkout to fellow/attending in a timely fashion.
PGY4/URO3 Other Requirements while on the Pediatric Urology Rotation
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Resident will demonstrate an ability to successfully take handover from on call resident regarding on call activities
related to the Children’s Urology Service.
Resident will prepare indications for future surgical patients, including imaging, previous operative notes or records
and other intricacies of preoperative preparation.
The resident on this rotation is expected to attend and participate in the following educational activities:
 Monday: Urology Educational Conference
 Tuesday: Pediatric Urology Indications Conference
 Friday: Urology Educational Conference
 Friday: Pediatric Uro-Radiology Conference (2nd Friday of month)
 Yearly In-Service Examination
 Yearly Mock Boards Oral Examination
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PGY4/URO3 TRANSPLANT ROTATION (6 MONTHS )
The six month block rotation will be at the OU Medical Center Oklahoma Transplant Center. This rotation provides a
robust learning opportunity for the PGY4 urology resident to learn how to care for the adult and pediatric renal transplant
patient. The residents will gain knowledge of evolving biomedical, clinical epidemiological and social behavioral sciences
as it applies to renal transplantation; immunology and pharmacology; and renovascular disease.
Renovascular disease and renal transplantation presentations during urology grand rounds will be given by the resident
twice during their four month rotation. The resident is expected to attend monthly transplant journal club, bi-weekly patient
selection and listing committee meeting, monthly kidney transplant M&M conference in addition to all of the urology core
didactic conferences.
In the inpatient and outpatient setting, the resident will be provided with experience in direct patient care with increasing
levels of responsibility (Level 1 supervision progressing to Level 2 supervision) in patient management as they advance
through the rotation.
The resident will participate in the total care of the chronic renal failure, renal transplant and end stage renal disease
patient including initial evaluation, establishment of diagnosis, selection of appropriate therapy and management of
complications.
The resident will participate in the continuity of patient care through preoperative and postoperative transplant clinics and
inpatient admits and consults. The resident will participate in preoperative and postoperative care in a clinic or private office
setting. During the rotation, the resident will have progressive degree of responsibility (Level 1 progressing to Level 2) in
outpatient setting, inpatient setting and performing surgeries. The Program Director will meet with the resident to ensure
that progressive responsibility for patient management and the level of supervision of resident activities is appropriate.
The resident will be given responsibility based upon the individual resident’s knowledge, problem-solving ability, manual
skills, experience, and the severity and complexity of each patient’s status.
The resident is expected to participate in clinical and basic science research. If the resident has a special interest in renal
transplantation, he/she will be assigned a clinical research project related to renal transplantation.
Pre-Operative Evaluation Experience
Performance of these objectives will be evaluated by faculty using the form 15 which is self-generated by the
faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
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The resident will learn and demonstrate knowledge of established and evolving biomedical, clinical
epidemiological and social behavioral sciences, as well as the application of this knowledge to renal
transplantation in complex clinical scenarios. (MK)
The resident will learn to properly evaluate donors and recipients for match viability in complex clinical scenarios.
(MK, PC, SBP)
The resident will learn and participate in the education of end stage renal disease and renal transplant patients
and their families on details of vascular access, listing for transplants and post-transplant care in complex clinical
scenarios. (MK, ICS, SBP, PC)
The resident will learn and enhance skills in patient evaluation, creation of a treatment plan, scheduling and
preparation of patients for tests and procedures in complex transplant-related clinical scenarios. (MK, SBP, PC,
ICS)
The resident will collaborate with the transplant team and other services to provide care to pre-operative and postoperative renal transplant, chronic renal failure and end stage renal disease patients that is compassionate,
appropriate and effective in complex clinical scenarios. (MK, PC, SBP)
The resident will work with the transplant team to ensure the patient is ready for surgery in pre-operative area in
complex clinical scenarios. (MK, PC, ICS, SBP)
The resident will identify and ensure the correct ordering of necessary labs and imaging prior to surgical
intervention in complex transplant-related clinical scenarios. (MK, SBP)
The resident will be aware and take steps to prevent reason for surgical cancellation in complex transplant-related
clinical scenarios. (MK, PC, SBP)
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The resident will mentor lower level residents to ensure correct surgical site is marked and other services are
notified (if necessary) in complex transplant-related clinical scenarios. (MK, PC, SBP, P)
The resident will document complex discussion with patients undergoing transplant-related surgical procedures.
(ICS, PC, MK, SBP, P)
The resident will participate in quality improvement education personally for the transplant team and lower level
residents on self-improvement in area of pre-operative management in complex transplant-related clinical
scenarios. (PBL)
If resident identified areas of pre-operative management that need improvement, he/she will mentor and lead
discussion with lower level residents on quality improvement issue with the transplant team, i.e., correct preoperative antibiotics, stoppage of blood thinners, cardiac clearance in complex transplant-related clinical
scenarios. (MK, PC, PBL, SBP, ICS)
The resident will facilitate the effective working within the multi-professional transplant team in an outpatient
surgery setting in complex transplant-related clinical scenarios. (MK, ICS, P, SBP)
The resident will anticipate and take necessary steps to prevent factors that lead to surgery delay, unnecessary
patient waiting or <24 hour cancellation in complex transplant-related clinical scenarios. (MK, PC, SBP)
The resident will document any pre-operative discussions with patients in complex transplant-related clinical
scenarios. (ICS, PC, MK, SBP)
The resident will incorporate formative evaluation feedback into the daily care of transplant patients. (PBL)
The resident will analyze the process of renal transplantation and identify areas which can be improved. (PBL)
If areas are identified which can be improved, the resident will then implement changes to patient care and their
rotation with goal of practice improvement. (PBL)
The resident will demonstrate a commitment to carrying out the professional responsibilities and an adherence to
ethical principles as it relates to the transplant patient (P)
The resident will demonstrate compassion, integrity and respect for the transplant patient and their families. (P)
The resident will be responsive to the transplant patient needs that supersedes self-interest. (P)
The resident will show respect for the transplant patient privacy and autonomy. (P)
The resident will be accountable to the transplant patient, society and the profession. (P)
The resident will show sensitivity and responsiveness to the transplant patient population. (P)
The resident will demonstrate an awareness of and responsiveness to the context and system of health care as it
relates to the transplant patient to provide optimal health care. (SBP)
The resident will work effectively in renal transplant related health care delivery settings and systems. (SBP)
The resident will coordinate renal transplant patient care both pre and post-operative. (SBP)
The resident will incorporate considerations of cost awareness and risk-benefit analysis as it relates to the renal
transplant patient. (SBP)
The resident will advocate for quality patient care and optimal patient care systems as it relates to the renal
transplant patient. (SBP)
The resident will work in interprofessional teams to enhance patient safety and improve patient care quality as it
relates to the renal transplant patient. (SBP)
The resident will identify system errors and implement potential system solutions as it relates to the renal
transplant patient. (SBP)
Operating Room Experience
Performance of these cases will be evaluated by faculty using the form 16 which is self-generated by the faculty
in Medhub. (PC, MK, SBP, IC, P, PBL)
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The resident will learn and will facilitate the learning of lower level residents in all of the clinical details in complex
transplant-related scenarios. (MK, ICS, SBP)
The resident will learn and will facilitate the learning of lower level residents in the findings on all relevant imaging
in complex transplant-related scenarios. (MK, ICS, SBP)
The resident will be prepared for all transplant-related cases by reading articles, textbooks, surgical atlases and
prior operative notes and will be able to effectively communicate this information in a teaching format to lower
level residents in complex transplant-related clinical scenarios. (PBL, ICS, MK)
The resident will learn and will be able to facilitate discussion with lower level residents and medical students in
instrumentation, materials needed, patient positioning and anesthesia needed to complete transplant-related
cases in complex clinical scenarios. (MK, P, ICS, SBP)
The resident will practice and will mentor lower level residents in cost awareness in complex transplant-related
clinical scenarios. (MK, SBP, P, ICS)
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The resident will work within and lead lower level residents in working within the interprofessional OR team to
include scrub techs, circulators, IMS, anesthesiologists, anesthesia residents, nurse anesthetists, attending
surgeons, upper level surgeons, transplant coordinators, social workers, etc., in complex transplant-related
clinical scenarios. (P, MK, SBP, ICS)
The resident will be able to recognize system errors and will bring it to the attention of the transplant team in
complex transplant-related clinical scenarios. (MK, SBP, P, ICS)
The resident will ensure correct dictation of operative reports as required by attending physician within 24 hours of
completion of operation in complex transplant-related clinical scenarios. These reports will be reviewed by the
attending physician. (P, MK, SBP)
The resident will learn and will mentor lower level residents in billing and required documentation in complex
transplant-related clinical scenarios. (ICS, P, SBP, MK)
The resident will effectively communicate with other physicians and members of the transplant team, i.e.,
nephrologists, general surgeons, internal medicine, etc.) in order to provide information about transplant-related
case details. (MK, P, ICS, SBP)
The resident will take responsibility for entering all cases performed into ACGME surgery log online system within
one week of case completion and will serve as a mentor to lower level residents to ensure correct of their cases in
complex transplant-related clinical scenarios. (P, SBP, MK)
The resident will maintain comprehensive, timely and legible medical records as it relates to the transplant patient.
(P, SBP, MK, ICS)
The resident will communicate effectively with renal transplant patients and their families across a broad range of
socioeconomic and cultural backgrounds and will mentor lower level residents and medical students. (P, SBP,
MK, ICS)
The resident will incorporate formative evaluation feedback into the daily care of transplant patients. (PBL)
The resident will analyze the process of renal transplantation and identify areas which can be improved. (PBL)
If areas are identified which can be improved, the resident will then implement changes to patient care and their
rotation with goal of practice improvement. (PBL)
The resident will demonstrate a commitment to carrying out the professional responsibilities and an adherence to
ethical principles as it relates to the transplant patient (P)
The resident will demonstrate compassion, integrity and respect for the transplant patient and their families. (P)
The resident will be responsive to the transplant patient needs that supersedes self-interest. (P)
The resident will show respect for the transplant patient privacy and autonomy. (P)
The resident will be accountable to the transplant patient, society and the profession. (P)
The resident will show sensitivity and responsiveness to the transplant patient population. (P)
Operating Room – Technical
Performance of these cases will be evaluated by faculty using the form 16 which is self-generated by the faculty
in Medhub. (PC, MK, SBP, IC, P, PBL)
The resident will progress from assisting surgeries for the first several cases to performing non-critical parts of the
procedures, following by performing critical portions such as ureteral reimplantation and vascular anastomosis. The
progression will be monitored by the attending physicians and the surgical responsibilities will be delegated according to
the resident’s manual skill level, individual knowledge, problem-solving ability and complexity of each specific case.
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Donor Nephrectomy
Open and Laparoscopic Surgery
Cadaver Transplant
Living Donor Transplant
Adult Transplant
Pediatric Transplant
Ureteroneocystostomy
Dialysis Access
o AV Fistulas
o AV Grafts
o Central Venous Access
o Peritoneal Dialysis Catheter Placement
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The resident will incorporate formative evaluation feedback into the daily care of transplant patients. (PBL)
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The resident will analyze the process of renal transplantation and identify areas which can be improved. (PBL)
If areas are identified which can be improved, the resident will then implement changes to patient care and their
rotation with goal of practice improvement. (PBL)
The resident will demonstrate a commitment to carrying out the professional responsibilities and an adherence to
ethical principles as it relates to the transplant patient (P)
The resident will demonstrate compassion, integrity and respect for the transplant patient and their families. (P)
The resident will be responsive to the transplant patient needs that supersedes self-interest. (P)
The resident will show respect for the transplant patient privacy and autonomy. (P)
The resident will be accountable to the transplant patient, society and the profession. (P)
The resident will show sensitivity and responsiveness to the transplant patient population. (P)
PGY4/URO3 Outpatient Transplant Clinic
The resident will participate in the Outpatient Transplant Clinic with Level 1 supervision progressing to Level 2
supervision.
Performance of the following goals will be evaluated by faculty using the form 14 by the faculty in Medhub. (PC,
MK, SBP, IC, P, PBL)
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The resident will strengthen skills in the management of transplant immunosuppression, postoperative
complications of transplants and the evaluation of acute and chronic rejection of transplant organs. (MK, PC, PBL,
SBP)
The resident will follow chronic hemodialysis patients from initial clinic visit to post-surgical visit. (MK, PC, SBP)
The resident will educate lower level residents and medical students on care of renal transplant patients. (MK,
ICS, P)
The resident will demonstrate the ability to investigate and evaluate their care of the renal transplant patient.
(PBL)
The resident will demonstrate their ability to appraise and assimilate scientific evidence and to continuously
improve patient care based on constant self-evaluation and life-long learning as it relates to renal transplantation
and dialysis access. (PBL)
The resident will demonstrate interpersonal and communication skills that result in the effective exchange of
information and collaboration with patients, their families and health professionals as it relates to renal
transplantation and dialysis access. (ICS)
The resident will incorporate formative evaluation feedback into the daily care of transplant patients. (PBL)
The resident will analyze the process of renal transplantation and identify areas which can be improved. (PBL)
If areas are identified which can be improved, the resident will then implement changes to patient care and their
rotation with goal of practice improvement. (PBL)
The resident will demonstrate a commitment to carrying out the professional responsibilities and an adherence to
ethical principles as it relates to the transplant patient (P)
The resident will demonstrate compassion, integrity and respect for the transplant patient and their families. (P)
The resident will be responsive to the transplant patient needs that supersedes self-interest. (P)
The resident will show respect for the transplant patient privacy and autonomy. (P)
The resident will be accountable to the transplant patient, society and the profession. (P)
The resident will show sensitivity and responsiveness to the transplant patient population. (P)
The resident will prepare for each transplant clinic by reading applicable material and will be able to facilitate and
lead discussion with lower level residents. (ICS, MK, PBL, P)
The resident will become proficient in direct patient care including initial evaluation, establishment of diagnosis,
selection of therapy and management of complications in complex transplant-related clinical scenarios. (MK, PC)
The resident will demonstrate accuracy in medical billing including selecting appropriate E&M code, selecting
appropriate diagnosis. (MK, SBP)
The resident will perform history and physical examination and lead in a consultative and teaching role for lower
level residents. (MK, PC, ICS)
The resident will develop differential diagnosis and plan of care in complex transplant-related clinic scenarios. (MK)
The resident will effectively schedule patient for surgery in complex transplant-related clinic scenarios. This will
include: (MK, SBP, PC)
o Resident-patient discussion
o Risk/benefit assessment and communication
o Post-operative expectations
Page 84
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The resident will take all the steps in order for patient to go from clinic to inpatient/outpatient surgery. (PC, SBP)
The resident will facilitate the understanding and learning in lower level residents in self-improvement by teaching
them how to identify deficiencies in patient care. (PBLI)
The resident will know evidence based practice and will know sources of information easily identifiable and will
mentor lower level residents. (MK, PBL)
The resident will identify quality improvement issues and bring them to attention of faculty in complex transplantrelated clinical scenarios. (MK, SBP, PBL)
The resident will practice cost awareness in complex transplant-related scenarios. (SBP)
The resident will work effectively within interprofessional team of nurses, clinic manager, clerks, schedulers,
transplant coordinators, social workers, other residents and attendings in complex transplant-related clinical
scenarios. (SBP, P, IC)
The resident will become proficient in using EMR and will mentor lower level residents in the appropriate and
correct use of EMR (SBP, IC)
The resident will communicate clear and concise language when describing a complex transplant-related clinical
scenario. (IC, MK)
The resident will become proficient in documentation of complex transplant-related patient visits and will ensure that
all the needed information is included in the note. (IC, MK, SBP)
The resident will use Clinical Ethics for urologist module in complex transplant-related clinical scenarios and will
facilitate the education of clinical ethics in lower level residents. (PBL, ICS)
PGY4/URO3 Transplant Rounding, In-Patient Consultations, Outpatient Consultations
Performance of these cases will be evaluated by faculty using the form 15 by the faculty in Medhub. (PC, MK,
SBP, IC, P, PBL)
Description: During rotation on Transplant Service, the resident will participate in all aspects of inpatient and
outpatient care, including consults with Level 1 supervision, progressing to Level 2 supervision.
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The resident will enhance their skills in consulting with other services. (MK, SBP, PC)
The resident will incorporate formative evaluation feedback into the daily care of transplant patients. (PBL)
The resident will analyze the process of renal transplantation and identify areas which can be improved. (PBL)
If areas are identified which can be improved, the resident will then implement changes to patient care and their
rotation with goal of practice improvement. (PBL)
The resident will act in a consultative role to other physicians and health care professionals as it relates to the
transplant patient. (ICS)
The resident will demonstrate a commitment to carrying out the professional responsibilities and an adherence to
ethical principles as it relates to the transplant patient (P)
The resident will demonstrate compassion, integrity and respect for the transplant patient and their families. (P)
The resident will be responsive to the transplant patient needs that supersedes self-interest. (P)
The resident will show respect for the transplant patient privacy and autonomy. (P)
The resident will be accountable to the transplant patient, society and the profession. (P)
The resident will show sensitivity and responsiveness to the transplant patient population. (P)
The resident will provide and mentor lower level residents in evaluation and management of inpatient renal disease
in complex transplant-related clinical scenarios (PC)
The resident will perform comprehensive history and physical examination with emphasis on renal system and renal
failure complaint in complex transplant-related clinical scenarios (PC)
The resident will lead in decisions on diagnostic and therapeutic treatment options in complex transplant-related
clinical scenarios (PC, MK, ICS)
The resident will work with other urology residents and medical students to coordinate care delivery provided by
consult team in complex transplant-related clinical scenarios (IC, SBP, P)
The resident will communicate finding from rounds or consults, including recommendations to requesting physicians
(IC, SBP)
The resident will communicate results of tests, pathology results, intra-operative findings to patients and family in
complex transplant-related clinical scenarios (IC, P)
The resident will review literature on disease processes encountered in patients. Based on literature and
knowledge, facilitate patient care in complex transplant-related clinical scenarios (PC, MK, PBL)
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



The resident will teach transplant-related urology to medical students, lower level residents, other services
requesting consults (IC, P, MK)
The resident will work effectively with other health care providers, including social workers, case managers, nurses,
pharmacists to optimize resources available to transplant patients (IC, P, SBP, MK)
The resident will perform all required documentation in order to provide accurate and useful information to other
team members, consulting teams, billing department (IC, P)
The resident will practice cost awareness in complex transplant-related clinical inpatient scenarios (SBP)
Resident will participate in the following weekly educational activities:
Monday
Urologic Subspecialty Conference 5pm
Journal Club/Chapter Review 5pm
UroPathology (6x yr, 3 cases each) 4pm
Tuesday
Transplant Journal Club
Transplant Morbidity and Mortality Conference
Transplant Patient Selection Committee
Friday
Indications/Imaging/IVP Conference 6am
Urology Grand Rounds (two presentations) 7am
Chief Case Presentations (three presentations) 7am
Morbidity and Mortality Conference 7am
Page 86
KNOWLEDGE OBJECTIVES
Kidney Transplantation Goals and Objectives
Immunology Goals and Objectives
Pharmacology and Immunosuppression Goals and Objectives
Kidney Transplantation Goals and Objectives
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
List the indication for kidney transplantation, explain the different disease processes resulting
in end-stage renal disease and describe the treatment options.
Outline the basic of principles of donor and recipient selection and deceased donor organ
allocation.
Describe and perform living and deceased donor kidney transplant procedures.
Explain the basic immunosuppressive strategies used in kidney transplantation, including
induction and maintenance therapy.
Recognize and diagnose renal transplant rejection, identify basic pathologic findings of
rejection and describe treatment strategies for rejection.
Describe the appropriate long term follow-up and be able to identify and treat short and long
term complications of kidney transplantation.
Outline the basic principles of renal replacement therapy; identify indications for and surgical
techniques necessary to place hemo- and peritoneal dialysis access.
Identify kidney transplant candidates.
Completion requirements.
Required Activities.
Learner Objectives
I. List the indications for kidney transplantation, explain the different disease processes resulting in
end-stage renal disease and describe the treatment options for end-stage renal disease.
A. Understand the process that result in end-stage kidney disease in adults and children
including pathophysiology, rate of progression, incidence of recurrent disease and impact on
transplantation for the following diseases:
1. Hypertensive nephropathy
2. Diabetic nephropathy
3. Glomerulonephritis
4. Reflux disease
5. Autoimmune kidney disease (e.g., Lupus, Wegners)
6. Inherited cystic diseases
B. Define the evaluation process for patients considering kidney transplantation including the
following components:
1. Minimal pre-operative testing
2. Cancer screening and period of waiting following diagnosis
3. Cardiac evaluation
4. Serologic evaluation and importance of viral testing (CMV, EBV, Hep B+C, HIV)
C. Understand when patients should be listed for transplant
1. Minimal listing criteria (CrCI <20)
2. Pre-emptive vs. following the initiation of dialysis
D. Properly and completely consent the patient and family and explain the risks and benefits of
renal transplantation compared with dialysis.
1. Compare life expectancy on dialysis vs. transplant for a variety of patient populations.
2. Understand basic peri-operative complications.
II.
Outline the basic principles of donor and recipient selection and deceased donor organ allocation.
A. Describe criteria used to assess the suitability of a deceased donor for organ transplant.
1. Demographic factors (age, race, sex)
2. Cause of death
3. High risk behaviors
4. Presence of malignancy (CNS vs. others)
5. Viral status (Hep C, Hep B, HTLV-1)
6. Infection in donor
7. Hemodynamic status, vasopressor requirements
Page 87
III.
IV.
V.
Page 88
8. Anatomic considerations (multiple arteries, ureters, surgical damage)
B. Describe criteria used to assess the suitability of a living donor for organ transplant.
1. Demographic factors (age, size, gender)
2. Evaluation of renal function including protein excretion
3. Presence of illnesses that may predispose the donor to renal insufficiency
4. Anatomic evaluation and considerations
a)
Multiple arteries
b)
Duplicated collecting systems
c)
Left vs. right kidney
5. Crossmatching
6. Psychological and psychosocial evaluation
7. Understand and perform the consent process for living donation including risks and
benefits of laparoscopic and open nephrectomy, risk of short and long term
complications, potential for transplant failure
8. Appreciate the ethical issues involved in living donor transplantation, the role of
independent donor advocates and the potential for coercion.
Describe and perform living and deceased donor kidney transplant procedures:
A. Prepare the kidney for transplantation
1. Strategies to deal with common anatomic features including multiple arteries and veins
B. Understand possible surgical approaches for kidney transplant including extraperitoneal and
intraperitoneal location
C. Describe the technique for isolating the iliac vessels and performing vascular anastomoses
D. Details the procedure for implanting the ureter and importance of the blood supply to the
ureter
1. Creation of anti-reflux tunnel
2. Indications for stent placement
E. Use of intra-operative adjunctive medications
F. Details the post-operative care of renal transplant patients including:
1. Fluid and electrolyte management
2. Recognition and treatment of cardiac complications
G. Identify and treat surgical complications
1. Bleeding
2. Ureteral leak
3. Lymphocele
4. Vascular thrombosis
5. Wound complications
H. Describe and interpret relevant radiological evaluations
1. Ultrasound
2. CT scanning
3. Lasix-renogram
4. Interventional diagnostics (angiogram, percutaneous nephrostogram)
I.
Identify and manage delayed graft function
1. Determine the need for post-operative dialysis
2. When should a biopsy be performed?
Explain the rationale for immunosuppressive strategies used in kidney transplantation, including
induction therapy.
A. Induction immunosuppression
1. Understand the basics of induction immunosuppression
a)
Steroids
b)
Antibody preparations
B. Determine appropriate maintenance immunosuppressive regimen
1. Rationale for choice of CNI, anti-proliferative and/or steroids
2. Appreciate issues of timing (e.g., delayed CNI for DGF)
C. Counsel patients regarding the need for compliance, potential side effects and important
drug interactions and strategies to minimize side effects.
Recognize and diagnose renal transplant rejection including performing diagnostic biopsy and
interpreting basic pathological findings
A. Participate in the care of post-transplant patients
B.
VI.
VII.
VIII.
IX.
X.
Page 89
Review and evaluate pertinent laboratory data to identify potential for rejection or other
etiologies of graft dysfunction
C. Determine the need for a percutaneous biopsy, ultrasound examination or other diagnostic
procedure
D. Renal biopsy
1. Provide appropriate consent discussion for patients
2. Utilize ultrasound for location of graft
3. Perform needle biopsy with the assistance of the fellow or attending
4. Send specimen for appropriate diagnostic studies (H and E evaluation, C4D staining)
5. In cooperation with renal pathologist, review biopsy results and identify the basic
pathologic features of rejection of renal allografts
E. Describe the treatment approaches for acute allograft rejection
1. Understand the difference in treatment for cellular and humoral rejection
F. Understand the impact on long term outcome from acute rejection episodes
Describe appropriate long-term follow-up and be able to identify and treat short and long-term
complication of kidney transplantation
A. Participate in and understand the process of long-term follow-up transplant patients
B. Appreciate the health maintenance needs of transplant patients
C. Describe techniques to preserve long-term graft function
D. Understand the impact of cardiac disease on the long-term outcome of renal transplant
patients
Describe the short and long-term outcomes of kidney transplantation
A. Appreciate short and long-term outcome of kidney recipients
Outline the basic principles of renal replacement therapy; identify indications for and surgical
techniques necessary to place hemo- and peritoneal dialysis access
A. Describe the pre-operative evaluation of patients considering vascular access
B. Independently consent patients for vascular access and explain the risks, benefits and
options
C. Perform vascular access procedure including
1. Arm fistulas
2. Arm grafts
3. Place percutaneous line for dialysis
D. Describe techniques for complicated access (leg fistula, chest grafts, leg grafts)
E. Identify and design treatment strategies for complications of access procedures
1. Stenosis/thrombosis
2. Steal syndrome
3. Poor maturation of fistula
F. Evaluate patients for peritoneal catheter placement
Identify kidney transplant patients
A. Kidney/pancreas transplant
1. Identify candidate for kidney/pancreas transplant
2. Indications to the surgery
3. Contraindications to the surgery
4. Risks and benefits from kidney/pancreas transplant
B. Kidney/liver transplant
1. Identify candidate for kidney/pancreas transplant
2. Indications to the surgery
3. Contraindications to the surgery
4. Risks and benefits from kidney/pancreas transplant
Completion Requirements
A. Four months rotation as Uro3/Pgy4
B. Outpatient clinic
C. Inpatient consultations for kidney transplant
D. Outpatient consultations for kidney transplant
E. Surgical experience
F. Donor nephrectomy
1. Open
2. Laparoscopic
G. Learn transplant surgery
XI.
Page 90
1. Cadaver transplant
2. Living donor transplant
3. Adult transplant
4. Pediatric transplant
Required activities
A. Kidney transplant journal club
B. Patient selection and listing
C. Kidney transplant grand rounds
D. Kidney transplant morbidity and mortality
E. Transplant related activities
Immunology Goals and Objectives
1. Develop an understanding of basic and clinical immunology including cellular and antibody
mediated immune responses.
a. Describe the mechanisms by which neutrophils and macrophages distinguish pathogens
and normal host tissue;
b. List the pro-inflammatory molecules secreted by macrophages and describe their role in
tissue damage;
c. Describe the roles of the classical and alternative pathways of complement activation in
host defenses.
2. Describe Basic Immunology – adaptive or specific immunity.
a. Describe the relationship between antigen presenting cells and cytokines released by cells
of the innate immune response;
b. Describe the types of antigen presenting cells and the changes that occur following
exposure to antigen;
c. List the subsets of T cells and describe their function;
d. Describe the functions of B cells;
e. Describe the distribution of MHC Class I and Class II molecules on immune cells and
commonly transplanted organs;
f. Describe the function of MHC Class I and Class II antigens;
g. Define the first, second and third signals involved in the initiation of an effective antigen
specific response;
h. Describe the steps involved in cellular injury mediated by cytotoxic T cells;
i. Describe the steps involved in cellular injury mediated by antibodies;
j. Describe the steps involved in the generation of memory T or B cells;
k. Describe the role of T regulatory cells in controlling immune responsiveness.
3. Understand the basic principles of and current techniques used to assess blood and tissue
compatibility, allosensitization and immunocompetence. Upon completion of this section, the
resident will be able to:
a. Describe blood and tissue compatibility.
i. List the blood groups that would be ABO-compatible allografts for recipients with
blood groups O, A, B and AB;
ii. Define hyperacute rejection; list the possible causes and usual measures taken to
avoid it;
iii. Distinguish between high- and low resolution molecular testing and serologic
techniques currently in use for MHC typing (tissue typing). Identify common
clinical uses for each technique;
iv. Define “donor specific antibody” and explain its implication for long-term allograft
survival;
v. Explain the use of the crossmatch in organ allocation;
vi. Explain the differences between cytotoxic, anti-kappa and flow cytometry methods
for cross matching;
vii. Define “panel reactive antibody” (PRA) and explain its relevance to
transplantation;
viii. Define “high throughput” assays for anti-HLA antibodies.
b. Describe allosensitization.
i. Distinguish between “direct” and “indirect” pathways of antigen presentation;
ii. Distinguish between allosensitization and other types of immune responses;
iii. List the inflammatory factors that contribute to the efficient immune response to
alloantigen in a transplant setting;]
iv. Explain the significance of C4d positivity on an allograft biopsy.
c. Describe immunocompetence.
i. Understand the desired balance between immune reactivity and immune
suppression in transplant recipients;
ii. List the problems associated with over immunosuppression;
iii. List the problems associated with under immunosuppression;
iv. Describe the mechanism behind tests measuring lymphocyte response to mitogen
stimulation as a measure of immunocompetence;
v. Describe limitations of such testing.
Page 91
d. Explain the basic mechanisms relevant to organ transplantation including:
Ischemia/reperfusion, inflammation, immunologic recognition of and response to
alloantigen, acute and chronic allograft rejection and tolerance.
i. Describe ischemia/reperfusion injury
1. Define ischemia/reperfusion injury
2. Explain the role of reactive oxygen species in ischemia/reperfusion injury
3. Explain the role of apoptosis in ischemia/reperfusion injury
4. Describe the role of organ preservation solution components in the
prevention/modulation of ischemia/reperfusion injury.
ii. Describe inflammation
1. Describe the mechanisms by which inflammatory reactions can
exacerbate donor specific immune mediated allograft damage
2. List the inflammation-associated cytokines that can enhance the initial
phases of adaptive immune responses.
iii. Describe immune response to alloantigen
1. Define alloantigen
2. Describe the relative importance of CD4, CD8 and delayed type
hypersensitivity T cells in response to allografts
3. Describe the role and source of perforin and granzyme
4. Define the role of donor specific antibody in relation to allograft survival
5. Describe antibody dependent cell mediated cytoxicity.
iv. Describe acute and chronic allograft rejection
1. Define hyperacute rejection
2. Define acute rejection
3. Define chronic rejection
4. List components of the immune system involved in each type of rejection
5. List currently accepted treatments for hyper acute rejection and state the
relative efficacy of each
6. List currently accepted treatments for acute rejection and state the relative
efficacy of each
7. List currently accepted treatments for chronic rejection and state the
relative efficacy of each
8. Describe the effect of hyperacute rejection on allograft survival
9. Describe the effect of acute rejection on allograft survival
10. Describe the effect of chronic rejection on allograft survival
v. Describe tolerance
1. Define tolerance
2. Explain the rationale of using co-stimulation blockade to induce clinical
tolerance
3. Explain the rationale for using lymphocyte depletion followed by
reconstitution with donor bone marrow or stem cells to induce clinical
tolerance.
Page 92
Pharmacology and Immunosuppression Goals and Objectives
I.
II.
III.
IV.
V.
Explain the basic pharmacology (mechanisms of action, metabolism, adverse effects, potential interactions,
dosing strategies and target levels) for all immunosuppressive agents in current clinical use.
Understand the rationale of multi-drug immunosuppression including use of induction therapy and
maintenance regiments.
Outline potential complications and clinical and laboratory markers of over- and under-immunosuppression
and be able to develop appropriate care plans.
Define the donor and recipient factors which impact the use of immunosuppressive agents including the risk
of rejection, infection, wound healing and malignancy.
Identify the clinical and pathologic features of hyperactive, acute and chronic cellular and humoral rejection
and implement appropriate pharmacologic therapy; identify short and long-term ramifications of rejection
episodes.
Learner Objectives
I.
Explain the basic pharmacology (mechanisms of action, metabolism, adverse effects, potential interactions,
dosing strategies and target levels) for all immunosuppressive agents in current clinical use. Upon
completion of this section, the resident will be able to:
A.
Discuss calcineurin-inhibitors.
1.
Describe the basic chemical structure of cyclosporine (CsA) and tacrolimus;
a)
Explain the mechanism of action of both agents. How are they similar and how do
they differ?
2.
Define calcineurin;
3.
Describe target trough levels for both agents in the early and late period of renal, pancreas
and liver transplantation;
4.
List commonly used drugs that interfere with CsAltacrolimus metabolism by acting as
substrates, inhibitors and inducers of the cytochrome P450 enzyme CYP3A4 system;
5.
List the most common clinical side effects of CsA acrolimus.
B.
Discuss sirolimus.
1.
Describe the basic chemical structure of sirolimus;
2.
Explain the mechanism of action of this agent;
3.
Define mTOR;
4.
Describe possible target trough levels for the use of this agent when used in combination
with a calcineurin inhibitor or with other anti-proliferative agents;
5.
List the common clinical side effects of this drug.
C.
Discuss antiproliferative agents (mycophenolate mofetil, mycophenolic acid and azathioprine).
1.
Explain the mechanism of action of these agents;
2.
Define prodrug;
3.
Describe the clinical side effect profiles and dosing strategies for these agents.
D.
Discuss monoclonal antibodies 9basiliximab, dacilzumab, muromonab CD3).
1.
Describe the difference between a depleting vs. non-depleting and a monoclonal vs. a
polyclonal antibody preparation;
2.
Explain the difference between a chimeric and a humanized monoclonal antibody;
3.
Describe the mechanism of action, side effect profile and appropriate dosing strategies for
all three antibodies.
E.
Discuss polyclonal antibodies (rabbit ATG, equine ATG).
1.
Explain the basic steps in the preparation of xenogenic polyclonal anti-human lymphocyte
sera;
2.
Describe the mechanisms – do polyclonal antibodies deplete peripheral lymphocytes;
3.
List the known binding sites of polyclonal antibodies;
4.
Describe dosing strategies for the use of poly clonal antibodies.
F.
Discuss corticosteroids.
1.
Describe several possible mechanisms of action of prednisone;
2.
Discuss the importance of steroids in the treatment of rejection and for maintenance3
immunotherapy;
3.
Compare the advantages and disadvantages of steroid-free immunosuppressive protocols
in renal, pancreas and liver transplantation;
4.
Describe the side effect profile and dosing strategy for prednisone.
Page 93
II.
III.
Page 94
Understand the rationale of multi-drug immunosuppression including use of induction therapy and
maintenance regimens. Upon completion of this section, the resident will be able to:
A.
Understand the rationale for use of multi-drug therapy versus single drug therapy in maintenance
immunosuppression.
Outline potential complications and clinical and laboratory markers of over- and under-immunosuppression
and be able to develop appropriate care plans. Upon completion of this section, the resident will be able to:
A.
Describe diagnostic and treatment plans in patients with opportunistic infections.
1.
List typical opportunistic infections associated with transplantation;
2.
Understand at what time points post-transplantation certain types of opportunistic infections
are usually observed;
3.
Describe the management of immunosuppression for a transplant patient with an
opportunistic infection;
4.
Describe the association between cytomegalovirus (CMV) infection, acute rejection and
long-term graft outcomes;
5.
Describe the alterations in immunosuppression necessary with the diagnosis of:
a)
CMV disease in solid organ transplantation
b)
BK virus nephropathy
c)
HSV or varicella infection in solid organ transplantation
d)
Fungal infection in solid organ transplantation
(1)
Candida species
(2)
Other fungal infections
B.
Describe diagnostic and treatment plans in patients with malignancy.
1.
List the most common malignancies associated with transplantation;
2.
Determine what percent greater risk of malignancy are transplant recipients compared with
the general population;
3.
Explain the association between Epstein-Barr virus (EBV) infection and Post-Transplant
Lymphoproliferative Disorders (PTLD);
4.
Describe the management of immunosuppression for a transplant recipient diagnosed with
PTLD.
C.
Describe laboratory values associated with toxicity of:
1.
Calcineurin-inhibitors
2.
Sirolimus
3.
Anti-proliferative agents
4.
Antibody preparations.
PGY-5/URO-4
This PGY-5/URO-4 resident year is structured so that 12 months are spent on Teams 1 and 2 at Presbyterian Tower
participating in the adult clinics and in inpatient and outpatient surgeries.
This urology resident year provides continued exposure to the six core competencies (PC, IC, MK, PBLI, P, SBP) with
emphasis on integrating them into the team approach in the diagnosis and treatment of urologic conditions.
Successful completion of PGY-4/URO-3 residency year is required prior to being promoted to this urology resident year.
PGY-5 urology residents do participate in the yearly Mock Oral Board Examinations.
Goals
 Teach, guide and evaluate lower level residents in the basic basic diagnostic and treatment strategies for patients with
urologic problems (PC, MK, P)
 Teach, guide and evaluate lower level residents in the basic understanding of the principles of evidence-based urology
treatment parameters (MK, PC)
 Teach, guide and evaluate lower level residents in the basic surgical skills including manual dexterity, proper handling of
surgical instruments, and knot tying proficiency (MK, PC)
 Teach, guide and evaluate lower level residents to the team approach to clinical care with emphasis on the basic
principles of coordinating patient care within a standard and complex health care system (PC, P, IC, SBP, PBLI)
 Teach, guide and evaluate lower level residents of the resources available in the health care system that will allow
optimal coordination of patient care (PBLI, SBP)
Evaluations – Appendix 3
Evaluations are done at the end of the rotation by supervising faculty, residents and ancillary staff and entered into MEDHUB
(College of Medicine sponsored resident tracking program) using Form(s) 12, 13, 14, 15, 16, 17, 18, 21, 22, 23, 25, 26, 27,
28, 30, 31, 32, 33 and 34. A review of all evaluations done on the resident during that rotation are also reviewed by the
Program Director at this time.
On Call Activities
PGY-5 urology residents take at home 2nd call with Level 2 and Level 3 supervision.
Supervision - Graded Authority and Responsibility:
The PGY-5 urology resident, whether involved in patient care or clinical research activities, will be supervised by qualified
faculty. Progressive authority and responsibility of teaching, supervising and evaluating lower level residents will be given
based on direct observation and medical knowledge.
Page 95
BLOCK DIAGRAM
PGY5/ 12 months
URO 4
Presbyterian Tower Team 1 and 2
Mon: PT OR/Clinic
Mon 5-7pm: Urology Educational
Conference
Tue: PT OR/Clinic
Wed: PT OR/Clinic
Thurs: PT OR/Clinic
Fri 6-8am: Urology Educational
Conference
Fri am: PT OR/Clinic
Fri 1-3pm: PPOB DOC Clinic
Page 96
PGY5/URO4 Presby Service Rotation
4 months Team 1
4 months Team 2

Pre-Operative Evaluation Experience
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 15 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o

Resident will collaborate with the team and other services to provide care to pre-operative and post-operative
patients that is compassionate, appropriate and effective in standard and complex clinical scenarios.
Resident will mentor the team to ensure the patient is ready for surgery in pre-operative area in simple and complex
clinical scenarios.
Resident will identify and ensure the correct ordering of necessary labs and imaging prior to surgical intervention in
standard and complex clinical scenarios.
Resident will be aware and take steps to prevent reason for surgical cancellation in standard and complex clinical
scenarios.
Resident will mentor lower level residents to ensure correct surgical site is marked and other services are notified (if
necessary) in standard and complex clinical scenarios.
Resident will document complex discussion with patients undergoing major surgical procedures.
Resident will lead quality improvement education personally for the team and of PGY 1, 2, 3 and 4 residents on selfimprovement in area of pre-operative management in standard and complex clinical scenarios. (PBL)
If resident identified areas of pre-operative management that need improvement, he/she will mentor and lead
discussion with lower level residents on quality improvement issue with the team, i.e., correct pre-operative
antibiotics, stoppage of blood thinners, cardiac clearance in standard and complex clinical scenarios.
Resident will facilitate the effective working within the multi-professional team in outpatient surgery setting in a
standard and complex clinical scenario.
Resident will anticipate and take necessary steps to prevent factors that lead to surgery delay, unnecessary patient
waiting or <24 hour cancellation in standard and complex clinical scenarios.
Resident will document any pre-operative discussions with patients in standard and complex clinical scenarios.
Operating Room Experience
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 16 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
Resident will know and facilitate the learning of lower level residents in all of the clinical details in standard and
complex clinical scenarios.
Resident will know and facilitate the learning of lower level residents in the findings on all relevant imaging in
standard and complex clinical scenarios.
Resident will be prepared for all cases by reading articles, textbooks, surgical atlases and prior operative notes and
be able to effectively communicate this information in a teaching format to lower level residents in standard and
complex clinical scenarios.
Resident will know and be able to facilitate discussion with lower level residents in instrumentation, materials
needed, patient positioning and anesthesia needed to complete the case in standard and complex clinical
scenarios.
Resident will have read and be able to describe prior to coming to OR the applicable pages from Laparoscopic and
Robotic Fundamentals and AUA Handbook on Robotics in complex clinical scenarios and will promote investigation
of self to others to improve patient care.
Resident will practice and be able to mentor lower level residents in standard and complex scenarios cost
awareness.
Resident will know and lead work within the interprofessional OR team; scrub tech, circulator, IMS,
anesthesiologists, anesthesia resident, nurse anesthetists, attending surgeon, upper level surgeon.
Resident will know system errors and will bring it to the attention of the team in complex clinical scenarios.
Resident will assess and ensure correct dictation by lower level residents of operative reports as required by
attending physician within 24 hours of completion of operation in standard and complex clinical scenarios. These
reports will be reviewed by attending physician.
Resident will know and mentor the lower level residents in billing and of required documentation in standard and
complex clinical scenarios.
Resident will effectively communicate with other members of Presbyterian team in order to provide information
about case details.
Page 97
o
o
Resident will take responsibility for entering all cases performed into ACGME surgery log online system within one
week of case completion and will serve as a mentor to lower level residents to ensure correct entry of their cases.
Resident will participate in the education of PGY1, PGY2, PGY3 and PGY4 residents and medical students.
Operating Room – Technical
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 16 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
Resident will perform and become proficient in general urology and endourology:
 Transurethral resection cases (TURP, TURBT)
 Scrotal and inguinal surgery
 Stent placement (retrograde approach)
 Ureteroscopy (upper and lower)
 Laparoscopy
 Male and female reconstruction
 Intestinal diversion
 Oncology cases including prostate, bladder, kidney, retroperitoneum
 Renal Transplantation
Page 98
PGY5/URO4 Presbyterian Resident Clinic
Performance of the following goals and teaching and supervising of lower level residents will be evaluated by
faculty using the form 14 by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Resident will prepare for each sub-specialty clinic by reading applicable material and will be able to facilitate and
lead discussion with lower level residents.
Resident will be proficient in direct patient care including initial evaluation, establishment of diagnosis, selection of
therapy and management of complications in standard and complex clinical scenarios.
Resident will demonstrate accuracy in medical billing including selecting appropriate E&M code, selecting
appropriate diagnosis.
Resident will perform history and physical examination and lead in a consultative and teaching role for lower level
residents.
Resident will develop differential diagnosis and plan of care in standard and complex clinic scenarios.
Resident will effectively schedule patient for surgery in standard and complex clinic scenarios. This will include:
 Resident-patient discussion
 Risk/benefit assessment and communication
 Post-operative expectations
Resident will take all the steps in order for patient to go from clinic to inpatient/outpatient surgery
Resident will facilitate the understanding and learning in lower level residents in self-improvement by teaching them
how to identify deficiencies in patient care. (PBLI)
Resident will know evidence based practice and will know sources of information easily identifiable and will mentor
lower level residents.
Resident will identify quality improvement issues and bring them to attention of faculty in standard and complex
clinical scenarios.
Resident will practice cost awareness in standard and complex scenarios. (SBP)
Resident will work effectively within interprofessional team of nurses, clinic manager, clerks, schedulers, other
residents and attendings in standard and complex clinical scenarios. (SBP, P, IC)
Resident will be proficient in obtaining access and using EMR and will mentor lower level residents in the
appropriate and correct use of EMR (SBP, IC)
Resident will communicate clear and concise language when describing a standard and complex clinical scenario.
(IC, MK)
Resident will be proficient in documentation of standard and complex patient visits and will ensure that all the
needed information is included in the note. (IC, MK, SBP)
Resident will perform clinic procedures and will supervise lower level residents in clinic visits under standard and
complex circumstances.
Performance of these clinic procedures and teaching and supervising of lower level residents will be
evaluated by faculty using the form 16 which is self-generated by the faculty in Medhub. (PC, MK, SBP, IC,
P, PBL)










o
o
Cystoscopy
TRUS
Prostate biopsy
Stent removal
UDY procedure and interpretation
Cystogram
Nephrostogram
Nephrostomy tube change
Renal ultrasound
Pelvic ultrasound
Resident will use Clinical Ethics for urologist module in standard and complex clinical scenarios and will facilitate
the education of clinical ethics in lower level residents.
Resident will ensure accurate dictations were performed by lower level residents.
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PGY5/URO4 Rounding, In-Patient Work, Consults
Performance of these cases and teaching and supervising of lower level residents will be evaluated by faculty
using the form 15 by the faculty in Medhub. (PC, MK, SBP, IC, P, PBL)
Description: During rotation on Presbyterian Hospital, resident will participate, supervise and evaluate lower level
residents in all aspects of inpatient care, including consults.
Resident will:
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Provide and mentor lower level residents in evaluation and management of inpatient GU disease in standard and
complex clinical scenarios (PC)
Perform comprehensive history and physical examination with emphasis on GU system and GU complaint in
standard and complex clinical scenarios (PC)
Leads in decisions on diagnostic and therapeutic treatment options in standard and complex clinical scenarios (PC,
MK, ICS)
Work with other urology residents and medical students to coordinate care delivery provided by consult team in
standard and complex clinical scenarios (IC, SBP, P)
Communicate finding from rounds or consults, including recommendations to requesting physicians (IC, SBP)
Communicate results of tests, pathology results, intra-operative findings to patients and family in standard and
complex clinical scenarios (IC, P)
Review literature on disease processes encountered in patients. Based on literature and knowledge, facilitate
patient care in standard and complex clinical scenarios (PC, MK, PBL)
Teach basic urology to medical students, PGY1, PGY2, PGY3 and PGY4 urology residents, other services
requesting consults (IC, P, MK)
Work effectively with other health care providers, including social workers, case managers, nurses, pharmacists to
optimize resources available to patients (IC, P, SBP, MK)
Perform all required documentation in order to provide accurate and useful information to other team members,
consulting teams, billing department (IC, P)
Practice cost awareness in standard and complex clinical inpatient scenarios (SBP)
The resident on this rotation is expected to attend and participate in the following education activities:
 Monday, Urology Educational Conference
 Friday, Urology Educational Conference
 Yearly In-Service Examination
 Yearly Mock Board Oral Examination
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