New Application: Pediatric Urology
Review Committee for Urology
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
PROGRAM PERSONNEL AND RESOURCES
Program Director
1. Briefly describe the involvement of the fellowship program director in the core urology residency
program. [PR II.A.1.b)]
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2. Describe the responsibility of the program director, faculty members, and fellows in preparing and
presenting required conferences, including morbidity and mortality, imaging, and journal review.
Limit response to 400 words. [PR II.A.3.h)]
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Resources
1. Indicate with an ‘X’ if equipment to perform the following procedures is available for each
participating site.
Type of equipment
Cystoscopy
Urethroscopy
Percutaneous endoscopy
Percutaneous renal access
Shock wave lithotripsy
Ultrasonography
Fluoroscopy
Laparoscopy
Laser therapy
Urodynamic evaluation equipment
Video imaging
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2. Briefly describe the space and equipment available for resident education, including meeting rooms
and classrooms; office space; diagnostic, therapeutic and research facilities; and outpatient facilities
and clinics. [PR II.D.2.]
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3. Provide statistical information for the most recent 12-month period for each participating site listed
in the Accreditation Data System (ADS). [PR II.D.4.]
Pediatric Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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Number of pediatric urology cases
Number of pediatric urologic outpatient visits
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4. Does the program have a minimum of 500 pediatric urology procedures per year? [PR II.D.4.]
.................................................................................................................................... ☐ YES ☐ NO
5. Does the program have a minimum of 2000 pediatric urology outpatient visits per year?
.................................................................................................................................... ☐ YES ☐ NO
OTHER LEARNERS
1. Provide the type of program, name of rotation, length of rotation, and the number of residents
and/or fellows from other programs assigned to the program. Add rows as necessary.
Type of Program
Name of Rotation
Length of
Rotation
Number of
Residents/Fellows
Assigned
2. Provide a brief description of the planned interaction between the pediatric urology fellows and the
urology residents.
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EDUCATIONAL PROGRAM
Patient Care
1. Describe the clinical pediatric urology program with regard to fellows’ clinical responsibilities and
how each of the following areas will be included/taught in the program. Include, when applicable, a
description of the inpatient or outpatient experiences.
a) Inpatient and outpatient consultations requiring management of pediatric urologic disease, with
graded responsibility for patient care [PR IV.A.2.a).(2).(b)]
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b) Imaging modalities used in the care of pediatric patients [PR IV.A.2.a).(2).(c)]
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c) Performance and evaluation of urodynamic studies [PR IV.A.2.a).(2).d)]
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d) Multidisciplinary management of patients with urologic tumors [PR IV.A.2.a).(2).(e)]
Pediatric Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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e) Multidisciplinary management of patients with urologic trauma [PR IV.A.2.a).(2).(f)]
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f)
Multidisciplinary management of nephrological disease and endocrinologic (adrenal) disease
[PR IV.A.2.a).(2).(g)]
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g) Pre- and post-operative management and treatment of severely ill neonates, children, and
adolescents with genitourinary problems who require intensive medical care [PR
IV.A.2.a).(2).(h)]
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h) Multidisciplinary management of myelomeningocele and other neuropathic bladder entities [PR
IV.A.2.a).(2).(i)]
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i)
Multidisciplinary management of patients with problems relating to sexual development and
medical aspects of DSD states [PR IV.A.2.a).(2).(j)]
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j)
Performance of prenatal and postnatal genetic counseling for genitourinary tract anomalies [PR
IV.A.2.a).(2).(k)]
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k) Management of genitourinary infections [PR IV.A.2.a).(2).(l)]
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Medical Knowledge
Briefly describe how the program will ensure that fellows demonstrate specialty-specific knowledge in
each of the following areas [PR IV.A.2.b).(1)]:
a)
b)
c)
d)
e)
f)
fetal and perinatal nephrology
endocrinology
radiation safety
appropriate pain management
chronic renal diseases
pharmacology of commonly used drugs and chemicals
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Practice-based Learning and Improvement
Pediatric Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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1. Briefly describe one planned quality improvement activity or project that will allow the fellow to
demonstrate an ability to analyze, improve and change practice or patient care. Describe planning,
implementation, evaluation and provisions of faculty support and supervision that will guide this
process. [PR IV.A.2.c).(1)] (Limit response to 400 words)
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2. Briefly describe one example of a learning activity in which fellows engage to develop the skills
needed to locate, appraise, and assimilate evidence from scientific studies and apply it to their
patients' health problems. [PR IV.A.2.c).(2)] (Limit response to 400 words)
The description should include:
 Locating information
 Appraising information
 Assimilating evidence information (from scientific studies)
 Applying information to patient care
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Interpersonal and Communication Skills
1. Briefly describe one learning activity in which fellows demonstrate interpersonal and communication
skills that result in the effective exchange of information and collaboration with patients, their
families, and health professionals. [PR IV.A.2.d)] (Limit response to 400 words)
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Professionalism
1. Briefly describe the learning activity(ies), other than lecture, by which fellows demonstrate a
commitment to carrying out professional responsibilities and an adherence to ethical principles. [PR
IV.A.2.e)] (Limit response to 400 words)
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Systems-based Practice
1. Briefly describe the learning activity(ies) through which fellows 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. [PR IV.A.2.f)] (Limit
response to 400 words)
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INSTITUTIONAL DATA
Supply the surgical data for the FULL PEDIATRIC YEAR. Patients up to 20 years of age inclusive are
considered pediatric cases. Combined surgical statistics from ALL sites in which fellows served during this
time are to be included in this one form and not broken down into separate sites.
Pediatric Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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Date of One-Year Period Covered
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(for all site):
Endourology/Stone Disease
SWL/ureteroscopy/PCNL
Ureterocele incision
Posterior valve ablation
Other (endourology/stone disease)
Scrotal/Inguinal Surgery
Hernia repair/orchiopexy
Varicocelectomy
Other (scrotal/inguinal surgery)
Penile Surgery
Distal hypospadias
Proximal hypospadias
Hypospadias complication repair
Epispadias
Other (penile surgery)
Bladder/Ureteral Surgery
Ureteroneocystostomy
Cysto with subureteric injection
Other (bladder/ureteral surgery)
Major Abdominal/Reconstructive Procedures
Pyeloplasty
Nephrectomy
DSD surgery
Appendicovesicostomy
Enterocystoplasty
Exstrophy closure
Other (major abdominal/reconstructive)
Urodynamic Studies
Urodynamic studies
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Pediatric Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Updated 9/2015
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