Urology
I.
Rational
Family physicians encounter a significant number of urologic problems in the course of practice. A family
physician must be prepared to evaluate patients with urologic complaints, diagnose their illness, and
formulate a treatment plan acceptable to the patient.
II.
Competencies
Patient Care
Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective
for the treatment of health problems and the promotion of health.
Objectives:
A. Collect information in a focused manner to analyze the patient’s urologic problem. Plan work
up and treatment in a cost-effective, evidence-based manner.
1. Take a comprehensive history for urologic complaints
2. Perform a thorough, focused examination appropriate to the symptoms including:
a. A digital exam of the prostate.
b. Exam of the scrotum and scrotal contents
c. Examination of external female genitalia
3. Plan appropriate work-up for the patient's urologic condition.
4. Integrate medical, clinical, and environmental data to plan sufficient and cost
effective testing and treatment for the patient.
B. Learn a set of procedural skills and test interpretation common to and appropriate for the
practice of Urology in family medicine.
1. Develop competence in skills for office practice including:
a. bladder catheterization
b. vasectomy
c. cryotherapy and podophyllin treatment of warts
d. androscopy
e. infant circumcision
2. Perform surgical skills relevant to the family practice hospitalized patient including
a. Infant circumcision
b. Bladder catheterization
3. Appropriately interprets and utilizes test results to manage work-up or referral of
patients, including the following:
a. Abdominal films, RUG
b. Cystoscopy
c. CT-Abdominal and pelvic
d. Doppler flow and vascular studies
e. PSA
f. Urinalysis
g. Ultrasound
Last Updated April 19, 2013
C. Learn screening for risk and prevention counseling for urologic diseases
a. Tracks family history of prostate disease
b. Counsels patient on and utilizes current screening guidelines
c. Assists patients in identifying environmental or substance abuse risks that relate
to disease development.
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
x
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
x
Attending Evaluation
x
Program Director Review
x
x
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
Directly Supervised
Procedures
In-Training Exam
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Morning Report
x
Faculty Supervision and
Feedback
360' Evaluation with nursing personnel, patients
Medical Knowledge
Goal: Resident will acquire knowledge required to prepare the family physician to evaluate and
appropriately refer urologic patients, to properly advise and support their patients undergoing a
procedure, and manage these patients in the pre-, peri- and post-operative periods.
Objectives:
A. Develop a knowledge base of surgical problems including skillful at early recognition of
symptoms and initial diagnostic work-up of:
1. nephrolithiasis
2. pyelonephritis
3. hematuria
4. cystitis
5. urinary incontinence
6. urinary retention
7. urethritis
8. varicoceles
9. spermatoceles
10. hernias
11. epididymitis
12. testicular torsion
13. testicular masses
14. prostatitis
15. BPH
16. prostatic cancer
17. neoplasm of the urinary tract
Last Updated April 19, 2013
18.
19.
20.
21.
22.
23.
24.
hematospermia
balanitis/phimosis
undescended testicles
hydroceles
cryptorchidism
ureterovesical reflux
urinary tract infections
B. Identify when the above problems necessitate urologic consultation or referral, especially
urgently or emergently
C. Develop skills in shared pre-, intra-, and postoperative management of patients
D. Evaluates operative risk and risks of anesthesia in their patients including those with the
following conditions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Asthma
Cerebrovascular disease
Coronary Artery Disease
Congestive Heart Failure
COPD
Diabetes
Elderly patient
Endocrine disorders
Hepatic disease
HTN
lmmune suppressed
Obesity
Pregnancy
Prophylactic antibiotic use
Renal insufficiency
Thromboembolic disease history or increased risk conditions
E. Serves as first assistant for common general urologic procedures.
F. Manages patients post-operatively in cooperation with the urology residents and faculty,
including the following problems:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Atalectasis
Fevers
Fluid management
Hemorrhage
Ileus
Indications and management of transfusions and transfusion reactions
Nosocomial infections
Wound infections
Nausea
Nutritional support during the recovery period
Pain control
Thromboembolic disease
Urinary retention
Last Updated April 19, 2013
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
x
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
x
Attending Evaluation
x
x
x
Program Director Review
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
Directly Supervised
Procedures
In-Training Exam
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Morning Report
x
Faculty Supervision and
Feedback
360' Evaluation with nursing personnel, patients
Practice-Based Learning and Improvement
Goal: The resident should develop skills in acquiring, analyzing, and applying medical knowledge to
patient care. Further, the resident will develop the ability for self-analysis and quality improvement to
optimize patient outcomes.
Objectives:
A. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology.
B. Locate, appraise, and assimilate evidence from scientific studies related to their patients'
health problems.
C. Obtain and use information about their own population of patients and the larger population
from which their patients are drawn.
D. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness.
E. Use information technology to manage information, access on-line medical information; and
support their own education.
F. Facilitate the learning of students and other health care professionals.
G. Learn to incorporate health promotion and disease prevention into patient care.
H. Use evidence-based medicine, evaluation of available evidence, and use of best-available
evidence at morning report meetings and during routine clinical care
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
Last Updated April 19, 2013
x
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
x
Attending Evaluation
x
x
Program Director Review
x
Directly Supervised
Procedures
In-Training Exam
Morning Report
x
Faculty Supervision and
Feedback
Quality improvement project
Interpersonal and Communication Skills
Goal:
Residents must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, their patients families, and professional associates.
Objectives:
A. Develop patient sensitive skills for interviewing that allow accurate, and complete collection
of information regarding symptoms, the family and the community that affect the patient's
health and care.
B. Develop skills in communicating results to patients, their families, other health care providers.
C. Develop skills in educating patients and their families, in dealing with sensitive issues for
patients and families, and in negotiating a plan of investigation and treatment with the
patient and family.
D. Develop professional relationships with co-workers, consultants, ancillary staff and other
professionals to enable assembling of health care teams and mobilization of community
resources to optimize care of the patient.
E. Develop an understanding of the role of the family medicine consultant, and is able to support
the patient through the process of consultation, medical evaluation, treatment, rehabilitation
and long- term care.
F. Use professional language and demeanor when communicating with other residents, with
Family Medicine attending physicians, with physicians from other services, with non-physician
clinical staff, with non-physician non-clinical staff, and with patients and their families.
G. Create and sustain a therapeutic and ethically sound relationship with patients.
H. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills.
I. Work effectively with others as a member or leader of a health care team or other professional
group.
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
x
Attending Evaluation
x
Program Director Review
x
x
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
Directly Supervised
Procedures
In-Training Exam
360' Evaluation with nursing personnel, patients
Last Updated April 19, 2013
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Morning Report
x
Faculty Supervision and
Feedback
Professionalism
Goal:
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Develop a personal ethic for patient care and care decision-making
1. Utilize compassion when working with the patient and family under stress.
2. Assist the patient in making a well-informed decision about their medical care.
3. Realistically appraise a patient's recovery potential and life quality depending on course of
action selected
B. Learn resources for personal education and develops a plan for ongoing education
1. Identify skills and procedures needed for future practice intentions and selects electives or
seeks patient care experience in areas of need
2. Identify sources of information for future continuing education
C. Recognizes strengths and weaknesses of knowledge and skills in self and others
1. Select consultants for competence and excellence in their area of expertise
2. Utilize consultants early in areas of weakness in knowledge and skill
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
x
Attending Evaluation
x
Program Director Review
x
360' evaluations
x
x
x
x
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
Directly Supervised
Procedures
In-Training Exam
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Morning Report
x
Faculty Supervision and
Feedback
Systems Based Practice
Goal:
Residents must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal value.
Last Updated April 19, 2013
Objectives:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of
the system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality
of care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
E. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance.
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
x
Attending Evaluation
x
Program Director Review
x
x
x
x
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
Directly Supervised
Procedures
In-Training Exam
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Morning Report
x
Faculty Supervision and
Feedback
Other
III.
Instructional Strategies (see above)
A.
B.
C.
D.
E.
F.
IV.
Evaluation Strategies (see above)
A.
B.
C.
D.
E.
V.
Observation of preceptor
Assessment of actual patients in preceptor’s office
Management of actual patients in continuity clinic
Case discussions
Ambulatory care conference
Associated rotations: family medicine, pediatrics, emergency medicine, gynecology, internal
medicine, and obstetrics
Observation of resident by urology preceptor
Observation of resident by clinic preceptor
Procedure / diagnosis documentation
Attendance at conference series
End of rotation evaluation
Implementation Methods
Location: The rotation will be at Midtown Urology & Surgical Center,128 North Avenue, NE, Suite 100
Atlanta, GA 30303 with Dr. Jennelle Foote.
Last Updated April 19, 2013
Contact: The resident is expected to call Foote’s office the day prior to determine where and when they
are expected and to confirm the anticipated schedule regarding the family practice center time. If patient
assignments are already clear, the resident should plan on discussing the patients with the residents who
is leaving, or arriving early to review off- service notes.
Mon
Tues
Wed
Thurs
Fri
AM
Midtown
FPC
FPC
Didactics
Midtown
PM
Midtown
FPC
FPC
FPC
Midtown
Family Practice Center: One to two half days per week.
Call/Vacation: Call will be with the FMS at Emory University Midtown Hospital. Vacation not permitted.
Supervision: Residents will be supervised by Dr. Jenelle Foote. Residents should document all
procedures in their residency passport.
Conferences: The resident is expected to attend Family Medicine Conferences and Urology Grand
Rounds.
Suggested Readings: AFP Monographs (Male Genitourinary Conditions #361, Female Genitourinary
Conditions #314)
Last Updated April 19, 2013