College of Medicine
DEPARTMENT OF UROLOGY
RESIDENT MANUAL
2012 - 2013
CONTENTS
Faculty .................................................................pg 4 & 5
Department of Urology Residents.............................................pg 6
&7
Resident Rotations ...................................................................pg 7
&8
Goals and Objectives ...............................................................pg 913
Educational Conferences ...........................................................pg
14
Clinical Training (Educational Objectives/ACGME Comp) pg 14 41
Resident Promotion Process (Policy) ....................................... pg
42
Call / Working Environment ................................................ .pg 43
Chief Residents ......................................................………
pg 43
Resident Responsibilities .......................................................pg 44
Communication ..............................................................pg 44
Duty Hour’s (Policy)……………………………………pg 44
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Department of Urology
2012-2013
Medical Records .............................................................pg 44
Referrals and Consultations .......................................... pg 45
Clinics .............................................................................pg 45
Orders .............................................................................pg 45
Rounds ........................................................................... pg 46
Progress Notes ............................................................... .pg 46
Preoperative Notes ......................................................... pg 46
Operating Room (OR) Schedule ......................................pg 47
Operating Room (OR) Etiquette ......................................pg 47
Operative Notes ...............................................................pg 47
Operative Report Dictation ..............................................pg 48
Operative Experience Record ..............................… pg 48& 49
Supervisory Lines of Responsibility for Patient Care (Policy) pg
50&51
(Hand- Over/ Transfer of Patient Care)(Faculty Involvement
Protocol)
Education ...................................................................................pg
52
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Department of Urology
2012-2013
General ...............................................................................pg 51
Conference Schedule ..........................................................pg 51
Urology Library ..................................................................pg 52
Residency Office and Lounge ............................................pg 53
Society Membership ...........................................................pg 53
Resident Research Presentations and Urology Review Courses
Medical Student Teaching ..................................................pg 53
Research and Educational Projects ..........................................pg 53
Resident Selection .........................................................pg 54 & 55
American Bd of Urology In-Training Exam (ABUITE) .....pg 55
Resident Evaluation of the Program and Faculty(Policy) ....pg 55 &
56
Stipends ........................................................................pg 56
Licensure ...............................................................................pg 57
Moonlighting (Policy) ...................................................... pg 57 &
58
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Department of Urology
2012-2013
Identification ..........................................................................pg 58
Dress .......................................................................................pg 58
Vacation / Leaves of Absence ( Policy)…………………… pg 5760
Attestation ...............................................................................pg 61
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Department of Urology
2012-2013
DEPARTMENT OF UROLOGY
FACULTY
UTMC Clinical Faculty
Kenneth A. Kropp, M.D.,
Professor Emeritus
3065 Arlington Avenue
Toledo, Ohio 43614
419-383-3584
Steven H. Selman, M.D.,
Chairman, Program Director
3065 Arlington Avenue
Toledo, Ohio 43614
419-383-3584
Michael Rees, M.D., PhD
Renal Transplantation
3065 Arlington Avenue
Toledo, Ohio 43614
419-383-3961
Khaled Shahrour, M.D.
Assistant Professor
3065 Arlington Ave
Toledo, Ohio 43614
419-383-3584
Jerzy Jankun, PhD
Professor
3065 Arlington Ave
Toledo, Ohio 43614
Mirza Baig, M.D.
Assistant Professor
3065 Arlington Ave
Toledo, Ohio 43614
Saleem Zafar, M.D.
Assistant Professor
3065 Arlington Ave
Toledo, Ohio 43614
Alice Bonnell, M.D.
Assistant Professor
3065 Arlington Ave
Toledo, Ohio 43614
Nurse Practitioner – Theresa Barabash, CNP
Marc Crisenbery, CNP
Urology Clinic – Manager, Anna Moss
Department of Urology Administrator – Karen Edwards
Residency & Curriculum Coordinator – Karen M. Boling
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Department of Urology
2012-2013
COMMUNITY FACULTY
Emmett Boyle, M.D.
- Education Director, The Toledo Hospital
Gregory Haselhun, M.D.- Educational Director, St. Vincent Mercy Medical
Center
Robert Navarre, M.D.
Daniel Murtagh, M.D.
Mark Wainstein, M.D.
Michael Rashid, M.D.
Eric Pizza, M.D.
Timothy Schuster, M.D.
Gregor Emmert, M.D.
Salvador Peron, M.D.
Peter Zografides, M.D.
Parimal Vyas, M.D.
Carin Hopps, M.D.
Anyse Storey, M.D.
Mani Menon, M.D.
Steven Ariss, M.D.
Stephen Sutton, M.D.
Rou Wang, M.D.
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Department of Urology
2012-2013
DEPARTMENT OF UROLOGY RESIDENTS 2011-2012
Name
Medical School
Natalie Singer
University of Toledo
Resident
Year (PGY)
6
July 1, 2007-June 30, 2013
Thomas Zaciewski
University of Toledo
July 1, 2007-June 30, 2013
Evan Fynes
University of Toledo
5
July 2008- June 30, 2014
Stanton Regan
Indiana University
July 2008 – June 30, 2014
Adam Becker
University of Louisville
4
July 1, 2007-June 30, 2015
Stanton Regan
University of Toledo
July 1, 2007-June 30, 2015
Ryan Flynn
Georgetown University
July 1, 2010 – June 30, 2016
Timothy Suttle
University of Oklahoma
July 1, 2010 – June 30, 2016
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Department of Urology
2012-2013
3
Surgery Prelim
Omar Khan-2
Hesham Mostafa-2
Bradley Buck-1
Daniel Murtagh, Jr.-1
RESIDENT ROTATIONS
First Year
Surgery Prelim
Rotation
Urology
General Surgery
Includes:plastics,SICU
Trauma
Duration (months)
6 months
6 months
Site
SVMMC
UTMC,St.Lukes
TTH
Second Year
Surgery Prelim
Urology
General Surgery
Includes:Vasc, SICU
Trauma
6 months
6 months
TTH
UTMC,St.Lukes
TTH
Third Year
Urology – URO I
6 months
6 months
SVMMC
UTMC
Fourth Year
Urology – URO II
6 months
6 months
SVMMC
UTMC
Fifth Year
Urology – URO III
6 months
6 months
UTMC
TTH
Sixth Year
Urology – URO IV
6 months
6 months
SVMMC
UTMC
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Department of Urology
2012-2013
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Department of Urology
2012-2013
Urology Residency Program
Our Educational Philosophy:
The objective of the Urology Program at the University of Toledo (UTMC) is to train urologists
of the highest quality with the knowledge, clinical acumen and surgical skills to care for the
entire spectrum of urological disorders. We believe in a rigorous academic training program
with a strong didactic schedule, busy surgical caseload, and a valuable research experience.
Particular emphasis is placed on teaching our residents the importance of establishing strong
physician-patient relationships by the priority we place on continuity of care. We believe that
faculty must dedicate themselves to teaching and that residents must demonstrate a strong
commitment to learning. We expect that the residents trained in our program will become
leaders in the urology community and that they will practice urology with personal integrity,
high ethical standards, and respect for the rights of patients entrusted to their care.
These educational goals are based on attaining the objectives set forth in the ACGME General
Competencies of resident education.
Overall Objectives of the Urology Residency Program
The primary goal of this program is to provide training in the discipline of urology which will
allow the successful graduate of the program to function as a qualified practitioner of urology
and exhibit the level of performance necessary to attain board - certification. To achieve this goal
the program is committed to providing a structured progressive educational environment in
urology based on the six core competencies, technical skills and development of clinical
knowledge. Following the conclusion of their training the trainees should be able to function as
fully qualified physicians in the field of urology. The following objectives are also part of this
goal:
Graduate residents who are competent in the medical and surgical management of urological disorders in
adults and children.
Including:
A) Outpatient diagnosis and therapy
B) Inpatient diagnosis and management
Enhance the residents experience and training in professionalism in working with:
A) Peers
B) Support staff
C) Patients
Provide exposure to and participation in research on urological disorders through:
A) Work on projects in quality assurance and professional improvement
B) Support for presentation of appropriate research at national meetings
Educational Goals of the Urology Residency Program:
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Department of Urology
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The University of Toledo’s urology residency program seeks to develop proficiency and
competency for its trainees in the surgical specialty of pediatric and adult urology. The program
is broadly divided into two time frames. The first two years are considered the pre-urology years.
During these years the trainee will be classified as a general surgery resident and will be
educated in the principles of preoperative and postoperative care of the surgical patient. This
includes principles of preoperative preparation for surgery, fluid and electrolyte problems of the
surgical patient, surgical use of antibiotics and anticoagulation therapy, wound care and the
overall management of critically ill patients in a surgical intensive care unit. Exposure to the
surgical specialties of vascular surgery, plastic surgery and general surgery will provide the
groundwork for the proper handling of tissues, vascular and bowel anastomoses, complex wound
closures in the context of surgical anatomy. Additionally ample time in urology rotations in
which the fundamental skills of patient assessment, radiologic evaluation, endoscopic evaluation,
open and laparoscopic operative approach and postoperative management will be afforded. It is
anticipated that this two year exposure will inculcate the trainee with the team work ethic that
requires professionalism, self motivated education, communication skills and appreciation of
health care systems issues.
The subsequent 4 years will be spent in clinical urology. It is anticipated that with the gaining of
clinical experience and the developing of surgical skills, increasing responsibilities will be
assumed by the trainee. The clinical experience is centered at 3 venues, The University of Toledo
Medical Center, St. Vincents Medical Center, and The Toledo Hospital. Both St. Vincent’s
Mercy Medical Center and The Toledo Hospital are home to Pediatric Hospitals providing
opportunity in the management of pediatric urologic problems. Trainees will be afforded
exposure to a large number of urologic problems. Management of these problems will require
education in problem assessment including physical exam, serologic determinations, radiologic
evaluation including the modalities of standard x-rays, coaxial tomography, magnetic resonance,
ultrasound and photon emission tomography. Clinical problem management will encompass
endoscopic surgery, laparoscopic and robotic surgery, open surgery and the appropriate post
operative care including the recognition and management of postoperative complications.
Trainees will be exposed to the following broad classes of urologic disease:
Urologic Oncology
Pediatric Urology
Infertility
Sexual Dysfunction
Calculus Disease
Male and female Incontinence
Male and female Voiding Dysfunction
Neurogenic Bladder
Renal Transplantation
Procedure exposure will be provided in the following areas:
Open Surgery—Flank, Transabdominal (intra and extraperitoneal), perineal
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Transurethral
Laparoscopic and Robotic
Percutaneous
Endoureteral and endorenal
Ultrasound and fluoroscopically guided
Microsurgical
General Urology Clinics:
Goal 1
Perform a complete interview and accurate history from patients with urologic disorders
encountered in the urology outpatient clinic setting
Objectives –
1. Using appropriate and effective interview techniques, elicit and characterize an accurate
history of the present illness from patients presenting with genitourinary complaints
2. Develop effective listening skills and be able to elicit and provide information using
appropriate nonverbal and explanatory skills
3. Formulate and write coherent and legible notes in the medical record
4. Formulate treatment plans based on patient information and preferences for specific
genitourinary diseases
5. Appropriately counsel and educate patients and their families about specific urologic
problems
6. Be empathetic, understanding, compassionate and honest in dealings with patients and
their families
7. Be sensitive and responsive to the urology patients’ culture, age, gender, and disabilities
Goal 2
Perform a detailed and appropriately focused urologic physical examination
Objectives –
1. Discuss and demonstrate ability to perform a detailed examination of the following
genitourinary organ systems:
a) Abdominal examination of the kidneys (inspection, palpation, percussion and
auscultation)
b) Inspection, percussion and palpation of the bladder
c) Inspection and palpation of the penis
d) Inspection, palpation and transillumination of the scrotum and its contents,
including the testis, testicular tunics and adnexa, spermatic cord, and vas
deferens
2. Discuss and demonstrate ability to perform a detailed male rectal examination to include:
a) Assessment of the anal sphincter and lower rectum
b) Prostate palpation to characterize its size, consistency, mobility, and the
presence/absence of abnormalities, such as nodules or induration
3. Discuss and demonstrate an appropriate vaginal and rectovaginal examination in the
female
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Department of Urology
2012-2013
4. Be able to perform and interpret a focused neuro-urologic examination
5. Demonstrate ability to recognize visually and to palpate enlarged lymph nodes in regions
related to genitourinary disease and to discuss their importance relative to differential
diagnosis to various disorders
6. When performing physical examination, to be sensitive and responsive to the patients’
culture, age and gender
Goal 3
Accurate performance and interpretation of commonly performed urologic laboratory studies
Objectives –
Demonstrate ability to perform and interpret the following laboratory studies
a) routine urinalysis
b) residual urine measurements
c) expressed prostatic secretions
d) semen analysis
2. Interpret and discuss the following laboratory studies
a) serum PSA level and free/total PSA
b) urinary electrolyte studies
c) serum electrolyte studies and acid-base analysis
d) serum creatinine and BUN
e) creatinine clearance
Goal 4
Performance and accurate interpretation of radiographic studies in the outpatient clinic setting
Objectives –
1. Be able to competently perform and interpret the following radiographic studies
a) plain films of the kidney, ureters and bladder (KUB)
b) intravenous pyelogram (IVP)
c) retrograde pyelogram
d) retrograde urethrogram
e) voiding cystourethrogram (VCUG)
f) transrectal prostatic ultrasound
2. Be able to accurately interpret an abdominal/pelvic CT scan, MRI scan, renal ultrasound
and radionuclide studies of the genitourinary tract
Goal 5
Performance of diagnostic and therapeutic procedures encountered in the urology outpatient
clinic
Objectives –
1. Be able to perform the following outpatient procedures
a) transrectal ultrasound-guided prostate biopsy
b) flexible and rigid cystoscopy
c) suprapubic tube placement
d) vasectomy
e) spermatic cord and penile block
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Department of Urology
2012-2013
f) circumcision
g) intravesical administration of chemotherapeutic or immunotherapeutic agents
h) urethral dilation
Goal 6
Competent care and evaluation of the pre-operative and post-operative urologic patient
Objectives –
1. Perform and write clear, legible and an appropriately detailed history and physical
examination on all pre-operative patients
2. Prepare and write clear and detailed admission orders
3. Assess and discuss the operative and anesthetic risks of surgical procedures
4. Obtain informed consent for all surgical procedures
5. Understand the indications for obtaining consultation with other health care specialists
prior to the surgical procedure in select patients
6. Discuss the physiologic response of the normal patient to surgical procedures and factors
that modify these responses
7. Discuss and evaluate wound healing as it relates to surgical incisions
8. Treat and evaluate pain in a safe and effective manner in the post-surgical patient
9. Discuss and evaluate the role of pharmacological agents, singly or in combination, and
apply this knowledge to the care of the surgical patient
10. Understand the influence of other diseases and co-morbidities upon surgical care
11. Recognize and correct nutritional deficits in the surgical patient
12. Recognize and deal effectively with the psychological and emotional problems
associated with anxiety imposed by urologic surgery
ERECTILE DYSFUNCTION AND INFERTILITY :
Goal 1 – Be proficient in the diagnosis, evaluation and treatment of patients with erectile
dysfunction.
Objectives
1. Describe the normal development and demonstrate the anatomy and function of the penis
and male urethra
2. Describe the normal physiology of penile erection
3. List the etiologies of erectile dysfunction
4. Discuss common medical disorders associated with erectile dysfunction
5. Describe, in depth, the evaluation of patients with erectile dysfunction, including a sexual
history, medical history, surgical history, physical examination, laboratory evaluation,
and specialized testing
6. Describe, in detail, the various treatments of erectile dysfunction to include the
following:
a. medical treatment
b. intracavernosal injection
c. vacuum constriction devices
d. psychological and sexual therapy
e. surgical procedures
 implantation of penile prosthesis
 microvascular arterial bypass procedures
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Department of Urology
2012-2013
Goal 2 – Demonstrate ability to diagnose, evaluate and treat patients with idiopathic priapism
and prolonged penile erection secondary to intracavernosal injection of vasoactive drugs.
Objectives
1. Describe the normal development and surgical anatomy of the penis
2. Discuss disturbances in the mechanism of normal erection resulting in priapism
3. List and describe the various etiologic factors in priapism
4. Demonstrate the ability to take a pertinent history and physical examination in patients
with idiopathic or PIP-induced priapism
5. Demonstrate knowledge of the diagnostic studies that are helpful in establishing the
etiology of priapism
6. Describe the vascular shunting procedures used in the treatment of priapism
7. Discuss the complications of each therapeutic method and appropriate treatment of these
complications
Goal 3 – Understand the basic science of male reproductive physiology and infertility
Objectives
1. Demonstrate an understanding of the hypothalamic-pituitary-gonadal (HPG) axis and its
endocrine control of testicular function
2. Identify the hormones involved in the HPG axis, their origins, function, reciprocal
interrelationships and feedback control
3. List the endocrinopathies, both exogenous and endogenous, that may interfere with the
normal testicular axial relationships and specify the nature of these alterations
4. Describe the anatomy, physiology, and pathophysiology of the male reproductive tract,
spermatogenesis, sperm transport, and capacitation
5. Identify the sequence of sperm maturation, the cell types found within and between the
seminiferous tubules and the time sequence of spermatogenesis
6. Describe the mechanism of ejaculation, including neurologic control and the anatomic
structures involved
7. Identify disease states that interfere with ejaculation and the manner in which these states
disrupt normal ejaculatory mechanisms
8. Describe the difference between emission and ejaculation
Goal 4
Competent diagnosis, evaluation, and treatment of patients with male infertility
Objectives
1. List the important components of a historical review in males presenting with infertility
2. Describe the components of the physical examination of infertile males
3. List the specific laboratory studies that should be obtained as part of the male infertility
evaluation and the manner in which abnormal results may contribute to or reflect the
extent of infertility
4. Select the surgical diagnostic techniques used in patients with male infertility including
vasography, rectal sonography, and testicular biopsy
5. Identify exogenous drugs that may suppress fertility, ejaculation, and erectile
dysfunction
6. Identify the appropriate surgical or medical therapies for patients with male infertility
and defend the rationale and indications for clinical application of these modalities
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Department of Urology
2012-2013
7.
List and describe, in detail, the assisted reproductive techniques commonly used in
patients with male factor infertility
UROLITHIASIS:
Goal 1
Know the etiology and pathophysiology of urinary tract stone disease
Objectives
1. Understand the epidemiology of urolithiasis to include the following:
 Geographic distribution of urinary calculus incidence in this country and the
world
 Incidence in relation to race, sex, age, and climatic factors
 The effects of dietary and fluid intake on occurrence
2. Describe the crystalline architecture of urinary calculi and theoretical factors affecting
crystallization
3. Describe the part played by matrix in the architecture and possible prevention or
initiation of stone formation
4. Describe the role of urinary tract obstruction in the etiology of urolithiasis
5. Present a working classification of the etiology of stone disease to include the following:
 Renal tubular syndromes
 Enzyme disorders
 Hypercalcemic conditions
 Hypercalciuric states
 Uric acid lithiasis
 Secondary urolithiasis
 Iatrogenic urolithiasis
Goal 2
Be proficient in the evaluation and diagnosis of a patient with urolithiasis
Objectives
1. Elicit a history compatible with stone disease from a patient including a list of pertinent
problems referable to stone formation
2. Discuss the information to be gained from urinalysis including the appearance of typical
crystals
3. Know the relationship of stone formation to urinary bacteria and pH
4. Select appropriate serum studies in the evaluation of stone disease including assessment
of serum creatinine, calcium, phosphate, and uric acid.
5. Describe the role of stone analysis in the diagnosis and treatment of patients with stone
disease
6. Have an in-depth knowledge of the radiographic evaluation of patients with stone
disease, including the use of both plain film radiography and the CT urolithiasis study
Goal 3
Select appropriate management strategies for patients with stone disease
Objectives
1. Describe the role of dietary restriction and fluid intake modifications
2. Discuss, in detail, the medical therapy of patients with metabolic stone disease
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Department of Urology
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3. Discuss, in detail, and perform various procedures used in the treatment of stone disease
to include the following:
 ESWL
 Percutaneous nephrolithotomy
 Pyelolithotomy
 Ureteroscopy
 Cystolithotomy
 Lithopaxy
4. Given a patient with recurrent stone disease, develop a plan for follow-up care including
metabolic evaluation, appropriate treatment by diet, fluid intake or medications and
subsequent evaluation by radiographic studies
Goal 4
Demonstrate competence in the use of ESWL in the treatment of urolithiasis
Objectives
1. List the types of ESWL machines available, including the sources of energy, methods of
coupling energy to patient, and the methods for imaging and targeting stones
2. Describe the physics of shock wave stone fragmentation, including the absorption of
energy at the acoustical interface, internal reflections of shock wave within the stone, and
cavitation bubbles
3. List the indications and contraindications for the use of ESWL
4. Be familiar with pre-lithotripsy management including the indications for pre-treatment
stents and selection of methods of anesthesia
5. Demonstrate ability to treat various stone types and describe initial energy levels used,
total energy delivered, and the use of contrast to assist stone targeting
6. Discuss the post-treatment management of patients treated with ESWL
7. List the complications and risks of ESWL
Goal 5
Develop competence in the use of endourologic techniques to treat upper urinary tract stones
Objectives
1. Describe the surface relationships of the kidney and the structures traversed when a
needle is passed into the renal pelvis through a posterior calyx
2. Know the intrarenal anatomy important to percutaneous renal access
3. Discuss the equipment commonly used in endourology, including guidewires, balloon
dilators, stents, stone baskets and lithotriptors
4. Demonstrate knowledge of the various types of fluoroscopy equipment and the risks of
fluoroscopy
5. Understand the technique of percutaneous nephrostomy placement, the use of
fluoroscopy or ultrasound for guidance and the potential complications of this access
procedure
6. Know the methods and instruments used for stone removal including forceps, baskets,
and various grabbers, and know which stones can be removed with each
7. Discuss various methods of power lithotripsy, including ultrasound, electrohydraulic and
laser lithotripsy
8. Know the complication of percutaneous stone removal and understand methods for their
management
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Department of Urology
2012-2013
9. Discuss the appropriate selection of patients for percutaneous lithotripsy as compared to
ESWL
10. Discuss the use of percutaneous stone dissolution and describe various chemolytic agents
11. List the complications specific to various types of stone dissolution techniques
Goal 6
Develop competence in the use of endourologic techniques to treat lower urinary tract stones
Objectives
1. Demonstrate ability to perform both rigid and flexible ureteroscopy in the treatment of
ureteral and renal stones
2. Understand the use of baskets, forceps, and other devices for ureteroscopic stone removal
3. Have a thorough knowledge of lithotripsy methods used via the ureteroscope to fragment
ureteral stones
4. Describe the immediate and long-term complications of ureteroscopy, including
extravasation, ureteral stricture, and avulsed ureter
5. Discuss the indications for ureteroscopic stone extraction as compared to the use of
ESWL in the treatment of ureteral stones
PEDIATRIC UROLOGY:
Goal 1
Diagnose, evaluate and treat pediatric patients with adrenal disease
Objectives
1. Understand the physiology of the normal adrenal
2. Recognize the clinical manifestations of the adrenal-genito (A-G) syndromes
3. Institute appropriate diagnostic steps in evaluation of the A-G syndrome
4. Institute treatment of the A-G syndrome
5. Counseling of families of patients with the A-G syndrome
6. Recognize, evaluate and treat patients with benign and malignant neoplasms of the
adrenal, including adrenal hemorrhage, adrenal adenoma, pheochromocytome, and
neuroblastoma.
Goal 2
Diagnose, evaluate and treat patients with space-occupying lesions of the kidney
Objectives
1. Diagnose and manage the spectrum of cystic disease of the kidney
2. Diagnose Wilm’s tumor of the kidney
3. Understand the role of adjuvant therapies for the management of patients with Wilm’s
disease
4. Understand the surgical approach to patients with Wilm’s tumor
Goal 3
Develop expertise in the management of UPJ anomalies
Objectives
1. Understand the role of prenatal ultrasound in the diagnosis of UPJ obstruction
2. Recognize the clinical spectrum of presentation of UPJ obstruction
3. Understand the role of renal nuclear scan in the management of patients with UPJ
obstruction
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Department of Urology
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4. Understand the various surgical approaches to the management of patients with UPJ
obstruction
5. Understand follow up strategies in patients having undergone repair
Goal 4
Be familiar with the diagnosis and management of ureteral anomalies
Objectives
1. Understand the embryology and physiology of the normal ureter
2. Recognize the clinical spectrum of the megaureter
3. Understand management strategies for the patient with a megaureter
4. Recognize the clinical implication of the Meyer Weigert rule
5. Know the surgical options in the management of patients with ureteral duplication and
associated renal anomalies
Goal 5
Manage vesico-ureteral reflux
Objectives
1. Know the classification system for vesico-ureteral reflux
2. Know and interpret the radiographic studies for the diagnosis of vesico-ureteral reflux
3. Understand the non-operative management of vesico-ureteral reflux
4. Know the surgical indications and techniques for the treatment of vesico-ureteral reflux
Goal 6
Manage pediatric voiding dysfunction
Objectives
1. Understand the role of urodynamics in the pediatric population
2. Know the options for management of the patient with enuresis
3. Understand the role of the urologist in the multidisciplinary management of patients with
meningomyelocele
4. Understand the role of vesical augmentation in the patient with the neurogenic bladder
5. Understand the Mitrofanoff technique
6. Understand the indications for the Malone procedure
7. Discuss and understand the indications and surgical options for bladder neck
reconstruction
Goal 7
Management of pediatric undescended testicle
Objectives
1. Know the embryology of the testes and testicular descent
2. Understand the indications for BHCG use in the management of the undescended testes
3. Know the indications for the use of laparoscopy in the management of patients with
nonpalpable testes
4. Understand the surgical principals involved with the repair of the undescended testicle
Goal 8
Management of the patient with ambiguous genitalia
Objectives
1. Understand the full spectrum of the biochemical and genetic disorders which lead to
intersex
2. Know the appropriate diagnostic steps in managing the patient with intersex
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Department of Urology
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3. Understand the surgical management of the patient with intersex
Goal 9
Management of the patient with urethral abnormalities
Objectives
1. Understand the embryology of the urethra
2. Classify the various degrees of hypospadias
3. Become adept in the surgical management of the hypospadiac urethra
UROLOGIC ONCOLOGY:
Goal 1
Know how to diagnose, evaluate and treat patients with kidney cancer
Objectives
1. Understand the normal development, function and surgical anatomy of the kidney
2. Identify and discuss the gross and histopathologic features of the various types of renal
tumors
3. Discuss the natural history and epidemiology of kidney cancer
4. Know the paraneoplastic syndromes that may be associated with renal cell carcinoma
5. Know and discuss the clinical and pathological staging systems used for renal cancer, and
identify the prognosis as a function of the TNM stage of disease
6. Discuss the evaluation and plan a course of therapy for selected patients with various
stages of renal cell carcinoma
7. Demonstrate the ability to select the best surgical approach (radical vs partial vs
laparoscopic nephrectomy) in patients with kidney cancer
8. Discuss adjuvant therapy for patients with renal cancer including the roles of
radiotherapy, chemotherapy and the use of biologic response modifier therapies
9. Identify and discuss the appropriate follow-up, including the role of radiographic
imaging, of patients after radical or partial nephrectomy for renal cancer
Goal 2
Competent diagnosis, evaluation and treatment of patients with cancer of the renal pelvis and
ureter
Objectives
1. Understand the normal development, function and anatomy of the ureter and renal pelvis
2. Discuss the theories regarding the etiology of cancer of the renal pelvis and ureter, and
know the natural history and risk factors for tumor progression
3. Know the histopathologic features of transitional cell carcinoma of the upper urinary
tract, including evaluation of urinary cytology
4. Demonstrate the ability to elicit a history compatible with cancer of the upper urinary
tract and discuss findings on physical examination
5. List and be able to interpret the appropriate laboratory studies necessary to diagnose and
stage cancer of the renal pelvis and ureter
6. Accurately select and interpret imaging studies of the upper urinary tract
7. Demonstrate competence in evaluation of the ureter and renal pelvis using endoscopic
techniques
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Department of Urology
2012-2013
8. Discuss the rationale for various surgical procedures used in the treatment of patients
with ureteral or renal pelvic cancer, including the indications of nephron-sparing
approaches in selected patients
9. Discuss the rationale, methodology, agents used and potential toxicities of intracavitary
agents used in the treatment of superficial tumors
10. For patients with invasive or metastatic tumors of the upper urinary tract, discuss the role
and potential toxicities of systemic chemotherapy
Goal 3
Competent diagnosis, evaluation and treatment of patients with cancer of the bladder
Objectives
1. Understand the embryology, normal development, function and anatomy of the bladder
2. Discuss the epidemiology of the various forms of bladder cancer, the concepts of
initiation and promotion of carcinogenesis and risk factors for bladder cancer
development
3. Know the natural history of superficial and muscle invasive bladder cancer
4. Know and discuss the clinical and pathological staging systems used for bladder cancer,
and identify the prognosis as a function of the TNM stage of disease
5. Demonstrate the ability to recognize the signs and symptoms of patients with bladder
cancer and be able to perform a bimanual examination of the bladder under anesthesia
6. Demonstrate the ability to interpret the results of laboratory and imaging studies in the
diagnosis and staging of bladder cancer
7. Demonstrate competence in the performance of urethroscopy and cystoscopy in the
evaluation and follow-up of patients with bladder cancer
8. Describe the endoscopic approaches to treatment of bladder cancer
9. Know and discuss the indications, efficacy, and complications associated with the use of
intravesical therapies
10. Know and discuss the role of open surgical therapy for patients with bladder cancer, and
discuss the role of lymph node dissection
11. Describe the various types of urinary diversion and considerations of their suitability in
the context of extent of disease and patient preferences
12. Discuss the role of radiotherapy and chemotherapy in the treatment (adjuvant and
therapeutic) of advanced bladder cancer
Goal 4
Be proficient in the diagnosis, evaluation and treatment of patients with prostate cancer
Objectives
1. Understand the embryology, normal development, function and anatomy of the prostate
2. Discuss the pathophysiology and theories regarding the etiology of prostate cancer
3. Know the gross and microscopic histopathology of prostate cancer and be able to
differentiate these from other common histologic entities
4. Discuss the natural history and epidemiology of prostate cancer
5. Elicit a detailed and appropriate history from patients with prostate cancer
6. Demonstrate an ability to perform a digital rectal examination, including location and
size of induration or nodules, pelvic sidewall and seminal vesicle extension of cancer
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Department of Urology
2012-2013
7.
Discuss the appropriate diagnostic and staging studies used to evaluate cancer of the
prostate and interpret their results
8. Demonstrate the ability to perform an adequate transrectal ultrasound and biopsy of the
prostate, and understand the rationale for various biopsy strategies
9. Discuss the risks, complications, and benefits of the various treatment options for
prostate cancer, and demonstrate the ability to select appropriate patients for each
treatment modality
10. Discuss with patients and families the prognosis and complications associated with
prostate cancer treatment and understand the medical and psychological management of
these complications
11. Know the appropriate follow-up regimens for patients after radical prostatectomy and
radiation therapy for prostate cancer
12. Discuss the indications and controversies surrounding the use of adjuvant therapy after
definitive therapy (radical prostatectomy or radiotherapy)
Goal 5
Competent diagnosis, evaluation and treatment of patients with testicular cancer
Objectives
1. Understand the embryology, normal development, function and surgical anatomy of the
testis and paratesticular structures
2. Know and discuss the lymphatic drainage of the testicle and the pattern of lymphatic
progression of disease to the retroperitoneum
3. Discuss various factors in the possible etiology of testis cancer
4. Know and differentiate the gross and histopathologic features of seminomatous,
nonseminomatous and non-germ cell tumors
5. Demonstrate the ability to elicit a history compatible with testicular cancer
6. Perform a complete and accurate physical examination of patients with testicular cancer,
including evaluation for lymphadenopathy or gynecomastia
7. List the appropriate diagnostic and staging studies used to evaluate cancer of the testicle
or be able to interpret the results of these studies
8. Discuss the use of serum tumor markers in patients with testis cancer
9. Interpret testicular ultrasound and abdominal/pelvic CT findings in patients with testis
cancer
10. Discuss the relative roles of retroperitoneal lymph node dissection and surveillance in
patients with Stage I nonseminomatous testis cancer
11. Understand and discuss the selection of radiotherapy for the treatment of patients with
testis cancer
12. Discuss various chemotherapeutic agents used in the treatment of advanced testis cancer
and their relative value, depending on tumor type and stage
Goal 6
Competent diagnosis, evaluation and treatment of patients with penile cancer
Objectives
1. Understand the embryology, normal development, function and surgical anatomy of the
penis and urethra
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Department of Urology
2012-2013
2.
3.
4.
5.
Discuss the incidence, epidemiology and potential etiologic factors of penile cancer
Identify and discuss treatment and follow-up of premalignant penile lesions
Know and use the TNM staging system for squamous cell carcinoma of the penis
Demonstrate an appropriate examination of the penis and inguinal lymph nodes in
patients diagnosed with penile cancer
6. Describe the surgical treatment options and their applicability to various stages of penile
cancer
7. Discuss the strategies and indications for inguinal lymph node dissection
8. Discuss the roles of radiotherapy and chemotherapy in the treatment of local and
advanced penile cancer
Goal 7
Understand the role of chemotherapeutic agents in the treatment of genitourinary malignancies
Objectives
1. Classify the commonly used chemotherapy agents used in urologic cancers
2. Discuss the pharmacology of the various types of chemotherapeutic drugs used in the
treatment of urologic cancers
3. Describe the current chemotherapeutic regimens for genitourinary cancers
4. Know the specific complications of chemotherapy, both immediate and long-term, and
treatment of these conditions
5. Discuss the treatment results and expected response rates of chemotherapy regimens used
for the treatment of various genitourinary malignancies
Goal 8
Understand the role of radiotherapy in the treatment of genitourinary malignancies
Objectives
1. Discuss the physical properties of ionizing radiation, including the fundamental units
used to describe the interaction of radiation matter and the differences in penetration and
absorption between different types of radiation
2. Know the differences between external beam and interstitial radiotherapy
3. Discuss the isotopes used for interstitial radiotherapy, including differences in energy
emitted, half-lives and the clinical utilization of each
4. Discuss the biologic factors impacting the effectiveness of radiotherapy
5. Demonstrate a basic understanding of radiotherapy principles as it relates to
genitourinary malignancy
6. Discuss the commonly employed curative and palliative radiotherapeutic doses,
schedules and fields for urologic tumors
7. Demonstrate knowledge of potential complications of radiotherapy, both in general and
those associated with the treatment of specific urologic tumors
Renal Transplantation:
Goal 1
Evaluate patients who are potential recipients of a renal transplant
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Department of Urology
2012-2013
Objectives:
1. Understand the pathologic states that lead to ESRD
2. Recognize co-morbid states which influence outcomes of renal transplantation.
3. Evaluate the suitability of potential renal transplant recipients
4. Understand the systems-based issues surrounding the acquisition of a renal transplant
5. Know the various immunosuppressive agents and their potential toxicities
6. Manage patients post transplantation with special emphasis of immunosuppressive
regimens
7. Perform renal transplantation
FEMALE UROLOGY:
Goal 1
Understand the normal development, function and surgical anatomy of the female urethra,
bladder and pelvis
Objectives
1. Describe and explain the developmental processes by which the urethra progresses to
tubular form and the hormonal influences in urethra development
2. Describe female urethral function by which urinary incontinence is maintained and the
functional role of secondary structures, such as striated muscle
3. Know the blood, lymphatic, and nerve supply of the female bladder and urethra
4. Understand the normal anatomy and support of the female pelvis, including all involved
organs and the supporting ligaments, muscle and fascia
Goal 2
Competent evaluation, diagnosis and treatment of females presenting with urinary incontinence
Objectives
1. Perform and demonstrate a complete medical history applicable of female patients
presenting with urinary incontinence
2. Demonstrate an appropriate and complete physical examination of women with
incontinence
3. Describe the laboratory studies that may assist with the diagnosis of women with
incontinence
4. Demonstrate the ability to chose and carry out the appropriate therapy for the following
conditions associated with female incontinence:
 Stress incontinence due to anatomical changes
 Stress incontinence due to sphincteric damage
 Urge incontinence and bladder instability
 Neurogenic bladder dysfunction
 Urinary retention and obstruction
 Urethral diverticula
5. Understand the role of pelvic floor neuromodulation in the treatment of patients with
refractory voiding dysfunction due to pelvic floor dysfunction
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Department of Urology
2012-2013
Goal 3
Know how to perform urodynamic studies in patients with voiding dysfunction
Objectives
1. Discuss the value and indications for urodynamic evaluation of the lower urinary tract
2. Have an in-depth knowledge of the relationship of specific part of the urodynamic study
to the filling/storage and emptying phases of micturition
3. Demonstrate the ability to independently set up and perform filling and voiding
cytometry and be able to identify and interpret all of the following:
 Urinary flow rate
 Residual urine volume
 Flow patterns
 Bladder compliance
 Involuntary bladder contractions
 Abnormal bladder sensation
 Leak point pressures
 Bethanechol supersensitivity test
 Pressure/flow studies
4. Demonstrate the ability to independently set up and perform videourodynamics
5. Demonstrate the ability to independently set up and perform electromyography utilizing
both needle and patch electrodes
Goal 4
Know how to evaluate, diagnose and treat patients with pelvic pain syndromes, including
interstitial cystitis
Objectives:
1. Demonstrate an understanding of the epidemiologic aspects of interstitial cystitis
2. Be familiar with the common theories regarding the pathogenesis of interstitial cystitis
3. List the typical symptoms of interstitial cystitis in men and women
4. Discuss the differential diagnosis of the symptoms of interstitial cystitis
5. Be familiar with the cystoscopic findings in patients with interstitial cystitis and the
indications and limitations of bladder biopsy
6. Explain the therapeutic rationale for the various treatments used in interstitial cystitis and
be familiar with their benefits, efficacy and side-effects
7. List the systemic and intravesical pharmacotherapies used to treat interstitial cystitis
8. Know the role of bladder hydrodistention in patients with interstitial cystitis
9. Know the role of pelvic floor neuromodulation in the treatment of patients with
interstitial cystitis and other pelvic pain syndromes
10. Know the role of surgical therapy for patients with refractory interstitial cystitis
11. Demonstrate proper selection of interstitial cystitis patients for surgical therapies
Goal 5
Be competent in the diagnosis and treatment of patients with vesicovaginal and ureterovaginal
fistulae
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Department of Urology
2012-2013
Objectives
1. List the signs and symptoms commonly associated with vesicovaginal (VVF) and
ureterovaginal (UVF) fistulae
2. Describe the pathogenesis of VVF, including iatronic, post-irradiation and obstetric
trauma induced fistulae
3. Describe the important components of the history and physical examination in patients
with VVF and UVF
4. Distinguish between VVF and UVF using historical and diagnostic techniques
5. Discuss the surgical principles involved in repair of these fistulas including the biology
of wound repair and the preparation of tissues for surgery
6. Describe the conservative management of VVF and UVF
7. Discuss in detail the surgical repair options for patients with VVF or UVF
UROLOGIC SURGERY:
Goal 1
Know the background, indications and potential complications of several commonly performed
urologic operative procedures
Objectives
1. Describe the rationale and indications for surgery, and list the complications associated
with the following surgical procedures:
 Nephrectomy
 Partial nephrectomy
 Pyeloplasty
 Ureteroureterostomy
 Ureteroneocystostomy
 Augmentation cystoplasty
 Transureteroureterostomy
 Boari flap and psoas hitch
 Ileal conduit
 Ileal neobladder
Goal 2
Develop and refine basic surgical techniques required for performance of some of the commonly
performed surgical cases in urology
Objectives:
1.
Describe specific surgical techniques applicable to the following operative procedures:
 Nephrectomy
 Partial nephrectomy
 Ureteroureterostomy
 Ureteroneocystostomy
 Augmentation cystoplasty
 Transureteroureterostomy
 Boari flap and psoas hitch
 Ileal conduit
 Ileal neobladder
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Department of Urology
2012-2013
The knowledge base for the practice of urology will be provided through a series of conferences
including a weekly standard textbook review, morbidity and mortality conference, indications
conference, journal club, pathology review, tumor board and visiting professor rounds. During
the URO III year those trainees assigned to the transplant service are expected to attend the
weekly multidisciplinary patient evaluation conference as well as the monthly transplant
operations meeting. Scholarly/Research opportunities both in clinical and basic science areas are
provided and encouraged throughout the training years. It is expected that during the URO III
year trainees will complete a research project suitable for presentation at a regional or national
meeting appropriate for the research context.
Residents will be expected to understand the fundamental importance of the six basic
competencies and how they shape modern medical practice. The six competencies are:
Patient Care
Medical Knowledge
Practice Based Learning
Interpersonal and Communication Skills
Professionalism
Systems-Based Practice
Educational evaluation will use faculty and health professional feedback. Each trainee will meet
with the program director twice per year for assessment of progress. Each trainee is expected to
participate in the yearly in-service examination. Professional skills training will be provided.
Trainees will be evaluated within the framework of the six competencies. Evaluation is a
two way process and it is expected that residents at all levels will provide constructive feedback
as to the content and quality of the learning experience. Promotion will be based upon a
consensus of program directors from the three training sites.
General Competency-Based Goals and Objectives
URO I, URO II, URO III, URO IV
Level Specific Goals & Objectives
URO – I :
During the URO I year rotations include the first steps in mastery of all aspects of the clinical
activities for both adult and pediatric urology. During this time, the resident develops the core of
clinical and basic sciences knowledge required to care for patients with urologic diseases. In
conjunction with the faculty at The Toledo Hospital and St. Vincent Mercy Medical Center, the
residents master the fundamentals of the interpretation of urologic imaging, such as intravenous
pyelography, coaxial tomography, and renal ultrasonography. The resident will also develop
familiarity with invasive examination of the genitourinary tract, cystoscopy, ureteroscopy, and
transrectal ultrasonography. Resident core knowledge of the diagnosis and staging of urologic
malignancies, diagnosis of calculus disease, forms of incontinence, as well as embryologic and
pediatric urologic problems develop through supervised patient contact and structured didactic
sessions. Residents can expect their accumulating knowledge to be "tested" by faculty questions
that assess the depth of resident knowledge of the clinical problem at hand.
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Department of Urology
2012-2013
URO I residents are directly supervised by the Chief Resident. Daily rounds (except when off
call on weekends, vacations and holidays) are made in conjunction with the Chief Resident.
Efficient, expeditious and compassionate care-giving is developed. Residents are expected to
develop basic bedside skills, such as suprapubic tube placement, use of filiforms and followers,
catheter guides and flexible cystoscopy. Emergency room coverage and consultations are
performed when on call in conjunction with the Chief Resident. Outpatient evaluations the
Urology outpatient clinic are of great importance in the URO I training as a way to develop
timely and cost-effective skills in the diagnosis and management of patients. Costs of patient
management (pharmaceutical and lab expenses, etc.) are reviewed with the Chief Resident and
attending physician in a prospective manner. Proper documentation of care in a problem-oriented
and legible manner is emphasized.
Technical Skills: In general, URO I residents participate in all endoscopic and open procedures.
Principals of surgical handling of tissues and basic endoscopic skills are further developed.
Residents are expected to “first assist” on procedures commensurate with their level of surgical
training and “second assist” on more technically advanced open cases.
PATIENT CARE:
Goal
To provide quality care that is appropriate, effective and compassionate to patients with
urological health problems
Objectives –
1. Obtain a complete and accurate history and physical examination from patients with
genitourinary complaints
2. Interpret and obtain appropriate laboratory studies for the evaluation of urologic
disorders
3. Formulate treatment plans based on patient information and preferences for specific
genitourinary diseases
4. Apply current scientific evidence using information technology to facilitate the diagnosis
and treatment of urologic disease
5. Appropriately counsel and educate patients and their families about specific urologic
problems
6. Know the health care services aimed at preventing urologic problems and maintaining
health
7. Work with other medical and surgical disciplines and healthcare professionals to provide
multidisciplinary care to the urology patient
8. Competently perform all diagnostic and invasive procedures required for the appropriate
management of genitourinary disorders in the outpatient setting
9. Perform all urologic surgical procedures including open, endourologic and laparoscopic
cases, in a competent manner
MEDICAL KNOWLEDGE:
Goal
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Department of Urology
2012-2013
Acquire basic scientific and clinical knowledge of the full spectrum of genitourinary disorders
and be able to apply this knowledge to the care of the urologic patient
Objectives –
1. Know the embryology, anatomy and physiology of the genitourinary system
2. Apply knowledge of the pathophysiology of the urologic disorders to the care of
individual patients
3. Obtain and process knowledge about urologic disorders from reading standard urologic
sources, current literature, internet sources and didactic teaching sessions
4. Perform well on standardized examinations (both written and oral) assessing fund of
basic science and clinical knowledge
5. Dedication to improvement in medical knowledge through a commitment to continued
medical education
6. Score in the 20th percentile or above on the annual American Board of Urology In-service
examination
PRACTICE-BASED LEARNING AND IMPROVEMENT:
Goal
Improve urologic patient care practices by the critical evaluation of current practice patterns and
by the appraisal and assimilation of scientific evidence
Objectives –
1. Critically analyze on a regular basis current practice experience using a systemic and
reliable methodology
2. Perform practice-based improvement by implementing a change in practice based on
newly acquired clinical information
3. Locate, appraise, and assimilate scientific studies from the urologic literature applicable
to patient management
4. Understand scientific study design and statistical analysis to allow evaluation and
appraisal of clinical studies
5. Use information technology to access and manage on-line medical information
6. Be an effective teacher of medical students, junior urology residents, and other healthcare
professionals
INTERPERSONAL AND COMMUNICATION SKILLS:
Goal
Develop interpersonal and communication (verbal and writing) skills that will allow effective
exchange of information with urologic patients, their families, and other healthcare professionals
Objectives –
1. Develop rapport with urologic patients and their families
2. Develop effective listening skills and be able to elicit and provide information using
appropriate non-verbal, explanatory and patient interview skills
3. Formulate and write coherent and legible notes in the medical record
4. Write clear, concise and comprehensible manuscripts for publication in the urologic
literature
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Department of Urology
2012-2013
5. Prepare and deliver oral or case presentations in a thoughtful, organized and coherent
manner
6. Work effectively with others (urologic residents and faculty) as a member/leader of the
urology healthcare team
PROFESSIONALISM:
Goal
Be professional by adherence to high ethical standards, professional responsibilities, and
sensitivity to the diverse patient population
Objectives –
1. Have respect, compassion, and integrity in interactions with patients, their family
members, and other healthcare professionals
2. Accept responsibility readily, be industrious and self-motivated, and bring assigned tasks
to completion
3. Function as an effective leader of the urology healthcare team
4. Understand and commit to the ethical principles pertaining to provision or withholding
of clinical care, confidentiality of patient information, informed consent, and urology
business practices
5. Be sensitive and responsive to the urology patients’ culture, age, gender, and disabilities
SYSTEMS-BASED PRACTICE:
Goal
Be aware of and responsive to the healthcare system and use available resources from this
system to optimize the care of urologic patients
Objectives –
1. Understand how urology patient care practices affect other healthcare professionals
within the local, regional, and national healthcare system
2. Describe how these varied types of healthcare systems affect individual urology practice
3. Understand differences between various types of medical practices and delivery systems,
especially with regards to healthcare costs and allocation of resources.
4. Readily identify and correct healthcare system deficiencies that may result in less than
optimal care of the urology patient
5. Assist urology patients in dealing with healthcare system complexities
6. Practice cost-effective healthcare and resource allocation without compromising quality
of patient care
7. Know how to partner with healthcare managers or other providers in efforts to improve
coordination and effectiveness of the healthcare system
It is the intent of this training program to develop physicians who are clinically competent in
urology. Physicians completing this program will be eligible for certification by the American
Board of Urology with an ultimate goal of a 100% pass rate on this examination. To achieve this
goal, the program has the following additional comprehensive objectives:
1. To provide an educational environment in urology so that postgraduate trainees
receive and utilize adequate knowledge and experience to function as surgeons in
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Department of Urology
2012-2013
2.
3.
4.
5.
the field of urology following conclusion of six years of progressive education and
training.
To provide the trainee the opportunity to learn and understand the fundamentals of
basic science as applied to clinical urology.
To instill in the trainee a strong sense of honesty, integrity, and compassion in patient
care.
To instill in the trainee the lifelong discipline to continually learn new developments
and changes in patient care so as to serve the patients.
To instill in the trainee a sense of responsibility to disseminate new knowledge and
teach other health professionals and colleagues.
This program is composed of educational conferences and clinical training activities which are
essential to the goals and objectives of the program. These essential functions of the program
provide the broad background required to establish the basic competency to practice medicine in
any field.
This residency program is established so that the residents receive a progressive education with
increasing responsibilities in the broad field of urology over a period of six years.
This program is designed in such a fashion that the trainee receives education for evaluation of
the patient, appropriate work-up to establish a diagnosis, management of patients and any
complications of the disease or treatment in the broad field of urology; specifically, diseases of
the genitourinary system, the comprehensive management of urologic trauma and emergency
operations, and urologic critical care. The trainee will also receive education and clinical
training in the surgical subspecialties to establish and understand basic principles of pre-, intra-,
and postoperative management of patients in pediatric urology and renal transplant surgery.
The trainee will also receive education and training in formulating, participating, and analyzing
academic research activities.
EDUCATIONAL CONFERENCES
Required educational conferences are as follows:
Morbidity and Mortality Conference. All complications and causes of death in patients
admitted to the urologic services are discussed to establish the cause of complications or death
and methods to avoid this in the future. Also, the etiology of such complications, natural
history, and management of the complications are discussed. One hour conference held
monthly.
Journal Club. In this conference, select published literature is discussed to understand current
trends of management of different diseases as well as the relative merits of various reports in
contemporary journals. One hour conference held monthly.
Urologic Pathology Lecture Series. In this conference, residents receive education on
urologic pathology. One hour conference held monthly.
Textbook Conference. This is a systematic review of information from standard textbooks in
urology to familiarize residents with prevailing principles and methods of diagnosis and
management of urological patients. Residents present subject overviews which are carefully
reviewed with faculty members. One hour conference held weekly.
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Department of Urology
2012-2013
Grand Rounds. In-depth presentations of select cases with faculty members as to delineate
optimal management approaches to classic disease states Held monthly..
Visiting Professor Conference.
Other specialty educational conferences for residents are as follows:
Genitourinary Tumor Conference. Held biweekly for one hour. A multidisciplinary
conference emphasizing systems related issues as they apply to the care of the patient with
genitourinary cancer. Held monthly for one hour at TTH. Held monthly for one hour at
SVMMC.
Renal Transplant Conference. Held weekly for one hour. A multidisciplinary conference
emphasizing systems related issues as they apply to the care of the patient with End Stage
Renal Disease.
Preoperative Patient Safety & Quality Assurance Conference. Held weekly.
Voiding Dysfunction Conference. Held monthly
Pediatric Indications Conference. Held weekly
Level Specific Goals & Objectives
URO II:
The education process initiated in the URO I year continues throughout the URO – II year.
Residents continue to mature in their clinical diagnostic skills. During this year, URO II
residents have the opportunity to be the most senior residents on the urology service at The
Toledo Hospital and have six months of dedicated UTMC/ Mercy Children’s Pediatric service at
St. Vincent Mercy Medical Center. Faculty strive to enhance clinical confidence. Resident’s
must obtain prior approval from attending for absence in coverage. Residents are expected to
integrate their base of fundamental knowledge with the wide range of clinical urologic problems
encountered at these sites.
The URO II resident is the co-senior resident on the service at TTH. During this year, the
residents develop a mature attitude towards the responsibility of patient care which is reflected
by marked attention to all details of patient management, from admission to discharge planning.
Resident management of patients in the outpatient setting is now expeditious and focused.
Consults and emergency room coverage (when on call) includes patient evaluation, the ordering
of appropriate diagnostic tests, and the formulation of a treatment plan in conjunction with the
attending physician.
Technical Skills: During this year, URO II residents develop their skills, both endoscopic and
open surgical. In many cases, URO II residents are the surgeon or they “first assist” the
attending physician and are active participants in all aspects of the surgical case.
PATIENT CARE:
Goal
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Department of Urology
2012-2013
To provide quality care that is appropriate, effective and compassionate to patients with
urological health problems
Objectives –
1. Obtain a complete and accurate history and physical examination from patients with
genitourinary complaints
2. Interpret and obtain appropriate laboratory studies for the evaluation of urologic
disorders
3. Formulate treatment plans based on patient information and preferences for specific
genitourinary diseases
4. Apply current scientific evidence using information technology to facilitate the diagnosis
and treatment of urologic disease
5. Appropriately counsel and educate patients and their families about specific urologic
problems
6. Know the health care services aimed at preventing urologic problems and maintaining
health
7. Work with other medical and surgical disciplines and healthcare professionals to provide
multidisciplinary care to the urology patient
8. Competently perform all diagnostic and invasive procedures required for the appropriate
management of genitourinary disorders in the outpatient setting
9. Perform all urologic surgical procedures including open, endourologic and laparoscopic
cases, in a competent manner
MEDICAL KNOWLEDGE:
Goal
Acquire basic scientific and clinical knowledge of the full spectrum of genitourinary disorders
and be able to apply this knowledge to the care of the urologic patient
Objectives –
1. Know the embryology, anatomy and physiology of the genitourinary system
2. Apply knowledge of the pathophysiology of the urologic disorders to the care of individual
patients
3. Obtain and process knowledge about urologic disorders from reading standard urologic
sources, current literature, internet sources and didactic teaching sessions
4. Perform well on standardized examinations (both written and oral) assessing fund of basic
science and clinical knowledge
5. Dedication to improvement in medical knowledge through a commitment to continued
medical education
PRACTICE-BASED LEARNING AND IMPROVEMENT:
Goal
Improve urologic patient care practices by the critical evaluation of current practice patterns and
by the appraisal and assimilation of scientific evidence
Objectives –
1. Critically analyze on a regular basis current practice experience using a systemic and
reliable methodology
Page 34
Department of Urology
2012-2013
2. Perform practice-based improvement by implementing a change in practice based on
newly acquired clinical information
3. Locate, appraise, and assimilate scientific studies from the urologic literature applicable
to patient management
4. Understand scientific study design and statistical analysis to allow evaluation and
appraisal of clinical studies
5. Use information technology to access and manage on-line medical information
6. Be an effective teacher of medical students, junior urology residents, and other healthcare
professionals
INTERPERSONAL AND COMMUNICATION SKILLS:
Goal
Develop interpersonal and communication (verbal and writing) skills that will allow effective
exchange of information with urologic patients, their families, and other healthcare professionals
Objectives –
1. Develop rapport with urologic patients and their families
2. Develop effective listening skills and be able to elicit and provide information using
appropriate non-verbal, explanatory and patient interview skills
3. Formulate and write coherent and legible notes in the medical record
4. Write clear, concise and comprehensible manuscripts for publication in the urologic
literature
5. Prepare and deliver oral or case presentations in a thoughtful, organized and coherent
manner
6. Work effectively with others (urologic residents and faculty) as a member/leader of the
urology healthcare team
PROFESSIONALISM:
Goal
Be professional by adherence to high ethical standards, professional responsibilities, and
sensitivity to the diverse patient population
Objectives –
1. Have respect, compassion, and integrity in interactions with patients, their family
members, and other healthcare professionals
2. Accept responsibility readily, be industrious and self-motivated, and bring assigned tasks
to completion
3. Function as an effective leader of the urology healthcare team
4. Understand and commit to the ethical principles pertaining to provision or withholding
of clinical care, confidentiality of patient information, informed consent, and urology
business practices
Be sensitive and responsive to the urology patients’ culture, age, gender, and disabilities.
SYSTEMS-BASED PRACTICE:
Goal
Be aware of and responsive to the healthcare system and use available resources from this
system to optimize the care of urologic patients
Objectives –
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Department of Urology
2012-2013
1. Understand how urology patient care practices affect other healthcare professionals
within the local, regional, and national healthcare system
2. Describe how these varied types of healthcare systems affect individual urology practice
3. Understand differences between various types of medical practices and delivery systems,
especially with regards to healthcare costs and allocation of resources.
4. Readily identify and correct healthcare system deficiencies that may result in less than
optimal care of the urology patient
5. Assist urology patients in dealing with healthcare system complexities
6. Practice cost-effective healthcare and resource allocation without compromising quality
of patient care
7. Know how to partner with healthcare managers or other providers in efforts to improve
coordination and effectiveness of the healthcare system
It is the intent of this training program to develop physicians who are clinically competent in
urology. Physicians completing this program will be eligible for certification by the American
Board of Urology with an ultimate goal of a 100% pass rate on this examination. To achieve this
goal, the program has the following additional comprehensive objectives:
1. To provide an educational environment in urology so that postgraduate trainees
receive and utilize adequate knowledge and experience to function as surgeons in the
field of urology following conclusion of six years of progressive education and
training.
2. To provide the trainee the opportunity to learn and understand the fundamentals of
basic science as applied to clinical urology.
3. To instill in the trainee a strong sense of honesty, integrity, and compassion in patient
care.
4. To instill in the trainee the lifelong discipline to continually learn new developments
and changes in patient care so as to serve the patients.
5. To instill in the trainee a sense of responsibility to disseminate new knowledge and
teach other health professionals and colleagues.
This program is composed of educational conferences and clinical training activities which are
essential to the goals and objectives of the program. These essential functions of the program
provide the broad background required to establish the basic competency to practice medicine in
any field.
This residency program is established so that the residents receive a progressive education with
increasing responsibilities in the broad field of urology over a period of six years.
This program is designed in such a fashion that the trainee receives education for evaluation of
the patient, appropriate work-up to establish a diagnosis, management of patients and any
complications of the disease or treatment in the broad field of urology; specifically, diseases of
the genitourinary system, the comprehensive management of urologic trauma and emergency
operations, and urologic critical care. The trainee will also receive education and clinical
training in the surgical subspecialties to establish and understand basic principles of pre-, intra-,
and postoperative management of patients in pediatric urology and renal transplant surgery.
The trainee will also receive education and training in formulating, participating, and analyzing
academic research activities.
Page 36
Department of Urology
2012-2013
EDUCATIONAL CONFERENCES
Required educational conferences are as follows:
Morbidity and Mortality Conference. All complications and causes of death in patients
admitted to the urologic services are discussed to establish the cause of complications or death
and methods to avoid this in the future. Also, the etiology of such complications, natural
history, and management of the complications are discussed. One hour conference held
monthly.
Journal Club. In this conference, select published literature is discussed to understand current
trends of management of different diseases as well as the relative merits of various reports in
contemporary journals. One hour conference held monthly.
Urologic Pathology Lecture Series. In this conference, residents receive education on
urologic pathology. One hour conference held monthly.
Textbook Conference. This is a systematic review of information from standard textbooks in
urology to familiarize residents with prevailing principles and methods of diagnosis and
management of urological patients. Residents present subject overviews which are carefully
reviewed with faculty members. One hour conference held weekly.
Grand Rounds. In-depth presentations of select cases with faculty members as to delineate
optimal management approaches to classic disease states Held monthly..
Visiting Professor Conference.
Other specialty educational conferences for residents are as follows:
Genitourinary Tumor Conference. Held biweekly for one hour. A multidisciplinary
conference emphasizing systems related issues as they apply to the care of the patient with
genitourinary cancer. Held monthly for one hour at TTH. Held monthly for one hour at
SVMMC.
Renal Transplant Conference. Held weekly for one hour. A multidisciplinary conference
emphasizing systems related issues as they apply to the care of the patient with End Stage
Renal Disease.
Preoperative Patient Safety & Quality Assurance Conference. Held weekly.
Voiding Dysfunction Conference. Held monthly
Pediatric Indications Conference. Held weekly
Level Specific Goals & Objectives
URO III :
URO III is research, renal transplantation and infertility. The resident will have ample
opportunity to participate in one of the many research projects within the department. At the end
Page 37
Department of Urology
2012-2013
of the URO III year it is anticipated that the resident’s activities will culminate in the production
of new knowledge worthy of publication within a peer reviewed journal. Clinical education will
revolve around all aspects of renal transplantation. The foundations of clinical immunology and
immunosuppression will be mastered in this year as well as the elements of organ preservation.
Residents will continue to participate in all other scheduled teaching rounds, clinical duties and
didactic sessions during this year. A fertility clinic rotation at Genito Urinary Surgeons
(Promedica affiliate) is also part of the URO III year. The URO III residents work with the URO
IV residents at UTMC to supervise the URO I residents. During this year, the URO III continues
to develop advanced surgical skills (including open and laparoscopic surgeries). Residents also
continue to develop advanced patient management skills with an emphasis on renal transplant
and infertility.
Technical Skills: Residents will develop the technical skills for the safe and efficient removal of
kidneys during multi-organ retrieval. All aspects of renal transplantation will include the
vascular and ureteral anastomoses will be mastered. In addition, the techniques of needle biopsy
of transplanted kidneys, implantation and removal of CAPD catheters will be included in this
year. Transplant nephrectomy as well as laparoscopic donor nephrectomies will be preformed.
PATIENT CARE:
Goal
To provide quality care that is appropriate, effective and compassionate to patients with
urological health problems
Objectives –
1. Obtain a complete and accurate history and physical examination from patients with
genitourinary complaints
2. Interpret and obtain appropriate laboratory studies for the evaluation of urologic disorders
3. Formulate treatment plans based on patient information and preferences for specific
genitourinary diseases
4. Apply current scientific evidence using information technology to facilitate the diagnosis
and treatment of urologic disease
5. Appropriately counsel and educate patients and their families about specific urologic
problems
6. Know the health care services aimed at preventing urologic problems and maintaining
health
7. Work with other medical and surgical disciplines and healthcare professionals to provide
multidisciplinary care to the urology patient
8. Competently perform all diagnostic and invasive procedures required for the appropriate
management of genitourinary disorders in the outpatient setting
9. Perform all urologic surgical procedures including open, endourologic and laparoscopic
cases, in a competent manner
MEDICAL KNOWLEDGE:
Goal
Acquire basic scientific and clinical knowledge of the full spectrum of genitourinary disorders
and be able to apply this knowledge to the care of the urologic patient
Objectives –
Page 38
Department of Urology
2012-2013
1. Know the embryology, anatomy and physiology of the genitourinary system
2. Apply knowledge of the pathophysiology of the urologic disorders to the care of
individual patients
3. Obtain and process knowledge about urologic disorders from reading standard urologic
sources, current literature, internet sources and didactic teaching sessions
4. Perform well on standardized examinations (both written and oral) assessing fund of
basic science and clinical knowledge
5. Dedication to improvement in medical knowledge through a commitment to continued
medical education
PRACTICE-BASED LEARNING AND IMPROVEMENT:
Goal
Improve urologic patient care practices by the critical evaluation of current practice patterns and
by the appraisal and assimilation of scientific evidence
Objectives –
1. Critically analyze on a regular basis current practice experience using a systemic and
reliable methodology
2. Perform practice-based improvement by implementing a change in practice based on
newly acquired clinical information
3. Locate, appraise, and assimilate scientific studies from the urologic literature applicable
to patient management
4. Understand scientific study design and statistical analysis to allow evaluation and
appraisal of clinical studies
5. Use information technology to access and manage on-line medical information
6. Be an effective teacher of medical students, junior urology residents, and other healthcare
professionals
INTERPERSONAL AND COMMUNICATION SKILLS:
Goal
Develop interpersonal and communication (verbal and writing) skills that will allow effective
exchange of information with urologic patients, their families, and other healthcare professionals
Objectives –
1. Develop rapport with urologic patients and their families
2. Develop effective listening skills and be able to elicit and provide information using
appropriate non-verbal, explanatory and patient interview skills
3. Formulate and write coherent and legible notes in the medical record
4. Write clear, concise and comprehensible manuscripts for publication in the urologic
literature
5. Prepare and deliver oral or case presentations in a thoughtful, organized and coherent
manner
6. Work effectively with others (urologic residents and faculty) as a member/leader of the
urology healthcare team
PROFESSIONALISM:
Page 39
Department of Urology
2012-2013
Goal
Be professional by adherence to high ethical standards, professional responsibilities, and
sensitivity to the diverse patient population
Objectives –
1. Have respect, compassion, and integrity in interactions with patients, their family
members, and other healthcare professionals
2. Accept responsibility readily, be industrious and self-motivated, and bring assigned tasks
to completion
3. Function as an effective leader of the urology healthcare team
4. Understand and commit to the ethical principles pertaining to provision or withholding
of clinical care, confidentiality of patient information, informed consent, and urology
business practices
5. Be sensitive and responsive to the urology patients’ culture, age, gender, and disabilities
SYSTEMS-BASED PRACTICE:
Goal
Be aware of and responsive to the healthcare system and use available resources from this
system to optimize the care of urologic patients
Objectives –
1. Understand how urology patient care practices affect other healthcare professionals
within the local, regional, and national healthcare system
2. Describe how these varied types of healthcare systems affect individual urology practice
3. Understand differences between various types of medical practices and delivery systems,
especially with regards to healthcare costs and allocation of resources.
4. Readily identify and correct healthcare system deficiencies that may result in less than
optimal care of the urology patient
5. Assist urology patients in dealing with healthcare system complexities
6. Practice cost-effective healthcare and resource allocation without compromising quality
of patient care
7. Know how to partner with healthcare managers or other providers in efforts to improve
coordination and effectiveness of the healthcare system
It is the intent of this training program to develop physicians who are clinically competent in
urology. Physicians completing this program will be eligible for certification by the American
Board of Urology with an ultimate goal of a 100% pass rate on this examination. To achieve this
goal, the program has the following additional comprehensive objectives:
1.
2.
3.
To provide an educational environment in urology so that postgraduate trainees
receive and utilize adequate knowledge and experience to function as surgeons in
the field of urology following conclusion of six years of progressive education and
training.
To provide the trainee the opportunity to learn and understand the fundamentals of
basic science as applied to clinical urology.
To instill in the trainee a strong sense of honesty, integrity, and compassion in
patient care.
Page 40
Department of Urology
2012-2013
4.
5.
To instill in the trainee the lifelong discipline to continually learn new
developments and changes in patient care so as to serve the patients.
To instill in the trainee a sense of responsibility to disseminate new knowledge and
teach other health professionals and colleagues.
This program is composed of educational conferences and clinical training activities which are
essential to the goals and objectives of the program. These essential functions of the program
provide the broad background required to establish the basic competency to practice medicine in
any field.
This residency program is established so that the residents receive a progressive education with
increasing responsibilities in the broad field of urology over a period of six years.
This program is designed in such a fashion that the trainee receives education for evaluation of
the patient, appropriate work-up to establish a diagnosis, management of patients and any
complications of the disease or treatment in the broad field of urology; specifically, diseases of
the genitourinary system, the comprehensive management of urologic trauma and emergency
operations, and urologic critical care. The trainee will also receive education and clinical
training in the surgical subspecialties to establish and understand basic principles of pre-, intra-,
and postoperative management of patients in pediatric urology and renal transplant surgery.
The trainee will also receive education and training in formulating, participating, and analyzing
academic research activities.
EDUCATIONAL CONFERENCES
Required educational conferences are as follows:
Morbidity and Mortality Conference. All complications and causes of death in patients
admitted to the urologic services are discussed to establish the cause of complications or death
and methods to avoid this in the future. Also, the etiology of such complications, natural
history, and management of the complications are discussed. One hour conference held
monthly.
Journal Club. In this conference, select published literature is discussed to understand current
trends of management of different diseases as well as the relative merits of various reports in
contemporary journals. One hour conference held monthly.
Urologic Pathology Lecture Series. In this conference, residents receive education on
urologic pathology. One hour conference held monthly.
Textbook Conference. This is a systematic review of information from standard textbooks in
urology to familiarize residents with prevailing principles and methods of diagnosis and
management of urological patients. Residents present subject overviews which are carefully
reviewed with faculty members. One hour conference held weekly.
Grand Rounds. In-depth presentations of select cases with faculty members as to delineate
optimal management approaches to classic disease states Held monthly..
Visiting Professor Conference.
Other specialty educational conferences for residents are as follows:
Page 41
Department of Urology
2012-2013
Genitourinary Tumor Conference. Held biweekly for one hour. A multidisciplinary
conference emphasizing systems related issues as they apply to the care of the patient with
genitourinary cancer. Held monthly for one hour at TTH. Held monthly for one hour at
SVMMC.
Renal Transplant Conference. Held weekly for one hour. A multidisciplinary conference
emphasizing systems related issues as they apply to the care of the patient with End Stage
Renal Disease.
Preoperative Patient Safety & Quality Assurance Conference. Held weekly.
Voiding Dysfunction Conference. Held monthly
Pediatric Indications Conference. Held weekly
Level Specific Goals & Objectives
URO IV :
URO IV, the Chief Resident (CR) year, is the culmination of the urology residency program.
The CR assumes a major role in educational leadership. A diagnosis and management plan is
synthesized by the CR prior to consultation with the attending physician, with documentation of
the consult completed in a timely manner. The CR reviews junior residents’ assessments of the
consults where appropriate. Consults to the emergency room are channeled through the CR prior
to enlisting attending physician involvement unless such a pathway leads to delay in patient care
management. The CR participates in urology outpatient clinic settings when not involved in the
operating room or other aspects of direct patient care.
The URO IV resident directly supervises the junior residents at both UTMC and SVMMC as
well as the Pre URO resident at SVMMC. They are responsible for leading daily patient rounds
as well as distributing the daily work load including case coverage. This administrative role also
includes creating the conference calendar and call schedules. Residents in this year guide junior
residents in the formulation of a patient care plan in both an inpatient and outpatient setting.
Technical Skills: The CR has a major responsibility in all urological surgeries. Upon
completion of the URO IV year, the CR is able to demonstrate competence in all aspects of open
surgical and endoscopic surgery.
PATIENT CARE:
Goal
To provide quality care that is appropriate, effective and compassionate to patients with
urological health problems
Objectives –
1. Obtain a complete and accurate history and physical examination from patients with
genitourinary complaints
Page 42
Department of Urology
2012-2013
2. Interpret and obtain appropriate laboratory studies for the evaluation of urologic
disorders
3. Formulate treatment plans based on patient information and preferences for specific
genitourinary diseases
4. Apply current scientific evidence using information technology to facilitate the diagnosis
and treatment of urologic disease
5. Appropriately counsel and educate patients and their families about specific urologic
problems
6. Know the health care services aimed at preventing urologic problems and maintaining
health
7. Work with other medical and surgical disciplines and healthcare professionals to provide
multidisciplinary care to the urology patient
8. Competently perform all diagnostic and invasive procedures required for the appropriate
management of genitourinary disorders in the outpatient setting
9. Perform all urologic surgical procedures including open, endourologic and laparoscopic
cases, in a competent manner
MEDICAL KNOWLEDGE:
Goal
Acquire basic scientific and clinical knowledge of the full spectrum of genitourinary disorders
and be able to apply this knowledge to the care of the urologic patient
Objectives –
1. Know the embryology, anatomy and physiology of the genitourinary system
2. Apply knowledge of the pathophysiology of the urologic disorders to the care of
individual patients
3. Obtain and process knowledge about urologic disorders from reading standard urologic
sources, current literature, internet sources and didactic teaching sessions
4. Perform well on standardized examinations (both written and oral) assessing fund of
basic science and clinical knowledge
5. Dedication to improvement in medical knowledge through a commitment to continued
medical education
PRACTICE-BASED LEARNING AND IMPROVEMENT:
Goal
Improve urologic patient care practices by the critical evaluation of current practice patterns and
by the appraisal and assimilation of scientific evidence
Objectives –
1. Critically analyze on a regular basis current practice experience using a systemic and
reliable methodology
2. Perform practice-based improvement by implementing a change in practice based on
newly acquired clinical information
Page 43
Department of Urology
2012-2013
3. Locate, appraise, and assimilate scientific studies from the urologic literature applicable
to patient management
4. Understand scientific study design and statistical analysis to allow evaluation and
appraisal of clinical studies
5. Use information technology to access and manage on-line medical information
6. Be an effective teacher of medical students, junior urology residents, and other healthcare
professionals
INTERPERSONAL AND COMMUNICATION SKILLS:
Goal
Develop interpersonal and communication (verbal and writing) skills that will allow effective
exchange of information with urologic patients, their families, and other healthcare professionals
Objectives –
1. Develop rapport with urologic patients and their families
2. Develop effective listening skills and be able to elicit and provide information using
appropriate non-verbal, explanatory and patient interview skills
3. Formulate and write coherent and legible notes in the medical record
4. Write clear, concise and comprehensible manuscripts for publication in the urologic
literature
5. Prepare and deliver oral or case presentations in a thoughtful, organized and coherent
manner
Work effectively with others (urologic residents and faculty) as a member/leader of the urology
healthcare team
PROFESSIONALISM:
Goal
Be professional by adherence to high ethical standards, professional responsibilities, and
sensitivity to the diverse patient population
Objectives –
1. Have respect, compassion, and integrity in interactions with patients, their family
members, and other healthcare professionals
2. Accept responsibility readily, be industrious and self-motivated, and bring assigned tasks
to completion
3. Function as an effective leader of the urology healthcare team
4. Understand and commit to the ethical principles pertaining to provision or withholding
of clinical care, confidentiality of patient information, informed consent, and urology
business practices
5. Be sensitive and responsive to the urology patients’ culture, age, gender, and disabilities
SYSTEMS-BASED PRACTICE:
Goal
Be aware of and responsive to the healthcare system and use available resources from this
system to optimize the care of urologic patients
Page 44
Department of Urology
2012-2013
Objectives –
1. Understand how urology patient care practices affect other healthcare professionals
within the local, regional, and national healthcare system
2. Describe how these varied types of healthcare systems affect individual urology practice
3. Understand differences between various types of medical practices and delivery systems,
especially with regards to healthcare costs and allocation of resources.
4. Readily identify and correct healthcare system deficiencies that may result in less than
optimal care of the urology patient
5. Assist urology patients in dealing with healthcare system complexities
6. Practice cost-effective healthcare and resource allocation without compromising quality
of patient care
7. Know how to partner with healthcare managers or other providers in efforts to improve
coordination and effectiveness of the healthcare system
It is the intent of this training program to develop physicians who are clinically competent in
urology. Physicians completing this program will be eligible for certification by the American
Board of Urology with an ultimate goal of a 100% pass rate on this examination. To achieve this
goal, the program has the following additional comprehensive objectives:
1. To provide an educational environment in urology so that postgraduate trainees
receive and utilize adequate knowledge and experience to function as surgeons in the
field of urology following conclusion of six years of progressive education and
training.
2. To provide the trainee the opportunity to learn and understand the fundamentals of
basic science as applied to clinical urology.
3. To instill in the trainee a strong sense of honesty, integrity, and compassion in patient
care.
4. To instill in the trainee the lifelong discipline to continually learn new developments
and changes in patient care so as to serve the patients.
5. To instill in the trainee a sense of responsibility to disseminate new knowledge and
teach other health professionals and colleagues.
This program is composed of educational conferences and clinical training activities which are
essential to the goals and objectives of the program. These essential functions of the program
provide the broad background required to establish the basic competency to practice medicine in
any field.
This residency program is established so that the residents receive a progressive education with
increasing responsibilities in the broad field of urology over a period of six years.
This program is designed in such a fashion that the trainee receives education for evaluation of
the patient, appropriate work-up to establish a diagnosis, management of patients and any
complications of the disease or treatment in the broad field of urology; specifically, diseases of
the genitourinary system, the comprehensive management of urologic trauma and emergency
operations, and urologic critical care. The trainee will also receive education and clinical
training in the surgical subspecialties to establish and understand basic principles of pre-, intra-,
and postoperative management of patients in pediatric urology and renal transplant surgery.
Page 45
Department of Urology
2012-2013
The trainee will also receive education and training in formulating, participating, and analyzing
academic research activities.
EDUCATIONAL CONFERENCES
Required educational conferences are as follows:
Morbidity and Mortality Conference. All complications and causes of death in patients
admitted to the urologic services are discussed to establish the cause of complications or death
and methods to avoid this in the future. Also, the etiology of such complications, natural history,
and management of the complications are discussed. One hour conference held monthly.
Journal Club. In this conference, select published literature is discussed to understand current
trends of management of different diseases as well as the relative merits of various reports in
contemporary journals. One hour conference held monthly.
Urologic Pathology Lecture Series. In this conference, residents receive education on urologic
pathology. One hour conference held monthly.
Textbook Conference. This is a systematic review of information from standard textbooks in
urology to familiarize residents with prevailing principles and methods of diagnosis and
management of urological patients. Residents present subject overviews which are carefully
reviewed with faculty members. One hour conference held weekly.
Grand Rounds. In-depth presentations of select cases with faculty members as to delineate
optimal management approaches to classic disease states Held monthly..
Visiting Professor Conference.
Other specialty educational conferences for residents are as follows:
Genitourinary Tumor Conference. Held biweekly for one hour. A multidisciplinary
conference emphasizing systems related issues as they apply to the care of the patient with
genitourinary cancer. Held monthly for one hour at TTH. Held monthly for one hour at
SVMMC.
Renal Transplant Conference. Held weekly for one hour. A multidisciplinary conference
emphasizing systems related issues as they apply to the care of the patient with End Stage
Renal Disease.
Preoperative Patient Safety & Quality Assurance Conference. Held weekly.
Voiding Dysfunction Conference. Held monthly
Pediatric Indications Conference. Held weekly
Rotation Specific Goals & Objectives for General Urology
URO – I (UTMC)
Overview:
The Uro I Residents have completed two years of general surgery training. At the time of
entering the URO 1 level, the resident is expected to know the basic human anatomy,
Page 46
Department of Urology
2012-2013
physiology, and pathology of multiple organs. The resident has developed some manual dexterity
with surgical instruments and learned to assist with surgical procedures.
Goal: To develop a foundation in general urology based on the six core competencies.
Objectives for Uro - I
1. Demonstrate ability to interact with urological patients and their families, obtain histories and
perform physical examinations.
2. Demonstrate ability to diagnose urological disease.
3. Demonstrate basic understanding of uropathology.
4. Interpret the KUB, IVP, CT, MRI scans of the abdomen, sonography of the GU system and
renal scan.
5. Determine treatment plan after adequate history and physical examination and laboratory
testing including radiographic studies.
6. Assist and perform urological procedures:
(a) Familiarity with all urological equipment, prepare for use and check their condition, and
be aware of any potential problems or pitfalls.
(b) Able to insert Foley catheter including difficult catheterization, perform cystoscopy and
insertion of ureteral stents.
(c) Perform minor urological procedures and fulguration of bleeders by endoscopy.
(d) Demonstrate ability to be first assistant in minor and major urological procedures.
7. Demonstrate ability to recognize complications following urologic
procedures.
8. Demonstrate ability to care for post-op urological patients.
9. Demonstrate ability to interact with patients, patient's families, medical personnel and faculty
members.
10. Demonstrate leadership and teaching for residents in the Pre URO years as well as residents
from other specialties rotating through urology. They should also be able to teach and set role
models for medical students on the urology service.
11. Demonstrate familiarity with basic anatomy and physiology of the genitourinary system. The
resident should be able to discuss mechanisms of stone formation, assessments of
hypertension, evaluation of genitourinary neoplasms and physiology of obstructive uropathy.
12. Be able to discuss research protocols and have an understanding of basic statistics and
evaluation of manuscripts. The resident should be able to present case material in a precise
and organized manner.
13. Review and follow the general guidelines, factual knowledge, and technical skills and
clinical guidelines commonly expected of individuals trained to practice urology.
14. Review the competency plan of the division and be familiar with the evaluation tools.
15. Prepare and participate in oral exams in-service yearly and score above the 20th percentile.
Accomplishment of the above objectives will be facilitated by the activities below.
1. The resident is responsible for the admission of patients to the hospital including a history and
physical exam and review of all relevant preoperative workup, assisting in surgery, and
follow-up and discharge planning. The resident is to be in close contact with the patient
providing up-to-date progress reports and to anticipate any problems that might be
Page 47
Department of Urology
2012-2013
encountered in the patient's recovery. Communication with the appropriate attending urologist
is essential and mandatory.
2. The resident will be given dedicated time each week to participate in the evaluation and
management of patients in the outpatient clinic setting. Assignments to the clinic are designed
to identify new patients and to follow-up on post-operative patients who were under the
resident's care during the hospitalization.
3. Each resident will be required to begin working on a research project and to lay groundwork
for the protocol and conduct of the project. The resident is expected to continue work on the
project during clinical residency in urology, to prepare the material for presentation at a
regional or national conference and to prepare a manuscript for publication.
4. The resident is required to attend the weekly academic conferences, and to present cases
and participate in the meetings. Participation in the M & M, uropathology, radiology, pre-op,
Campbell's, Journal Club, Grand, Rounds, GU Tumor, Preoperative Patient Safety & Quality
Assurance and Voiding Dysfuction conferences is mandatory.
SPECIFIC OBJECTIVES – URO – I (UTMC)
The resident will observe, participate and have mentored experience in emergency room
urology, including the following:
__________ Assist complex Foley catheterization
__________ Post-operative evaluation
__________ Management and evaluation of hematuria, and assist in simple endoscopic
management
__________ Evaluation of stone disease
__________ Assist in evaluation of urologic trauma
__________ Evaluation of urologic emergencies
__________ Manage post operative complications presenting to the emergency room
The resident will observe, participate and have mentored experience in clinic-based urology,
including the following:
__________ Evaluation of urologic cancers
__________ Evaluation of stone disease, surgical and medical evaluation
__________ Evaluation of incontinence
__________ Evaluation of impotence
__________ Evaluation of voiding dysfunction
__________ Evaluation and management of GU infections
The resident will observe and perform minor urology procedures, including the following:
__________ Cystoscopy of adults and pediatric
__________ Stent removal, stent placement, stent change
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Penile biopsy
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Department of Urology
2012-2013
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
Prostate ultrasound
Prostate biopsy
Shock wave lithotripsy
CMG-EMG
Videourodynamics
Vasectomy
Varicocelectomy
Scrotal surgery
Circumcision
Orchiopexy
Orchiectomy
TUR bladder biopsy
The resident will observe and assist in major urology cases, including the following:
__________ Radical prostatectomy
__________ Radical cystectomy
__________ Continent diversion
__________ Procedures for urinary incontinence
__________ Radical nephrectomy
__________ Donor nephrectomy
__________ Percutaneous renal surgery
__________ Endourology, including ureteroscopy, laser lithotripsy, incisions of the urinary
tract
__________ Transurethral surgery, including TURBT and TURP
__________ Laparoscopic urology
__________ RPLND
The resident will work towards development in the six core competencies:
Patient Care
__________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
__________ Gather essential and accurate information about urologic patients
__________ Make informed decisions about diagnostic and therapeutic interventions in
urology based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment of urology faculty
__________ Develop and carry out patient management plans for select urologic disorders
__________ Counsel and educate patients and their families on urologic diseases
__________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
__________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
__________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
Page 49
Department of Urology
2012-2013
__________ Work with health care professionals, including those from other disciplines
__________ Provide patient-focused care in the SIU assigned clinics
Medical Knowledge
__________ Demonstrate an investigatory and analytic thinking approach to clinical situations
__________ Know and apply the basic (molecular biology) and clinically supportive sciences
(nephrology, human oncology, transplantation) in urology
_________
Performance on the annual American Board of Urology In-Training.
Failure to score above the 20th percentile will result in a warning and may
be grounds for probation
Practice-Based Learning and Improvement
__________ Analyze practice experience and perform practice-based improvement activities
via chart reviews and personal feedback by rotation faculty
__________ Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
__________ Obtain and use information about SIU patients and the larger population from
where their patients are drawn in clinical studies
__________ Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
particularly when presenting at state and national meetings
__________ Use information technology to manage information, access on-line medical
information
__________ Facilitate the learning of medical students and other health care professionals
including mid-level providers, RNs, MAs
Interpersonal and Communication Skills
__________ Create and sustain a therapeutic and ethically sound relationship with patients,
particularly ward patients
__________ Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
__________ Work effectively with others as a team member or leader of a health care team
(urology service)
__________ Monitor colleagues for excessive stress and fatigue as taught in lecture series
Professionalism
__________ Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
__________ Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times.
__________ Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
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Department of Urology
2012-2013
Systems-Based Practice
__________ Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and society and how these
elements of the system affect their own practice (chart reviews with rotation
faculty)
__________ Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
__________ Practice cost-effective health care and resource allocation that does not
compromise quality of care (chart reviews with rotation faculty)
__________ Advocate for quality patient care and assist patients in dealing with system
complexities
__________ 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 (experience on wards and in clinic on system-based
performance in urology
Rotation Specific Goals & Objectives for General Urology
URO – I (SVMMC)
Overview:
The Uro I Residents have completed two years of general surgery training. At the time of
entering the URO 1 level, the resident is expected to know the basic human anatomy,
physiology, and pathology of multiple organs. The resident has developed some manual dexterity
with surgical instruments and learned to assist with surgical procedures.
Goal: To develop a foundation in general urology based on the six core competencies.
Objectives for Uro - I
1. Demonstrate ability to interact with urological patients and their families, obtain histories and
perform physical examinations.
2. Demonstrate ability to diagnose urological disease.
3. Demonstrate basic understanding of uropathology.
4. Interpret the KUB, IVP, CT, MRI scans of the abdomen, sonography of the GU system and
renal scan.
5. Determine treatment plan after adequate history and physical examination and laboratory
testing including radiographic studies.
6. Assist and perform urological procedures:
(a) Familiarity with all urological equipment, prepare for use and check their condition, and
be aware of any potential problems or pitfalls.
(b) Able to insert Foley catheter including difficult catheterization, perform cystoscopy and
insertion of ureteral stents.
(c) Perform minor urological procedures and fulguration of bleeders by endoscopy.
(d) Demonstrate ability to be first assistant in minor and major urological procedures.
7. Demonstrate ability to recognize complications following urologic
procedures.
8. Demonstrate ability to care for post-op urological patients.
9. Demonstrate ability to interact with patients, patient's families, medical personnel
and
faculty members.
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Department of Urology
2012-2013
10. Demonstrate leadership and teaching for residents in the Pre URO years as well as residents
from other specialties rotating through urology. They should also be able to teach and set role
models for medical students on the urology service.
11. Demonstrate familiarity with basic anatomy and physiology of the genitourinary system. The
resident should be able to discuss mechanisms of stone formation, assessments of
hypertension, evaluation of genitourinary neoplasms and physiology of obstructive uropathy.
12. Be able to discuss research protocols and have an understanding of basic statistics and
evaluation of manuscripts. The resident should be able to present case material in a precise
and organized manner.
13. Review and follow the general guidelines, factual knowledge, and technical skills and
clinical guidelines commonly expected of individuals trained to practice urology.
14. Review the competency plan of the division and be familiar with the evaluation tools.
15. Prepare and participate in oral exams in-service yearly, obtain a minimum (50% of peer
group).
Accomplishment of the above objectives will be facilitated by the activities below.
1. The resident is responsible for the admission of patients to the hospital including a history and
physical exam and review of all relevant preoperative workup, assisting in surgery, and
follow-up and discharge planning. The resident is to be in close contact with the patient
providing up-to-date progress reports and to anticipate any problems that might be
encountered in the patient's recovery. Communication with the appropriate attending urologist
is essential and mandatory.
2. The resident will be given dedicated time each week to participate in the evaluation and
management of patients in the outpatient clinic setting. Assignments to the clinic are designed
to identify new patients and to follow-up on post-operative patients who were under the
resident's care during the hospitalization.
3. Each resident will be required to begin working on a research project and to lay
groundwork for the protocol and conduct of the project. The resident is expected to continue
work on the project during clinical residency in urology, to prepare the material for
presentation at a regional or national conference and to prepare a manuscript for publication.
4. The resident is required to attend the weekly academic conferences, and to present cases
and participate in the meetings. Participation in the M & M, uropathology, radiology, pre-op,
Campbell's, Journal Club, Grand, Rounds, GU Tumor, Pediatric Indications conferences is
mandatory.
SPECIFIC OBJECTIVES – URO – I (SVMMC)
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Department of Urology
2012-2013
The resident will observe, participate and have mentored experience in emergency room
urology, including the following:
__________ Assist complex Foley catheterization
__________ Post-operative evaluation
__________ Management and evaluation of hematuria, and assist in simple endoscopic
management
__________ Evaluation of stone disease
__________ Assist in evaluation of urologic trauma
__________ Evaluation of urologic emergencies
__________ Manage post operative complications presenting to the emergency room
The resident will observe, participate and have mentored experience in clinic-based urology,
including the following:
__________ Evaluation of urologic cancers
__________ Evaluation of stone disease, surgical and medical evaluation
__________ Evaluation of incontinence
__________ Evaluation of impotence
__________ Evaluation of voiding dysfunction
__________ Evaluation and management of GU infections
The resident will observe and perform minor urology procedures, including the following:
__________ Cystoscopy of adults and pediatric
__________ Stent removal, stent placement, stent change
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Penile biopsy
__________ Prostate ultrasound
__________ Prostate biopsy
__________ Shock wave lithotripsy
__________ CMG-EMG
__________ Videourodynamics
__________ Vasectomy
__________ Varicocelectomy
__________ Scrotal surgery
__________ Circumcision
__________ Orchiopexy
__________ Orchiectomy
__________ TUR bladder biopsy
The resident will observe and assist in major urology cases, including the following:
__________ Radical prostatectomy
__________ Radical cystectomy
__________ Continent diversion
__________ Procedures for urinary incontinence
__________ Radical nephrectomy
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Department of Urology
2012-2013
__________ Donor nephrectomy
__________ Percutaneous renal surgery
__________ Endourology, including ureteroscopy, laser lithotripsy, incisions of the urinary
tract
__________ Transurethral surgery, including TURBT and TURP
__________ Laparoscopic urology
__________ RPLND
The resident will work towards development in the six core competencies:
Patient Care
__________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
__________ Gather essential and accurate information about urologic patients
__________ Make informed decisions about diagnostic and therapeutic interventions in
urology based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment of urology faculty
__________ Develop and carry out patient management plans for select urologic disorders
__________ Counsel and educate patients and their families on urologic diseases
__________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
__________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
__________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
__________ Work with health care professionals, including those from other disciplines
__________ Provide patient-focused care in the SIU assigned clinics
Medical Knowledge
__________ Demonstrate an investigatory and analytic thinking approach to clinical situations
__________ Know and apply the basic (molecular biology) and clinically supportive sciences
(nephrology, human oncology, transplantation) in urology
Practice-Based Learning and Improvement
__________ Analyze practice experience and perform practice-based improvement activities
via chart reviews and personal feedback by rotation faculty
__________ Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
__________ Obtain and use information about SIU patients and the larger population from
where their patients are drawn in clinical studies
__________ Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
particularly when presenting at state and national meetings
__________ Use information technology to manage information, access on-line medical
information
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Department of Urology
2012-2013
__________ Facilitate the learning of medical students and other health care professionals
including mid-level providers, RNs, MAs
Interpersonal and Communication Skills
__________ Create and sustain a therapeutic and ethically sound relationship with patients,
particularly ward patients
__________ Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
__________ Work effectively with others as a team member or leader of a health care team
(urology service)
__________ Monitor colleagues for excessive stress and fatigue as taught in lecture series
Professionalism
__________ Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
__________ Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times.
__________ Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
Systems-Based Practice
__________ Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and society and how these
elements of the system affect their own practice (chart reviews with rotation
faculty)
__________ Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
__________ Practice cost-effective health care and resource allocation that does not
compromise quality of care (chart reviews with rotation faculty)
__________ Advocate for quality patient care and assist patients in dealing with system
complexities
__________ 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 (experience on wards and in clinic on system-based
performance in urology
Rotation Specific Goals & Objectives for General Urology
URO – II (UTMC)
Overview
The URO II Urology Resident has completed two years of general surgery and one year of
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Department of Urology
2012-2013
general urology training. At the time of entering the URO II level the resident has reached the
objectives as outlined for URO I in Urology.
Goal: To continue progression from the foundation built on the URO I year with a broad range
of objectives based on the six core competencies
Objectives for URO II Residents:
1. Demonstrate ability that the objectives of URO I resident as outlined have been successfully
achieved.
2. Perform minor and major urological procedures with supervision:
(a) Demonstrate the ability to perform endoscopic procedures such as transurethral resection
of the prostate gland, recognition of bladder tumors and resection of bladder tumors.
(b) Ability to use laser for urological procedures.
(c) Ability to perform minor and major open urological procedures with supervision.
(d) Demonstrate ability to be not only the first assistant, but also the surgeon in certain minor
and major urological procedures.
3. Demonstrate leadership and teaching for URO I residents and medical students. To have
completed all of the objectives for URO I level and be familiar with the embryology of the
genitourinary tract, congenital anomalies and evaluation and management of infertility.
Understanding of vesicoureteral reflux, adrenal abnormalities and congenital anomalies and
evaluation and management of infertility. Understanding of vesicoureteral reflux, adrenal
abnormalities and genitourinary infections. Should have an evaluation plan for urinary
incontinence and for erectile dysfunction.
Accomplishment of the above objectives will be facilitated by the activities below.
1. The resident is responsible for 1) the admission of patients to the hospital including a history
and physical exam and review of all relevant pre-operative workup, 2) assisting in surgery,
and 3) follow-up and discharge planning. The resident is to be in close contact with the
patient providing up-to-date progress reports and to anticipate any problems that might be
encountered in the patient's recovery. Communication with the appropriate attending
urologist is essential and mandatory.
2. The resident is required to participate in the evaluation and management of patients in the
outpatient clinic setting. This includes an opportunity to perform outpatient endoscopy, rectal
ultrasound and prostate biopsy, and urodynamic testing.
3. Throughout the year, and during all rotations, the URO II resident will be responsible for the
evaluation and management of patients at TTH. They will have a supervising, full-time
faculty member or a volunteer clinical faculty member in clinic during their own clinic for
assisting in management and decisions. The resident is responsible for the initial history and
physical exam, analysis of available laboratory and imaging studies, ordering additional
studies, follow-up of results of the tests ordered, discussion of options for treatment with
patients and their families, and follow-up after treatment. The resident will participate in the
surgeries of patients seen in the clinic and followed in their clinic after surgery.
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Department of Urology
2012-2013
4. The URO II resident will develop the ability to recognize urologic pathologic problems
associated with the genitourinary system.
The resident will observe, participate and have teaching-assistant based experience in emergency
room urology, including the following:
SPECIFIC OBJECTIVES - URO II - (UTMC):
The resident will observe, participate and have teaching-assistant based experience in
emergency room urology, including the following:
__________ Post-operative evaluation
__________ Evaluation of hematuria
__________ Management and evaluation of stone disease
__________ Evaluation of pediatric emergencies
__________ Evaluation and management of pediatric and adult urologic emergencies
__________ Experience with post operative complications
The resident will observe, participate and have teaching-assistant based experience in clinicbased urology, including the following:
__________ Evaluation of urologic cancers
__________ Evaluation of stone disease, surgical and medical evaluation
__________ Evaluation of pediatric urology disease
__________ Evaluation of incontinence
__________ Evaluation of impotence
__________ Evaluation of voiding dysfunction
__________ Evaluation of infertility
__________ Experience with post operative complications
The resident will perform and teach minor urology procedures, including the following:
__________ Cystoscopy
__________ Stent removal
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Penile biopsy
__________ Prostate ultrasound
__________ Prostate biopsy
__________ Cystoscopic and fluoroscopic stent placement
__________ Shock wave lithotripsy
__________ CMG-EMG
__________ Vasectomy
__________ Varicocelectomy
_________ Vasovasostomy
_________ Scrotal surgery, including hernia/hydrocoele, orchiopexy
_________ Videourodynamics
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Department of Urology
2012-2013
The resident will perform and teach major urology cases, including the following:
_________ Radical prostatectomy
_________ Radical cystectomy
_________ Continent diversion
_________ Procedures for urinary incontinence
_________ Radical nephrectomy
_________ Donor nephrectomy
_________ Percutaneous renal surgery
_________ Endo-urology
_________ Transurethral surgery, including TURBT and TURP
_________ Laparoscopic urology
_________ Pediatric urology including ureteral reimplantation, bladder augmentation,
pediatric endourology, portions of hypospadias, pyeloplasty, major reconstructive
procedures
The resident will work towards development in the six core competencies:
Patient Care
_________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
_________ Gather essential and accurate information about urologic patients
_________ Make informed decisions about diagnostic and therapeutic interventions in
urology based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment of urology faculty
_________ Develop and carry out patient management plans for select urologic disorders
_________ Counsel and educate patients and their families on urologic diseases
_________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
_________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
_________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
_________ Work with health care professionals, including those from other disciplines
Medical Knowledge
_________
_________
Demonstrate an investigatory and analytic thinking approach to clinical situations
Know and apply the basic (molecular biology) and clinically supportive sciences
(nephrology, human oncology, transplantation) in urology
_________
Analyze practice experience and perform practice-based improvement activities
via chart reviews and personal feedback by rotation faculty
Practice-Based Learning and Improvement
Page 58
Department of Urology
2012-2013
_________
_________
_________
_________
_________
Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
Obtain and use information about SIU patients and the larger population from
where their patients are drawn in clinical studies
Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
particularly when presenting at state and national meetings
Use information technology to manage information, access on-line medical
information
Facilitate the learning of medical students and other health care professionals
including mid-level providers, RNs, MAs
Interpersonal and Communication Skills
_________
_________
_________
_________
Create and sustain a therapeutic and ethically sound relationship with patients,
particularly ward patients
Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
Work effectively with others as a team member or leader of a health care team
(urology service)
Monitor colleagues for excessive stress and fatigue as taught in lecture series
Professionalism
_________
_________
_________
Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times.
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and
disabilities
Systems-Based Practice
_________
_________
_________
_________
_________
Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and society and how these
elements of the system affect their own practice (chart reviews with rotation
faculty)
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
Practice cost-effective health care and resource allocation that does not
compromise quality of care (chart reviews with rotation faculty)
Advocate for quality patient care and assist patients in dealing with system
complexities
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
Page 59
Department of Urology
2012-2013
affect system performance (experience on wards and in clinic on system-based
performance in urology)
Rotation Specific Goals & Objectives for Pediatric Urology
URO – II (SVMMC)
Overview
The URO II Urology Resident has completed two years of general surgery and one year of
general urology training. At the time of entering the URO II level the resident has reached the
objectives as outlined for URO I in Urology.
Goal: To build on the foundation of the URO I year, have a dedicated pediatric rotation and
progress to the next level of training.
Objectives for URO II Residents:
1. Demonstrate ability that the objectives of URO I resident as outlined have been successfully
achieved.
2. Perform minor and major pediatric urological procedures with supervision:
(a) Demonstrate the ability to perform endoscopic procedures such as transurethral resection
of the urethral valves, recognition of ureteralocele and intra vesical urethral
abnormalities.
(b) Ability to use laser for urological procedures.
(c) Ability to perform minor and major open urological pediatric procedures with
supervision.
(d) Demonstrate ability to be not only the first assistant, but also the surgeon in certain minor
and major urological procedures.
3. Demonstrate leadership and teaching for URO I residents and medical students. To have
completed all of the objectives for URO I level and be familiar with the embryology of the
genitourinary tract, and congenital anomalies Understanding of vesicoureteral reflux, adrenal
abnormalities and congenital anomalies and evaluation and management of infertility.
Understanding of vesicoureteral reflux, adrenal abnormalities and genitourinary infections.
Should have an evaluation plan for urinary incontinence and for voiding dysfunction.
Accomplishment of the above objectives will be facilitated by the activities below.
1. The resident is responsible for 1) the admission of patients to the hospital including a history
and physical exam and review of all relevant pre-operative workup, 2) assisting in surgery,
and 3) follow-up and discharge planning. The resident is to be in close contact with the
patient providing up-to-date progress reports and to anticipate any problems that might be
encountered in the patient's recovery. Communication with the appropriate attending
urologist is essential and mandatory.
2. The resident is required to participate in the evaluation and management of patients in the
Page 60
Department of Urology
2012-2013
outpatient clinic setting. This includes an opportunity to perform outpatient endoscopy,
abdominal ultrasound and prostate biopsy, and urodynamic testing.
3. Throughout the year, and during all rotations, the URO II resident will be responsible for the
evaluation and management of pediatric patients at SVMMC. They will have a supervising,
full-time faculty member or a volunteer clinical faculty member in clinic during their own
clinic for assisting in management and decisions. The resident is responsible for the initial
history and physical exam, analysis of available laboratory and imaging studies, ordering
additional studies, follow-up of results of the tests ordered, discussion of options for
treatment with patients and their families, and follow-up after treatment. The resident will
participate in the surgeries of patients seen in the clinic and followed in their clinic after
surgery.
4. The URO II resident will develop the ability to recognize urologic pathologic problems
associated with the genitourinary system.
SPECIFIC OBJECTIVES – URO II – (SVMMC):
The resident will observe, participate and have teaching-assistant based experience in
emergency room urology, including the following:
__________ Post-operative evaluation
__________ Evaluation of hematuria
__________ Management and evaluation of stone disease
__________ Evaluation of pediatric emergencies
__________ Evaluation and management of pediatric and adult urologic emergencies
__________ Experience with post operative complications
The resident will observe, participate and have teaching-assistant based experience in clinicbased urology, including the following:
__________ Evaluation of voiding dysfunction
__________ Evaluation of testicle & hernia
__________ Evaluation of pediatric urology disease
__________ Evaluation of infection
__________ Evaluation of hypospadias
__________ Evaluation of UPI obstruction
__________ Evaluation of intense reflux
__________ Experience with post operative complications
The resident will perform and teach minor urology procedures, including the following:
__________ Cystoscopy
__________ Stent removal
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Prostate biopsy
__________ Cystoscopic and fluoroscopic stent placement
__________ Shock wave lithotripsy
__________ CMG-EMG
Page 61
Department of Urology
2012-2013
__________ Varicocelectomy
_________ Scrotal surgery, including hernia/hydrocoele, orchiopexy
_________ Videourodynamics
The resident will perform and teach major urology cases, including the following:
_________ UPI obstruction repair
_________ Continent diversion
_________ Procedures for urinary incontinence
_________ Nephrectomy
_________ Percutaneous renal surgery
_________ Endo-urology
_________ Transurethral surgery
_________ Laparoscopic urology
_________ Major reconstructive procedures
The resident will work towards development in the six core competencies:
Patient Care
_________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
_________ Gather essential and accurate information about urologic patients
_________ Make informed decisions about diagnostic and therapeutic interventions in
urology based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment of urology faculty
_________ Develop and carry out patient management plans for select urologic disorders
_________ Counsel and educate patients and their families on urologic diseases
_________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
_________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
_________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
_________ Work with health care professionals, including those from other disciplines
_________ To provide patient-focused care in the pediatric clinic while at SVMMC
Medical Knowledge
_________
_________
Demonstrate an investigatory and analytic thinking approach to clinical situations
Know and apply the basic (molecular biology) and clinically supportive sciences
(nephrology, human oncology, transplantation) in urology
Practice-Based Learning and Improvement
_________
_________
Analyze practice experience and perform practice-based improvement activities
via chart reviews and personal feedback by rotation faculty
Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
Page 62
Department of Urology
2012-2013
_________
_________
_________
_________
Obtain and use information about patients and the larger population from where
their patients are drawn in clinical studies
Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
particularly when presenting at state and national meetings
Use information technology to manage information, access on-line medical
information
Facilitate the learning of medical students and other health care professionals
including mid-level providers, RNs, MAs
Interpersonal and Communication Skills
_________
_________
_________
_________
Create and sustain a therapeutic and ethically sound relationship with patients,
particularly ward patients
Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
Work effectively with others as a team member or leader of a health care team
(urology service)
Monitor colleagues for excessive stress and fatigue as taught in lecture series
Professionalism
_________
_________
_________
Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times.
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and
disabilities
Systems-Based Practice
_________
_________
_________
_________
_________
Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and society and how these
elements of the system affect their own practice (chart reviews with rotation
faculty)
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
Practice cost-effective health care and resource allocation that does not
compromise quality of care (chart reviews with rotation faculty)
Advocate for quality patient care and assist patients in dealing with system
complexities
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 (experience on wards and in clinic on system-based
performance in urology)
Page 63
Department of Urology
2012-2013
Rotation Specific Goals & Objectives for Transplant, Infertility & Research
URO – III (UTMC)
Overview
The URO III resident has demonstrated competence in all requirements for URO I and URO II
years and should be familiar with the entire spectrum of genitourinary disease. This year offers
an opportunity to work in renal transplantation as well as general urology and having research
experience. There’s also an opportunity to work at an outpatient fertility clinic to gain extra
expertise in the management of the infertile patient. The expectation at this level of training is
the independent evaluation of management of patients in the hospital and in the clinic. Specialty
clinics both in renal transplantation and infertility will be managed with attending and volunteer
faculty. The resident will rotate on clinical services in conjunction with the chief resident at the
University of Toledo Medical Center.
Goal: To build on the foundation of the URO I & URO II years and progress to the next level of
training based on the six core competencies. Prepare to be a chief resident.
Objectives for URO III Residents:
Objectives and responsibilities of URO III in Urology will have input and will have assignments
to the renal transplant service. The resident trained each year will also have time available for
independent research pursuits. The responsibilities are:
1.
2.
3.
4.
5.
6.
7.
8.
Developing an on call schedule for covering renal transplantation
Participating in operative cases that deal with the removal of donated organs in both the
living related and deceased environment. The involvement of the resident will be
dependent upon his demonstrated level of expertise in surgical skills.
Teaching of medical students in the operating room and the outpatient clinic and
providing back up for on-call residents as deemed necessary.
Teaching and conference responsibilities include participation in the transplant evaluation
clinic and in the transplant morbidity and mortality conference, in addition to the
transplant operations meeting. The resident will also be responsible for attending all
other general urology conferences as provided by the schedule.
Will participate in all aspects of renal transplantation including vascular and anastamosis
and ureteral re-implantation. The resident will participate in transplant nephrectomy and
secondary surgeries on transplant as deemed necessary.
Administrative responsibilities entail the smooth coverage of the transplant service with
the appropriate on-call schedules. Residents will also be responsible for picking cases for
presentation in the TOPS meeting and the morbidity and mortality meetings as they relate
to transplantation.
Evaluation of research opportunities and participating in independent research either at
the basic science level or at the chart review and database mining level.
Participating in an outpatient infertility evaluation clinic under the appropriate guidance
of a specially trained Urologist in infertility.
Specific objectives:
Page 64
Department of Urology
2012-2013
1.
2.
3.
4.
5.
6.
7.
The resident will gain teaching experience and emergency room urology as it relates to
transplantation including Foley catheter placement in a complicated system, postoperative evaluation, evaluation of fever of unknown origin, evaluation of stone disease
in the transplant patient, evaluation of the management of rejection, experience with
complications associated with transplantation.
The resident will gain experience in minor urology procedures including cystoscopy,
stent removal, retrograde polygram, transplant renal biopsy percutaneously. In addition,
testes biopsy, vericosolectomy and . The resident will perform major urology cases
including renal transplantation, the harvesting of renal organs.
Ureteral re-implantation
Transplant nephrectomy
Reconstructive surgery in the transplant period
Donor nephrectomy
Involved in independent research with interactions with IAWL or IRB as deemed
necessary. Project planning including assessment of proper power of the study. Data
collation and integration. Manuscript preparation and presentation
SPECIFIC OBJECTIVES - URO III - (UTMC)
The resident will gain teaching experience in emergency room urology, including the
following:
__________ Complex foley catheterization
__________ Post-operative evaluation
__________ Evaluation of hematuria
__________ Evaluation of stone disease
__________ Evaluation of pediatric emergencies
__________ Evaluation of adult urologic emergencies
__________ Experience with complications such as rejection
The resident will gain experience in minor urology procedures, including the following:
__________ Cystoscopy
__________ Stent removal
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Varicocelectomy
__________ Scrotal surgery
___________Transplant renal biopsy
The resident will perform major urology cases, including the following:
__________ Renal transplant
__________ Renal procurment
__________ Uteral implantation
__________ Procedures for urinary incontinence
__________ Transplant nephrectomy
__________ Percutaneous renal surgery
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Department of Urology
2012-2013
__________ Basic endo-urology
__________ Transurethral surgery, including TURBT and TURP
The resident will work towards development in the six core competencies
Patient Care
__________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
__________ Gather essential and accurate information about urologic patients
__________ Make informed decisions about diagnostic and therapeutic interventions in urology
based on patient information and preferences, up-to-date scientific evidence, and
clinical judgment of urology faculty
__________ Develop and carry out patient management plans for select urologic disorders
__________ Counsel and educate patients and their families on urologic diseases
__________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
__________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
__________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
__________ Work with health care professionals, including those from other disciplines
__________ Provide patient-focused care in the uro-oncology clinic and stone clinic while at
clinics assigned. Transplant and Infertility
Medical Knowledge
__________ Demonstrate an investigatory and analytic thinking approach to clinical
situations
__________ Know and apply the basic and clinically supportive sciences in urology
Page 66
Department of Urology
2012-2013
Practice-Based Learning and Improvement
__________ Analyze practice experience and perform practice-based improvement
activities via chart reviews and personal feedback with the rotation faculty
__________ Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
__________ Obtain and use information about patients and the larger population from
where their patients are drawn in clinical studies
__________ Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic
effectiveness, particularly when presenting at state and national meetings
__________ Use information technology to manage information, access on-line medical
information
__________ Facilitate the learning of medical students and other health care
professionals including mid-level providers, RNs, MAs
Interpersonal and Communication Skills
__________ Create and sustain a therapeutic and ethically sound relationship with
patients, particularly ward patients
__________ Use effective listening skills and elicit and provide information using
effective nonverbal, explanatory, questioning, and writing skills
__________ Work effectively with others as a team member or leader of a health care
team (urology service)
__________ Monitor colleagues for excessive stress and fatigue as taught in lecture
series
Professionalism
__________ Demonstrate respect, compassion, and integrity; a responsiveness to the
needs of patients and society that supercedes self-interest; accountability to
patients, society, and the profession; and a commitment to excellence and ongoing professional development
__________ Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times
__________ Demonstrate sensitivity and responsiveness to patients’ culture, age, gender,
and disabilities
Page 67
Department of Urology
2012-2013
Systems-Based Practice
__________ Understand how their patient care and other professional practices affect
other health care professionals, the health care organization, and society
andhow these elements of the system affect their own practice
__________ Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
__________ Practice cost-effective health care and resource allocation that does not
compromise quality of care
__________ Advocate for quality patient care and assist patients in dealing with system
complexities
__________ 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 (experience on wards and in clinic on system-based
performance in urology)
Rotation Specific Goals & Objectives for General Urology
URO – IV (UTMC)
Overview
The Chief Resident will have demonstrated competence in all of the requirements for URO I,
URO II and URO III, and should be familiar with the entire spectrum of genitourinary diseases.
The expectation at this level of training is the independent evaluation and management of
patients in the hospitals and in the clinic. Tailored supervision by the faculty for advice and
oversight is expected because he or she will have matured in both judgment and technical skill to
work independently. The Chief Resident will have administrative and teaching responsibilities,
and will serve as a role model for the junior residents.
The duties and expectation of the Chief Resident are the same as those outlined for the junior
urology residents; however, the Chief Resident will have leadership and administrative
responsibilities within the Division of Urology.
Goal: Successful completion of URO I, URO II and URO III levels. Graduation from the
residency program.
Objectives for URO IV – (Chief)
The Chief Resident in Urology will be the Administrative Chief and not be assigned to any
particular clinic service. The Chief Resident will be responsible for:
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Department of Urology
2012-2013
1) The resident on-call schedule.
2) In participation with the program chair, develop plan for resident coverage in periods of
shortage of residents.
3) Resident coverage of operative cases on the basis of available manpower, level of resident
experience, educational value of the cases, and service assignments.
4) The smooth transition of patient care responsibilities to the on-call resident.
5) Teaching medical students in the operating room and in the outpatient clinic settings, and
providing backup for the on-call resident.
6) Teaching and conference responsibilities will be conducted with the approval of the Program
Director. The Chief Resident has the responsibility to select cases for his or her own
operating room experience on the basis of educational need and to complete the entire
spectrum of operative cases by the time residency training is completed.
Administrative responsibilities entail oversight of the resident on-call schedule and monitoring
the selection and approval of vacation time for the resident staff. The Chief Resident will make
every effort to resolve any conflict within the resident staff. Only those conflicts that are
unresolved at that level will be brought to the attention of the Program Director.
The selection of cases and topics for conferences are the responsibility of the Chief Resident. He
or she will insure that the resident assigned to a case or topic has made adequate preparations,
and will be prepared to make additional comments or fill in on any deficiencies at the time of the
conference.
SPECIFIC OBJECTIVES - URO IV- (UTMC):
The resident will gain teaching experience in emergency room urology, including the
following:
__________ Complex foley catheterization
__________ Post-operative evaluation
__________ Evaluation of hematuria
__________ Evaluation of stone disease
__________ Evaluation of pediatric emergencies
__________ Evaluation of adult urologic emergencies
__________ Experience with complications
The resident will gain experience in minor urology procedures, including the following:
__________ Cystoscopy
__________ Stent removal
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Penile biopsy
__________ Varicocelectomy
__________ Scrotal surgery
The resident will perform major urology cases, including the following:
Page 69
Department of Urology
2012-2013
__________
__________
__________
__________
__________
__________
__________
__________
__________
Radical prostatectomy
Radical Cystectomy
Continent diversion
Procedures for urinary incontinence
Radical nephrectomy
Percutaneous renal surgery
Basic endo-urology
Transurethral surgery, including TURBT and TURP
Pediatric urology
The resident will work towards development in the six core competencies
Patient Care
_________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
_________ Gather essential and accurate information about urologic patients
_________ Make informed decisions about diagnostic and therapeutic interventions in
urology based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment of urology faculty
_________ Develop and carry out patient management plans for select urologic disorders
_________ Counsel and educate patients and their families on urologic diseases
_________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
_________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
_________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
_________ Work with health care professionals, including those from other disciplines
_________ To provide patient-focused care in the pediatric clinic and stone clinic while at
SVMMC
Medical Knowledge
_________
_________
Demonstrate an investigatory and analytic thinking approach to clinical situations
Know and apply the basic (molecular biology) and clinically supportive sciences
(nephrology, human oncology, transplantation) in urology
_________
Analyze practice experience and perform practice-based improvement activities
via chart reviews and personal feedback by rotation faculty
Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
Obtain and use information about patients and the larger population from where
their patients are drawn in clinical studies
Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
particularly when presenting at state and national meetings
Practice-Based Learning and Improvement
_________
_________
_________
Page 70
Department of Urology
2012-2013
_________
_________
Use information technology to manage information, access on-line medical
information
Facilitate the learning of medical students and other health care professionals
including mid-level providers, RNs, MAs
Interpersonal and Communication Skills
_________
_________
_________
_________
Create and sustain a therapeutic and ethically sound relationship with patients,
particularly ward patients
Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
Work effectively with others as a team member or leader of a health care team
(urology service)
Monitor colleagues for excessive stress and fatigue as taught in lecture series
Professionalism
_________
_________
_________
Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times.
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and
disabilities
Systems-Based Practice
_________
_________
_________
_________
_________
Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and society and how these
elements of the system affect their own practice (chart reviews with rotation
faculty)
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
Practice cost-effective health care and resource allocation that does not
compromise quality of care (chart reviews with rotation faculty)
Advocate for quality patient care and assist patients in dealing with system
complexities
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 (experience on wards and in clinic on system-based
performance in urology)
Rotation Specific Goals & Objectives for General Urology
URO – IV (SVMMC)
Overview
Page 71
Department of Urology
2012-2013
The Chief Resident will have demonstrated competence in all of the requirements for URO I,
URO II and URO III, and should be familiar with the entire spectrum of genitourinary diseases.
The expectation at this level of training is the independent evaluation and management of
patients in the hospitals and in the clinic. Tailored supervision by the faculty for advice and
oversight is expected because he or she will have matured in both judgment and technical skill to
work independently. The Chief Resident will have administrative and teaching responsibilities,
and will serve as a role model for the junior residents.
The duties and expectation of the Chief Resident are the same as those outlined for the junior
urology residents; however, the Chief Resident will have leadership and administrative
responsibilities within the Division of Urology.
Goal: Successful completion of URO I, URO II and URO III levels. Graduation from the
residency program.
Objectives for URO IV – (Chief)
The Chief Resident in Urology will be the Administrative Chief and not be assigned to any
particular clinic service. The Chief Resident will be responsible for:
1) The resident on-call schedule.
2) In participation with the program chair, develop plan for resident coverage in periods of
shortage of residents.
3) Resident coverage of operative cases on the basis of available manpower, level of resident
experience, educational value of the cases, and service assignments.
4) The smooth transition of patient care responsibilities to the on-call resident.
5) Teaching medical students in the operating room and in the outpatient clinic settings, and
providing backup for the on-call resident.
6) Teaching and conference responsibilities will be conducted with the approval of the Program
Director. The Chief Resident has the responsibility to select cases for his or her own
operating room experience on the basis of educational need and to complete the entire
spectrum of operative cases by the time residency training is completed.
Administrative responsibilities entail oversight of the resident on-call schedule and monitoring
the selection and approval of vacation time for the resident staff. The Chief Resident will make
every effort to resolve any conflict within the resident staff. Only those conflicts that are
unresolved at that level will be brought to the attention of the Program Director.
The selection of cases and topics for conferences are the responsibility of the Chief Resident. He
or she will insure that the resident assigned to a case or topic has made adequate preparations,
and will be prepared to make additional comments or fill in on any deficiencies at the time of the
conference.
SPECIFIC OBJECTIVES - URO IV- (SVMMC):
The resident will gain teaching experience in emergency room urology, including the
following:
__________ Complex foley catheterization
__________ Post-operative evaluation
__________ Evaluation of hematuria
__________ Evaluation of stone disease
Page 72
Department of Urology
2012-2013
__________ Evaluation of pediatric emergencies
__________ Evaluation of adult urologic emergencies
__________ Experience with complications
The resident will gain experience in minor urology procedures, including the following:
__________ Cystoscopy
__________ Stent removal
__________ Retrograde pyelogram
__________ Testes biopsy
__________ Penile biopsy
__________ Varicocelectomy
__________ Scrotal surgery
The resident will perform major urology cases, including the following:
__________ Radical prostatectomy
__________ Radical Cystectomy
__________ Continent diversion
__________ Procedures for urinary incontinence
__________ Radical nephrectomy
__________ Percutaneous renal surgery
__________ Basic endo-urology
__________ Transurethral surgery, including TURBT and TURP
__________ Pediatric urology
The resident will work towards development in the six core competencies
Patient Care
_________ Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients with urologic disease
_________ Gather essential and accurate information about urologic patients
_________ Make informed decisions about diagnostic and therapeutic interventions in
urology based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment of urology faculty
_________ Develop and carry out patient management plans for select urologic disorders
_________ Counsel and educate patients and their families on urologic diseases
_________ Use information technology (on-line journals, CD-rom educational programs,
lectures) to support patient care decisions and patient education
_________ Perform and assist competently medical and invasive procedures considered
essential in outpatient urology
_________ Provide health care services aimed at preventing health problems or maintaining
health, particularly prostate cancer, bladder cancer, stone disease, impotence,
voiding dysfunction
_________ Work with health care professionals, including those from other disciplines
_________ To provide patient-focused care in the pediatric clinic and stone clinic while at
SVMMC
Page 73
Department of Urology
2012-2013
Medical Knowledge
_________
_________
Demonstrate an investigatory and analytic thinking approach to clinical situations
Know and apply the basic (molecular biology) and clinically supportive sciences
(nephrology, human oncology, transplantation) in urology
_________
Analyze practice experience and perform practice-based improvement activities
via chart reviews and personal feedback by rotation faculty
Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems
Obtain and use information about patients and the larger population from where
their patients are drawn in clinical studies
Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
particularly when presenting at state and national meetings
Use information technology to manage information, access on-line medical
information
Facilitate the learning of medical students and other health care professionals
including mid-level providers, RNs, MAs
Practice-Based Learning and Improvement
_________
_________
_________
_________
_________
Interpersonal and Communication Skills
_________
_________
_________
_________
Create and sustain a therapeutic and ethically sound relationship with patients,
particularly ward patients
Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
Work effectively with others as a team member or leader of a health care team
(urology service)
Monitor colleagues for excessive stress and fatigue as taught in lecture series
Professionalism
_________
_________
_________
Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices at all times.
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and
disabilities
Systems-Based Practice
_________
_________
Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and society and how these
elements of the system affect their own practice (chart reviews with rotation
faculty)
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources (part of clinical lecture series)
Page 74
Department of Urology
2012-2013
_________
_________
_________
Practice cost-effective health care and resource allocation that does not
compromise quality of care (chart reviews with rotation faculty)
Advocate for quality patient care and assist patients in dealing with system
complexities
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 (experience on wards and in clinic on system-based
performance in urology)
Page 75
Department of Urology
2012-2013
CLINICAL TRAINING
The clinical portion of the education is implemented so that a resident experiences a
progressive exposure and responsibility in the examination, establishment of diagnosis,
management of patients, and management of unexpected complications. The educational
conferences are the foundation upon which the resident will build the knowledge of
patient management. The clinical training is a progressive, concentrated, experiential
training very carefully designed so that a resident, at the completion of residency training,
becomes a safe, knowledgeable, and compassionate surgeon.
During each year of the residency experience, clinical competence will be assessed on a
quarterly basis by supervisory faculty based on direct observation at bedside, in the
operating room, the out-patient clinics, and on work and teaching rounds. This
information is recorded on evaluation forms, reviewed, and maintained in the resident
file.
General Competencies:
It is expected that, during the training program, residents will become competent in the
following six areas at the level expected of an independent surgical practitioner: patient
care, medical knowledge, practice-based learning and improvement, interpersonal and
communication skills, professionalism, and systems-based practice. Listed below are
specific knowledge, skills, and attitudes required, as defined by the Accreditation Council
for Graduate Medical Education (ACGME).
1.
Patient Care that is compassionate, appropriate, and effective for the
treatment of health problems and the promotion of health.
Urology residents must demonstrate manual dexterity appropriate for their
training level and be able to develop and execute patient care plans.
2.
Medical Knowledge about established and evolving biomedical, clinical, and
cognate (e.g., epidemiological and social-behavioral) sciences and the
application of this knowledge to patient care.
Urology residents are expected to critically evaluate and demonstrate
knowledge of pertinent scientific information.
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Department of Urology
2012-2013
3.
Practice-Based Learning and Improvement that involves investigation and
evaluation of their own patient care, appraisal and assimilation of scientific
evidence, and improvements in patient care.
Urology residents are expected to critique personal practice outcomes and
demonstrate recognition of the importance of lifelong learning in surgical
practice.
4.
Interpersonal and Communication Skills that result in effective information
exchange and teaming with patients, their families, and other health
professionals.
Urology residents are expected to communicate effectively with other health
care professionals, counsel and educate patients and families, and effectively
document practice activities.
5.
Professionalism, as manifested through a commitment to carrying out
professional responsibilities, adherence to ethical principles, and sensitivity
to a diverse patient population.
Urology residents are expected to maintain high standards of ethical
behavior, demonstrate a commitment to continuity of patient care, and
demonstrate sensitivity to age, gender, and culture of patients and other
health care professionals.
6.
Systems-Based Practice as manifested by actions that demonstrate an
awareness of and response to the larger context and system of health care and
effectively call on system resources to provide optimal care.
Residents are expected to practice high quality, cost-effective patient care;
demonstrate knowledge of risk-benefit analysis; and demonstrate an
understanding of the role of different specialists and other health care
professionals in overall patient management.
The following specifies the competency, the associated skill(s) required, and the
corresponding evaluation methods utilized by the University of Toledo Urologic
Residency Program.
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Department of Urology
2012-2013
Patient Care

Caring and respectful behavior:
Checklist, patient survey

Interviewing:
Checklist, patient survey, simulated
model

Informed decision-making:
Checklist, oral examination, chart
simulated recall

Develop and carry out patient
management plans:
Counsel and educate patients and
families:
Chart simulated recall, checklist

Perform routine history and
physical examination:
Checklist, simulation model, chart
review

Perform procedures appropriate
for level:
Medical Procedures
Checklist, case log, chart simulated
recall

Preventive health services:
Checklist, case logs, records review

Work within a team:
Checklist, 360 evaluation

Checklist, patient survey, simulated
model
Medical Knowledge

Investigatory and analytic thinking: Oral examination, Chart simulated
recall, Portfolio

Knowledge and application of
basic sciences:
MCQ examination, oral examination,
portfolio
Practice-Based Learning and Improvement

Analyze own practice for needed
improvements:
Portfolio, checklist

Use of evidence from scientific
studies:
Portfolio, checklist, standard oral exam,
chart simulated recall

Application of research/statistical
Checklist, Portfolio
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Department of Urology
2012-2013

methods:
Use of information technology:
Portfolio, check list

Facilitate learning of others:
Checklist, 360 rating
Interpersonal Communication Skills

Respectful, altruistic:
Checklist, patient survey, simulated
model

Ethically sound practice:
Patient survey, checklist

Sensitive to cultural, age, gender,
disability issues:
Simulated model, patient survey,
checklist
Systems-Based Practice

Understand interaction of their
practices with the larger system:
Portfolio, Check list

Knowledge of practice and
delivery systems:
Portfolio

Practice cost-effective care:
Checklist

Advocate for patients within the
health care system:
Checklist, portfolio
Goals & Objectives
PGY 1 & 2- Surgery Prelim
Education: During the first two years of urologic residency, the foundation for the care
of the surgical patient is laid. Emphasis is placed on preoperative preparation and
postoperative management. Preoperative preparation includes the taking of an accurate
history and performing a detailed physical examination. Interpretation of pertinent lab
data, EKGs, and radiographs is emphasized. In the postoperative period, fluid and
electrolyte replacement, pain management, prevention of postoperative complications,
drain management, and discharge planning are among the areas of emphasis.
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Department of Urology
2012-2013
Resident participation in weekly urology and other specialty conferences is required.
Patient Care Responsibilities: Increasing responsibility for patient care is delegated as
competency develops during the first two years. Emphasis is placed on pre- and
postoperative management. During the first two years, residents work closely with senior
resident. Daily legible documentation of patient care is done within the framework of
cost-effective delivery of care. Surgical skills, such as the proper handling of tissues, are
emphasized in the operating room environment. Increasing opportunity for participation
within the operating room is assumed as resident competency and skill increase.
Technical Skills: It is anticipated that the skills needed for the proper handling of tissues
will be developed within the first two years. Methods for incising tissue and wound
closure are learned. The proper and appropriate use of different sutures is taught.
Exposure to the techniques of plastic and vascular surgery is included in these first two
years of training and serves as a basis for the reconstructive urologic techniques that will
be encountered later in residency training. Basic endoscopic skills are introduced.
Evaluation: Residents are evaluated by attending physicians as well as clinic support
and hospital staff. Residents meet biannually with the Residency Program Director to
discuss evaluations and attainment of educational goals.
In-Service Examination: Residents are expected to participate in the in-service
examination.
Goals & Objectives
PGY 3 - 6
Education: Education during the PGY-3 rotations includes the first steps in mastery of
all aspects of the clinical activities for both adult and pediatric urology. During this time,
the resident is expected to develop the core of clinical and basic sciences knowledge
needed for the care of patients with urologic diseases. Examples of this knowledge
include mastering the fundamentals of the interpretation of urologic imaging as
intravenous pyelography, coaxial tomography, and renal ultrasonography. Familiarity
with invasive examination of the genitourinary tract, cystoscopy, ureteroscopy, and
transrectal ultrasonography is also developed. Core knowledge of the diagnosis and
staging of urologic malignancies, diagnosis of calculus disease, forms of incontinence, as
well as embryologic and pediatric urologic problems are developed through supervised
patient contact and structured didactic sessions. Residents are expected to complete their
first reading and study of the standard textbook of urology by the end of the academic
year. The education process initiated in the PGY -3 year continues throughout the PGY-4
year. Residents continue to mature in their clinical diagnostic skills. The PGY- 4 has six
months of dedicated pediatric service. They also have the opportunity to be the most
senior residents on the urology service at Toledo Hospital.
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Department of Urology
2012-2013
The PGY – 5 is the Transplant Research Year. The resident will have ample opportunity
to participate in one of the many research projects within the department. Clinical
education will revolve around all aspects of renal transplantation.
The foundations of clinical immunology and immunosuppression will be mastered in this
year as well as the elements of organ preservation. A fertility clinic rotation at Genito
Urinary Surgeons (TTH affiliate) is also part of the PGY 5 year. Residents will continue
to participate in all other scheduled teaching rounds, clinical duties, didactic sessions and
on call activities during this year. The chief year, PGY -6 is the culmination of the
residency training program. The chief resident will assume a major role in education
leadership. It is expected that the chief resident will serve as a role model for junior
residents and students, providing guidance in understanding the pathophysiology and
management of urologic disease.
General Urology Clinics:
Goal 1
Perform a complete interview and accurate history from patients with urologic disorders
encountered in the urology outpatient clinic setting
Objectives –
8. Using appropriate and effective interview techniques, elicit and characterize an
accurate history of the present illness from patients presenting with genitourinary
complaints
9. Develop effective listening skills and be able to elicit and provide information
using appropriate nonverbal and explanatory skills
10. Formulate and write coherent and legible notes in the medical record
11. Formulate treatment plans based on patient information and preferences for
specific genitourinary diseases
12. Appropriately counsel and educate patients and their families about specific
urologic problems
13. Be empathetic, understanding, compassionate and honest in dealings with
patients and their families
14. Be sensitive and responsive to the urology patients’ culture, age, gender, and
disabilities
Goal 2
Perform a detailed and appropriately focused urologic physical examination
Objectives –
7. Discuss and demonstrate ability to perform a detailed examination of the
following genitourinary organ systems:
a) Abdominal examination of the kidneys (inspection, palpation, percussion
and auscultation)
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Department of Urology
2012-2013
b) Inspection, percussion and palpation of the bladder
c) Inspection and palpation of the penis
d) Inspection, palpation and transillumination of the scrotum and its contents,
including the testis, testicular tunics and adnexa, spermatic cord, and vas
deferens
8. Discuss and demonstrate ability to perform a detailed male rectal examination to
include:
a) Assessment of the anal sphincter and lower rectum
b) Prostate palpation to characterize its size, consistency, mobility, and the
presence/absence of abnormalities, such as nodules or induration
9. Discuss and demonstrate an appropriate vaginal and rectovaginal examination in
the female
10. Be able to perform and interpret a focused neuro-urologic examination
11. Demonstrate ability to recognize visually and to palpate enlarged lymph nodes in
regions related to genitourinary disease and to discuss their importance relative to
differential diagnosis to various disorders
12. When performing physical examination, to be sensitive and responsive to the
patients’ culture, age and gender
Goal 3
Accurate performance and interpretation of commonly performed urologic laboratory
studies
Objectives –
3. Demonstrate ability to perform and interpret the following laboratory studies
a) routine urinalysis
b) residual urine measurements
c) expressed prostatic secretions
d) semen analysis
4. Interpret and discuss the following laboratory studies
a) serum PSA level and free/total PSA
b) urinary electrolyte studies
c) serum electrolyte studies and acid-base analysis
d) serum creatinine and BUN
e) creatinine clearance
Goal 4
Performance and accurate interpretation of radiographic studies in the outpatient clinic
setting
Objectives –
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Department of Urology
2012-2013
3. Be able to competently perform and interpret the following radiographic studies
a) plain films of the kidney, ureters and bladder (KUB)
b) intravenous pyelogram (IVP)
c) retrograde pyelogram
d) retrograde urethrogram
e) voiding cystourethrogram (VCUG)
f) transrectal prostatic ultrasound
4. Be able to accurately interpret an abdominal/pelvic CT scan, MRI scan, renal
ultrasound and radionuclide studies of the genitourinary tract
Goal 5
Performance of diagnostic and therapeutic procedures encountered in the urology
outpatient clinic
Objectives –
2. Be able to perform the following outpatient procedures
a) transrectal ultrasound-guided prostate biopsy
b) flexible and rigid cystoscopy
c) suprapubic tube placement
d) vasectomy
e) spermatic cord and penile block
f) circumcision
g) intravesical administration of chemotherapeutic or immunotherapeutic
agents
h) urethral dilation
Goal 6
Competent care and evaluation of the pre-operative and post-operative urologic patient
Objectives –
13. Perform and write clear, legible and an appropriately detailed history and physical
examination on all pre-operative patients
14. Prepare and write clear and detailed admission orders
15. Assess and discuss the operative and anesthetic risks of surgical procedures
16. Obtain informed consent for all surgical procedures
17. Understand the indications for obtaining consultation with other health care
specialists prior to the surgical procedure in select patients
18. Discuss the physiologic response of the normal patient to surgical procedures and
factors that modify these responses
19. Discuss and evaluate wound healing as it relates to surgical incisions
20. Treat and evaluate pain in a safe and effective manner in the post-surgical patient
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Department of Urology
2012-2013
21. Discuss and evaluate the role of pharmacological agents, singly or in combination,
and apply this knowledge to the care of the surgical patient
22. Understand the influence of other diseases and co-morbidities upon surgical care
23. Recognize and correct nutritional deficits in the surgical patient
24. Recognize and deal effectively with the psychological and emotional problems
associated with anxiety imposed by urologic surgery
ERECTILE DYSFUNCTION AND INFERTILITY :
Goal 1 – Be proficient in the diagnosis, evaluation and treatment of patients with erectile
dysfunction.
Objectives
7. Describe the normal development and demonstrate the anatomy and function of
the penis and male urethra
8. Describe the normal physiology of penile erection
9. List the etiologies of erectile dysfunction
10. Discuss common medical disorders associated with erectile dysfunction
11. Describe, in depth, the evaluation of patients with erectile dysfunction, including a
sexual history, medical history, surgical history, physical examination, laboratory
evaluation, and specialized testing
12. Describe, in detail, the various treatments of erectile dysfunction to include the
following:
a. medical treatment
b. intracavernosal injection
c. vacuum constriction devices
d. psychological and sexual therapy
e. surgical procedures
 implantation of penile prosthesis
 microvascular arterial bypass procedures
Goal 2 – Demonstrate ability to diagnose, evaluate and treat patients with idiopathic
priapism and prolonged penile erection secondary to intracavernosal injection of
vasoactive drugs
Objectives
8. Describe the normal development and surgical anatomy of the penis
9. Discuss disturbances in the mechanism of normal erection resulting in priapism
10. List and describe the various etiologic factors in priapism
11. Demonstrate the ability to take a pertinent history and physical examination in
patients with idiopathic or PIP-induced priapism
12. Demonstrate knowledge of the diagnostic studies that are helpful in establishing
the etiology of priapism
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Department of Urology
2012-2013
13. Describe the vascular shunting procedures used in the treatment of priapism
14. Discuss the complications of each therapeutic method and appropriate treatment of
these complications
Goal 3 – Understand the basic science of male reproductive physiology and infertility
Objectives
9. Demonstrate an understanding of the hypothalamic-pituitary-gonadal (HPG) axis
and its endocrine control of testicular function
10. Identify the hormones involved in the HPG axis, their origins, function, reciprocal
interrelationships and feedback control
11. List the endocrinopathies, both exogenous and endogenous, that may interfere
with the normal testicular axial relationships and specify the nature of these
alterations
12. Describe the anatomy, physiology, and pathophysiology of the male reproductive
tract, spermatogenesis, sperm transport, and capacitation
13. Identify the sequence of sperm maturation, the cell types found within and
between the seminiferous tubules and the time sequence of spermatogenesis
14. Describe the mechanism of ejaculation, including neurologic control and the
anatomic structures involved
15. Identify disease states that interfere with ejaculation and the manner in which
these states disrupt normal ejaculatory mechanisms
16. Describe the difference between emission and ejaculation
Goal 4
Competent diagnosis, evaluation, and treatment of patients with male infertility
Objectives
8. List the important components of a historical review in males presenting with
infertility
9. Describe the components of the physical examination of infertile males
10. List the specific laboratory studies that should be obtained as part of the male
infertility evaluation and the manner in which abnormal results may contribute to
or reflect the extent of infertility
11. Select the surgical diagnostic techniques used in patients with male infertility
including vasography, rectal sonography, and testicular biopsy
12. Identify exogenous drugs that may suppress fertility, ejaculation, and erectile
dysfunction
13. Identify the appropriate surgical or medical therapies for patients with male
infertility and defend the rationale and indications for clinical application of these
modalities
14. List and describe, in detail, the assisted reproductive techniques commonly used
in patients with male factor infertility
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Department of Urology
2012-2013
UROLITHIASIS:
Goal 1
Know the etiology and pathophysiology of urinary tract stone disease
Objectives
6. Understand the epidemiology of urolithiasis to include the following:
 Geographic distribution of urinary calculus incidence in this country and
the world
 Incidence in relation to race, sex, age, and climatic factors
 The effects of dietary and fluid intake on occurrence
7. Describe the crystalline architecture of urinary calculi and theoretical factors
affecting crystallization
8. Describe the part played by matrix in the architecture and possible prevention or
initiation of stone formation
9. Describe the role of urinary tract obstruction in the etiology of urolithiasis
10. Present a working classification of the etiology of stone disease to include the
following:
 Renal tubular syndromes
 Enzyme disorders
 Hypercalcemic conditions
 Hypercalciuric states
 Uric acid lithiasis
 Secondary urolithiasis
 Iatrogenic urolithiasis
Goal 2
Be proficient in the evaluation and diagnosis of a patient with urolithiasis
Objectives
7. Elicit a history compatible with stone disease from a patient including a list of
pertinent problems referable to stone formation
8. Discuss the information to be gained from urinalysis including the appearance of
typical crystals
9. Know the relationship of stone formation to urinary bacteria and pH
10. Select appropriate serum studies in the evaluation of stone disease including
assessment of serum creatinine, calcium, phosphate, and uric acid.
11. Describe the role of stone analysis in the diagnosis and treatment of patients with
stone disease
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Department of Urology
2012-2013
12. Have an in-depth knowledge of the radiographic evaluation of patients with stone
disease, including the use of both plain film radiography and the CT urolithiasis
study
Goal 3
Select appropriate management strategies for patients with stone disease
Objectives
5. Describe the role of dietary restriction and fluid intake modifications
6. Discuss, in detail, the medical therapy of patients with metabolic stone disease
7. Discuss, in detail, and perform various procedures used in the treatment of stone
disease to include the following:
 ESWL
 Percutaneous nephrolithotomy
 Pyelolithotomy
 Ureteroscopy
 Cystolithotomy
 Lithopaxy
8. Given a patient with recurrent stone disease, develop a plan for follow-up care
including metabolic evaluation, appropriate treatment by diet, fluid intake or
medications and subsequent evaluation by radiographic studies
Goal 4
Demonstrate competence in the use of ESWL in the treatment of urolithiasis
Objectives
8. List the types of ESWL machines available, including the sources of energy,
methods of coupling energy to patient, and the methods for imaging and targeting
stones
9. Describe the physics of shock wave stone fragmentation, including the absorption
of energy at the acoustical interface, internal reflections of shock wave within the
stone, and cavitation bubbles
10. List the indications and contraindications for the use of ESWL
11. Be familiar with pre-lithotripsy management including the indications for pretreatment stents and selection of methods of anesthesia
12. Demonstrate ability to treat various stone types and describe initial energy levels
used, total energy delivered, and the use of contrast to assist stone targeting
13. Discuss the post-treatment management of patients treated with ESWL
14. List the complications and risks of ESWL
Goal 5
Develop competence in the use of endourologic techniques to treat upper urinary tract
stones
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Department of Urology
2012-2013
Objectives
12. Describe the surface relationships of the kidney and the structures traversed when
a needle is passed into the renal pelvis through a posterior calyx
13. Know the intrarenal anatomy important to percutaneous renal access
14. Discuss the equipment commonly used in endourology, including guidewires,
balloon dilators, stents, stone baskets and lithotriptors
15. Demonstrate knowledge of the various types of fluoroscopy equipment and the
risks of fluoroscopy
16. Understand the technique of percutaneous nephrostomy placement, the use of
fluoroscopy or ultrasound for guidance and the potential complications of this
access procedure
17. Know the methods and instruments used for stone removal including forceps,
baskets, and various grabbers, and know which stones can be removed with each
18. Discuss various methods of power lithotripsy, including ultrasound,
electrohydraulic and laser lithotripsy
19. Know the complication of percutaneous stone removal and understand methods
for their management
20. Discuss the appropriate selection of patients for percutaneous lithotripsy as
compared to ESWL
21. Discuss the use of percutaneous stone dissolution and describe various chemolytic
agents
22. List the complications specific to various types of stone dissolution techniques
Goal 6
Develop competence in the use of endourologic techniques to treat lower urinary tract
stones
Objectives
6. Demonstrate ability to perform both rigid and flexible ureteroscopy in the
treatment of ureteral and renal stones
7. Understand the use of baskets, forceps, and other devices for ureteroscopic stone
removal
8. Have a thorough knowledge of lithotripsy methods used via the ureteroscope to
fragment ureteral stones
9. Describe the immediate and long-term complications of ureteroscopy, including
extravasation, ureteral stricture, and avulsed ureter
10. Discuss the indications for ureteroscopic stone extraction as compared to the use
of ESWL in the treatment of ureteral stones
PEDIATRIC UROLOGY:
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Department of Urology
2012-2013
Goal 1
Diagnose, evaluate and treat pediatric patients with adrenal disease
Objectives
7. Understand the physiology of the normal adrenal
8. Recognize the clinical manifestations of the adrenal-genito (A-G) syndromes
9. Institute appropriate diagnostic steps in evaluation of the A-G syndrome
10. Institute treatment of the A-G syndrome
11. Counseling of families of patients with the A-G syndrome
12. Recognize, evaluate and treat patients with benign and malignant neoplasms of the
adrenal, including adrenal hemorrhage, adrenal adenoma, pheochromocytome, and
neuroblastoma.
Goal 2
Diagnose, evaluate and treat patients with space-occupying lesions of the kidney
Objectives
5. Diagnose and manage the spectrum of cystic disease of the kidney
6. Diagnose Wilm’s tumor of the kidney
7. Understand the role of adjuvant therapies for the management of patients with
Wilm’s disease
8. Understand the surgical approach to patients with Wilm’s tumor
Goal 3
Develop expertise in the management of UPJ anomalies
Objectives
6. Understand the role of prenatal ultrasound in the diagnosis of UPJ obstruction
7. Recognize the clinical spectrum of presentation of UPJ obstruction
8. Understand the role of renal nuclear scan in the management of patients with UPJ
obstruction
9. Understand the various surgical approaches to the management of patients with
UPJ obstruction
10. Understand followup strategies in patients having undergone repair
Goal 4
Be familiar with the diagnosis and management of ureteral anomalies
Objectives
6. Understand the embryology and physiology of the normal ureter
7. Recognize the clinical spectrum of the megaureter
8. Understand management strategies for the patient with a megaureter
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Department of Urology
2012-2013
9. Recognize the clinical implication of the Meyer Weigert rule
10. Know the surgical options in the management of patients with ureteral duplication
and associated renal anomalies
Goal 5
Manage vesico-ureteral reflux
Objectives
5. Know the classification system for vesico-ureteral reflux
6. Know and interpret the radiographic studies for the diagnosis of vesico-ureteral
reflux
7. Understand the non-operative management of vesico-ureteral reflux
8. Know the surgical indications and techniques for the treatment of vesico-ureteral
reflux
Goal 6
Manage pediatric voiding dysfunction
Objectives
8. Understand the role of urodynamics in the pediatric population
9. Know the options for management of the patient with enuresis
10. Understand the role of the urologist in the multidisciplinary management of
patients with meningomyelocele
11. Understand the role of vesical augmentation in the patient with the neurogenic
bladder
12. Understand the Mitrofanoff technique
13. Understand the indications for the Malone procedure
14. Discuss and understand the indications and surgical options for bladder neck
reconstruction
Goal 7
Management of pediatric undescended testicle
Objectives
5. Know the embryology of the testes and testicular descent
6. Understand the indications for BHCG use in the management of the undescended
testes
7. Know the indications for the use of laparoscopy in the management of patients
with nonpalpable testes
8. Understand the surgical principals involved with the repair of the undescended
testicle
Goal 8
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Department of Urology
2012-2013
Management of the patient with ambiguous genitalia
Objectives
4. Understand the full spectrum of the biochemical and genetic disorders which lead
to intersex
5. Know the appropriate diagnostic steps in managing the patient with intersex
6. Understand the surgical management of the patient with intersex
Goal 9
Management of the patient with urethral abnormalities
Objectives
4. Understand the embryology of the urethra
5. Classify the various degrees of hypospadias
6. Become adept in the surgical management of the hypospadiac urethra
UROLOGIC ONCOLOGY:
Goal 1
Know how to diagnose, evaluate and treat patients with kidney cancer
Objectives
10. Understand the normal development, function and surgical anatomy of the kidney
11. Identify and discuss the gross and histopathologic features of the various types of
renal tumors
12. Discuss the natural history and epidemiology of kidney cancer
13. Know the paraneoplastic syndromes that may be associated with renal cell
carcinoma
14. Know and discuss the clinical and pathological staging systems used for renal
cancer, and identify the prognosis as a function of the TNM stage of disease
15. Discuss the evaluation and plan a course of therapy for selected patients with
various stages of renal cell carcinoma
16. Demonstrate the ability to select the best surgical approach (radical vs partial vs
laparoscopic nephrectomy) in patients with kidney cancer
17. Discuss adjuvant therapy for patients with renal cancer including the roles of
radiotherapy, chemotherapy and the use of biologic response modifier therapies
18. Identify and discuss the appropriate follow-up, including the role of radiographic
imaging, of patients after radical or partial nephrectomy for renal cancer
Goal 2
Competent diagnosis, evaluation and treatment of patients with cancer of the renal pelvis
and ureter
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Department of Urology
2012-2013
Objectives
11. Understand the normal development, function and anatomy of the ureter and renal
pelvis
12. Discuss the theories regarding the etiology of cancer of the renal pelvis and ureter,
and know the natural history and risk factors for tumor progression
13. Know the histopathologic features of transitional cell carcinoma of the upper
urinary tract, including evaluation of urinary cytology
14. Demonstrate the ability to elicit a history compatible with cancer of the upper
urinary tract and discuss findings on physical examination
15. List and be able to interpret the appropriate laboratory studies necessary to
diagnose and stage cancer of the renal pelvis and ureter
16. Accurately select and interpret imaging studies of the upper urinary tract
17. Demonstrate competence in evaluation of the ureter and renal pelvis using
endoscopic techniques
18. Discuss the rationale for various surgical procedures used in the treatment of
patients with ureteral or renal pelvic cancer, including the indications of nephronsparing approaches in selected patients
19. Discuss the rationale, methodology, agents used and potential toxicities of
intracavitary agents used in the treatment of superficial tumors
20. For patients with invasive or metastatic tumors of the upper urinary tract, discuss
the role and potential toxicities of systemic chemotherapy
Goal 3
Competent diagnosis, evaluation and treatment of patients with cancer of the bladder
Objectives
13. Understand the embryology, normal development, function and anatomy of the
bladder
14. Discuss the epidemiology of the various forms of bladder cancer, the concepts of
initiation and promotion of carcinogenesis and risk factors for bladder cancer
development
15. Know the natural history of superficial and muscle invasive bladder cancer
16. Know and discuss the clinical and pathological staging systems used for bladder
cancer, and identify the prognosis as a function of the TNM stage of disease
17. Demonstrate the ability to recognize the signs and symptoms of patients with
bladder cancer and be able to perform a bimanual examination of the bladder
under anesthesia
18. Demonstrate the ability to interpret the results of laboratory and imaging studies
in the diagnosis and staging of bladder cancer
19. Demonstrate competence in the performance of urethroscopy and cystoscopy in
the evaluation and follow-up of patients with bladder cancer
20. Describe the endoscopic approaches to treatment of bladder cancer
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Department of Urology
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21. Know and discuss the indications, efficacy, and complications associated with the
use of intravesical therapies
22. Know and discuss the role of open surgical therapy for patients with bladder
cancer, and discuss the role of lymph node dissection
23. Describe the various types of urinary diversion and considerations of their
suitability in the context of extent of disease and patient preferences
24. Discuss the role of radiotherapy and chemotherapy in the treatment (adjuvant and
therapeutic) of advanced bladder cancer
Goal 4
Be proficient in the diagnosis, evaluation and treatment of patients with prostate cancer
Objectives
13. Understand the embryology, normal development, function and anatomy of the
prostate
14. Discuss the pathophysiology and theories regarding the etiology of prostate
cancer
15. Know the gross and microscopic histopathology of prostate cancer and be able to
differentiate these from other common histologic entities
16. Discuss the natural history and epidemiology of prostate cancer
17. Elicit a detailed and appropriate history from patients with prostate cancer
18. Demonstrate an ability to perform a digital rectal examination, including location
and size of induration or nodules, pelvic sidewall and seminal vesicle extension
of cancer
19. Discuss the appropriate diagnostic and staging studies used to evaluate cancer of
the prostate and interpret their results
20. Demonstrate the ability to perform an adequate transrectal ultrasound and biopsy
of the prostate, and understand the rationale for various biopsy strategies
21. Discuss the risks, complications, and benefits of the various treatment options for
prostate cancer, and demonstrate the ability to select appropriate patients for each
treatment modality
22. Discuss with patients and families the prognosis and complications associated
with prostate cancer treatment and understand the medical and psychological
management of these complications
23. Know the appropriate follow-up regimens for patients after radical prostatectomy
and radiation therapy for prostate cancer
24. Discuss the indications and controversies surrounding the use of adjuvant therapy
after definitive therapy (radical prostatectomy or radiotherapy)
Goal 5
Competent diagnosis, evaluation and treatment of patients with testicular cancer
Objectives
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Department of Urology
2012-2013
13. Understand the embryology, normal development, function and surgical anatomy
of the testis and paratesticular structures
14. Know and discuss the lymphatic drainage of the testicle and the pattern of
lymphatic progression of disease to the retroperitoneum
15. Discuss various factors in the possible etiology of testis cancer
16. Know and differentiate the gross and histopathologic features of seminomatous,
nonseminomatous and non-germ cell tumors
17. Demonstrate the ability to elicit a history compatible with testicular cancer
18. Perform a complete and accurate physical examination of patients with testicular
cancer, including evaluation for lymphadenopathy or gynecomastia
19. List the appropriate diagnostic and staging studies used to evaluate cancer of the
testicle or be able to interpret the results of these studies
20. Discuss the use of serum tumor markers in patients with testis cancer
21. Interpret testicular ultrasound and abdominal/pelvic CT findings in patients with
testis cancer
22. Discuss the relative roles of retroperitoneal lymph node dissection and
surveillance in patients with Stage I nonseminomatous testis cancer
23. Understand and discuss the selection of radiotherapy for the treatment of patients
with testis cancer
24. Discuss various chemotherapeutic agents used in the treatment of advanced testis
cancer and their relative value, depending on tumor type and stage
Goal 6
Competent diagnosis, evaluation and treatment of patients with penile cancer
Objectives
9. Understand the embryology, normal development, function and surgical anatomy
of the penis and urethra
10. Discuss the incidence, epidemiology and potential etiologic factors of penile
cancer
11. Identify and discuss treatment and follow-up of premalignant penile lesions
12. Know and use the TNM staging system for squamous cell carcinoma of the penis
13. Demonstrate an appropriate examination of the penis and inguinal lymph nodes in
patients diagnosed with penile cancer
14. Describe the surgical treatment options and their applicability to various stages of
penile cancer
15. Discuss the strategies and indications for inguinal lymph node dissection
16. Discuss the roles of radiotherapy and chemotherapy in the treatment of local and
advanced penile cancer
Goal 7
Understand the role of chemotherapeutic agents in the treatment of genitourinary
malignancies
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Department of Urology
2012-2013
Objectives
6. Classify the commonly used chemotherapy agents used in urologic cancers
7. Discuss the pharmacology of the various types of chemotherapeutic drugs used in
the treatment of urologic cancers
8. Describe the current chemotherapeutic regimens for genitourinary cancers
9. Know the specific complications of chemotherapy, both immediate and long-term,
and treatment of these conditions
10. Discuss the treatment results and expected response rates of chemotherapy
regimens used for the treatment of various genitourinary malignancies
Goal 8
Understand the role of radiotherapy in the treatment of genitourinary malignancies
Objectives
8. Discuss the physical properties of ionizing radiation, including the fundamental
units used to describe the interaction of radiation matter and the differences in
penetration and absorption between different types of radiation
9. Know the differences between external beam and interstitial radiotherapy
10. Discuss the isotopes used for interstitial radiotherapy, including differences in
energy emitted, half-lives and the clinical utilization of each
11. Discuss the biologic factors impacting the effectiveness of radiotherapy
12. Demonstrate a basic understanding of radiotherapy principles as it relates to
genitourinary malignancy
13. Discuss the commonly employed curative and palliative radiotherapeutic doses,
schedules and fields for urologic tumors
14. Demonstrate knowledge of potential complications of radiotherapy, both in
general and those associated with the treatment of specific urologic tumors
Renal Transplantation:
Goal 1
Evaluate patients who are potential recipients of a renal transplant
Objectives:
8. Understand the pathologic states that lead to ESRD
9. Recognize co-morbid states which influence outcomes of renal transplantation.
10. Evaluate the suitability of potential renal transplant recipients
11. Understand the systems-based issues surrounding the acquisition of a renal
transplant
12. Know the various immunosuppressive agents and their potential toxicities
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Department of Urology
2012-2013
13. Manage patients post transplantation
immunosuppressive regimens
14. Perform renal transplantation
with
special
emphasis
of
FEMALE UROLOGY:
Goal 1
Understand the normal development, function and surgical anatomy of the female
urethra, bladder and pelvis
Objectives
5. Describe and explain the developmental processes by which the urethra progresses
to tubular form and the hormonal influences in urethra development
6. Describe female urethral function by which urinary incontinence is maintained and
the functional role of secondary structures, such as striated muscle
7. Know the blood, lymphatic, and nerve supply of the female bladder and urethra
8. Understand the normal anatomy and support of the female pelvis, including all
involved organs and the supporting ligaments, muscle and fascia
Goal 2
Competent evaluation, diagnosis and treatment of females presenting with urinary
incontinence
Objectives
6. Perform and demonstrate a complete medical history applicable of female patients
presenting with urinary incontinence
7. Demonstrate an appropriate and complete physical examination of women with
incontinence
8. Describe the laboratory studies that may assist with the diagnosis of women with
incontinence
9. Demonstrate the ability to chose and carry out the appropriate therapy for the
following conditions associated with female incontinence:
 Stress incontinence due to anatomical changes
 Stress incontinence due to sphincteric damage
 Urge incontinence and bladder instability
 Neurogenic bladder dysfunction
 Urinary retention and obstruction
 Urethral diverticula
10. Understand the role of pelvic floor neuromodulation in the treatment of patients
with refractory voiding dysfunction due to pelvic floor dysfunction
Goal 3
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Department of Urology
2012-2013
Know how to perform urodynamic studies in patients with voiding dysfunction
Objectives
6. Discuss the value and indications for urodynamic evaluation of the lower urinary
tract
7. Have an in-depth knowledge of the relationship of specific part of the urodynamic
study to the filling/storage and emptying phases of micturition
8. Demonstrate the ability to independently set up and perform filling and voiding
cytometry and be able to identify and interpret all of the following:
 Urinary flow rate
 Residual urine volume
 Flow patterns
 Bladder compliance
 Involuntary bladder contractions
 Abnormal bladder sensation
 Leak point pressures
 Bethanechol supersensitivity test
 Pressure/flow studies
9. Demonstrate the ability to independently set up and perform videourodynamics
10. Demonstrate the ability to independently set up and perform electromyography
utilizing both needle and patch electrodes
Goal 4
Know how to evaluate, diagnose and treat patients with pelvic pain syndromes, including
interstitial cystitis
Objectives:
12. Demonstrate an understanding of the epidemiologic aspects of interstitial cystitis
13. Be familiar with the common theories regarding the pathogenesis of interstitial
cystitis
14. List the typical symptoms of interstitial cystitis in men and women
15. Discuss the differential diagnosis of the symptoms of interstitial cystitis
16. Be familiar with the cystoscopic findings in patients with interstitial cystitis and
the indications and limitations of bladder biopsy
17. Explain the therapeutic rationale for the various treatments used in interstitial
cystitis and be familiar with their benefits, efficacy and side-effects
18. List the systemic and intravesical pharmacotherapies used to treat interstitial
cystitis
19. Know the role of bladder hydrodistention in patients with interstitial cystitis
20. Know the role of pelvic floor neuromodulation in the treatment of patients with
interstitial cystitis and other pelvic pain syndromes
21. Know the role of surgical therapy for patients with refractory interstitial cystitis
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Department of Urology
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22. Demonstrate proper selection of interstitial cystitis patients for surgical therapies
Goal 5
Be competent in the diagnosis and treatment of patients with vesicovaginal and
ureterovaginal fistulae
Objectives
8. List the signs and symptoms commonly associated with vesicovaginal (VVF) and
ureterovaginal (UVF) fistulae
9. Describe the pathogenesis of VVF, including iatronic, post-irradiation and
obstetric trauma induced fistulae
10. Describe the important components of the history and physical examination in
patients with VVF and UVF
11. Distinguish between VVF and UVF using historical and diagnostic techniques
12. Discuss the surgical principles involved in repair of these fistulas including the
biology of wound repair and the preparation of tissues for surgery
13. Describe the conservative management of VVF and UVF
14. Discuss in detail the surgical repair options for patients with VVF or UVF
UROLOGIC SURGERY:
Goal 1
Know the background, indications and potential complications of several commonly
performed urologic operative procedures
Objectives
2. Describe the rationale and indications for surgery, and list the complications
associated with the following surgical procedures:
 Nephrectomy
 Partial nephrectomy
 Pyeloplasty
 Ureteroureterostomy
 Ureteroneocystostomy
 Augmentation cystoplasty
 Transureteroureterostomy
 Boari flap and psoas hitch
 Ileal conduit
 Ileal neobladder
Goal 2
Develop and refine basic surgical techniques required for performance of some of the
commonly performed surgical cases in urology
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Department of Urology
2012-2013
Objectives:
2. Describe specific surgical techniques applicable to the following operative
procedures:
 Nephrectomy
 Partial nephrectomy
 Ureteroureterostomy
 Ureteroneocystostomy
 Augmentation cystoplasty
 Transureteroureterostomy
 Boari flap and psoas hitch
 Ileal conduit
 Ileal neobladder
Goals & Objectives
The Toledo Hospital/St. Vincent Mercy Medical Center
(site specific)
Goals & Objectives
PGY- 1 & 2 – Surgery Prelim
Education: During the first two years of urology residency training, residents rotate on the
clinical services at The Toledo Hospital (TTH), St. Vincent Mercy Medical Center (SVMMC) and
St. Luke’s Hospital During these rotations, the foundation for urologic care of the patient is laid.
Emphasis is placed on preoperative preparation and postoperative management in both the
inpatient and outpatient settings. Preoperative preparation includes the taking of an accurate
history and performing a detailed physical examination. Interpretation of pertinent lab data,
EKGs, and radiographs is emphasized as they relate to planned surgical intervention. In the
postoperative period, fluid and electrolyte replacement, pain management, prevention of
postoperative complications, drain management, and discharge planning are among the areas
of training emphasis.
Patient Care Responsibilities: Increasing responsibility for patient care is delegated to the
resident as competency develops during the first two years. During the first two years, residents
work closely with senior residents. Legible daily documentation of patient care is done within
the framework of cost-effective delivery of care. The management of consultations and the
expeditious communication with referring services is emphasized. Surgical skills, such as the
proper handling of tissues, are taught in the operating room environment. Increasing
opportunity for participation within the operating room is assumed as resident competency and
skill matures.
An opportunity to work in an outpatient setting is afforded to the residents at Parkway Urology
Center, a urologic outpatient center, affiliated with The Toledo Hospital parent system of
ProMedica, Inc. Residents learn to obtain a complete history and physical examination in a
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timely fashion, and prepare patients for surgery with special attention to the patient’s concurrent
medical problems as these effect the approach to solving a specific urologic problem.
Technical Skills: Skills needed for the proper handling of tissues are developed within the first
two years. Methods for incising tissue and wound closure are learned. Accurate and
appropriate use of different sutures is taught. Basic endoscopic skills are introduced.
Residents learn to use both rigid and flexible endoscopes for diagnostic procedures. Residents
gain experience in the bedside management of patients with acute urologic problems.
Evaluation: Residents are evaluated by attending physicians as well as by others (360
evaluation) with whom the resident works for the care of the patient.
Goals & Objectives
PGY –3
Education: Education during the PGY-3 rotations includes the first steps in mastery of all
aspects of the clinical activities for both adult and pediatric urology. During this time, the
resident develops the core of clinical and basic sciences knowledge required to care for patients
with urologic diseases. In conjunction with the faculty at The Toledo Hospital and St. Vincent
Mercy Medical Center, the residents master the fundamentals of the interpretation of urologic
imaging, such as intravenous pyelography, coaxial tomography, and renal ultrasonography.
The resident will also develop familiarity with invasive examination of the genitourinary tract,
cystoscopy, ureteroscopy, and transrectal ultrasonography. Resident core knowledge of the
diagnosis and staging of urologic malignancies, diagnosis of calculus disease, forms of
incontinence, as well as embryologic and pediatric urologic problems develop through
supervised patient contact and structured didactic sessions. Residents can expect their
accumulating knowledge to be "tested" by faculty questions that assess the depth of resident
knowledge of the clinical problem at hand.
Patient Care Responsibility: PGY-3 residents are directly supervised by the Chief Resident.
Daily rounds (except when off call on weekends, vacations and holidays) are made in
conjunction with the Chief Resident. Efficient, expeditious and compassionate care-giving is
developed. Residents are expected to develop basic bedside skills, such as suprapubic tube
placement, use of filiforms and followers, catheter guides and flexible cystoscopy. Emergency
room coverage and consultations are performed when on call in conjunction with the Chief
Resident. Outpatient evaluations at Parkway Urology Center are of great importance in the
PGY-3 training as a way to develop timely and cost-effective skills in the diagnosis and
management of patients. Costs of patient management (pharmaceutical and lab expenses,
etc.) are reviewed with the Chief Resident and attending physician in a prospective manner.
Proper documentation of care in a problem-oriented and legible manner is emphasized.
Technical Skills: In general, PGY-3 residents participate in all endoscopic and open
procedures. Principals of surgical handling of tissues and basic endoscopic skills are further
developed. Residents are expected to “first assist” on procedures commensurate with their
level of surgical training and “second assist” on more technically advanced open cases.
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Evaluation: Residents are evaluated by attending physicians as well as support staff.
Goals & Objectives
PGY-4
Education: The education process initiated in the PGY-3 year continues throughout the PGY-4
year. Residents continue to mature in their clinical diagnostic skills. During this year, PGY-4
residents have the opportunity to be the most senior residents on the urology service at The
Toledo Hospital and have six months of dedicated UT/Mercy Children’s Pediatric service at St.
Vincent Mercy Medical Center. Faculty strive to enhance clinical confidence. Resident’s must
obtain prior approval from attending for absence in coverage. Residents are expected to
integrate their base of fundamental knowledge with the wide range of clinical urologic problems
encountered at these sites.
Patient Care Responsibilities: The PGY-4 resident is supervised by the attending at TTH and
SVMMC Pediatric Urology service. During this year, the residents develop a mature attitude
towards the responsibility of patient care which is reflected by marked attention to all details of
patient management, from admission to discharge planning. Resident management of patients
in the outpatient setting is now expeditious and focused. Consults and emergency room
coverage (when on call) includes patient evaluation, the ordering of appropriate diagnostic tests,
and the formulation of a treatment plan in conjunction with the attending physician.
Technical Skills: During this year, PGY-4 residents develop their skills, both endoscopic and
open surgical. In many cases, PGY-4 residents are the surgeon or they “first assist” the
attending physician and are active participants in all aspects of the surgical case.
Evaluation: Residents are evaluated by attending physicians as well as support staff.
Goals & Objectives
PGY – 5
Education: PGY – 5 is a year emphasizing research and renal transplantation. The resident
will have ample opportunity to participate in one of the many research projects within the
department. At the end of the PGY – 5 year it is anticipated that the resident’s activities will
culminate in the production of new knowledge worthy of publication within a peer reviewed
journal. Clinical education will revolve around all aspects of renal transplantation. The
foundations of clinical immunology and immunosuppression will be mastered in this year as well
as the elements of organ preservation. A fertility clinic rotation at the Genito Urinary Surgeons,
Inc (TTH affiliate) which is held the fourth Wednesday of the month is also included during the
PGY 5 year. Residents will continue to participate in all other scheduled teaching rounds,
clinical duties, didactic sessions and on-call activities during this year.
Patient Care Responsibilites: The PGY – 5 residents work with the PGY – 6 residents at
UTMC to supervise the PGY – 3 residents. During this year, the PGY – 5 continues to develop
advanced surgical skills (including open and laparoscopic surgeries). Residents also continue to
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develop advanced patient management skills with an emphasis on renal transplant and
infertility.
Technical Skills: Residents will develop the technical skills for the safe and efficient removal of
kidneys during multi-organ retrieval. All aspects of renal transplantation will include the vascular
and ureteral anastomoses will be mastered. In addition, the techniques of needle biopsy of
transplanted kidneys, implantation and removal of CAPD catheters will be included in this year.
Transplant nephrectomy as well as laparoscopic donor nephrectomies will be preformed.
Evaluation: residents are evaluated by attending physicians as well as support staff
Goals & Objectives
PGY-6
Education: PGY-6, the Chief Resident (CR) year, is the culmination of the urology residency
program. The CR assumes a major role in educational leadership. A diagnosis and
management plan is synthesized by the CR prior to consultation with the attending physician,
with documentation of the consult completed in a timely manner. The CR reviews junior
residents’ assessments of the consults where appropriate. Consults to the emergency room are
channeled through the CR prior to enlisting attending physician involvement unless such a
pathway leads to delay in patient care management. The CR participates in urology outpatient
clinic settings when not involved in the operating room or other aspects of direct patient care.
Patient Care Responsibilites: The PGY – 6 resident directly supervises the PGY 3 & 4
residents at both UTMC and SVMMC as well as the PGY- 1 resident at SVMMC. They are
responsible for leading daily patient rounds as well as distributing the daily work load including
case coverage. This administrative role also includes creating the conference calendar and call
schedules. Residents in this year guide junior residents in the formulation of a patient care plan
in both an inpatient and outpatient setting.
Technical Skills: The CR has a major responsibility in all urological surgeries. Upon
completion of the PGY-6 year, the CR is able to demonstrate competence in all aspects of open
surgical and endoscopic surgery.
Evaluation: Residents are evaluated by attending physicians as well as clinic support staff.
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RESIDENT PROMOTION PROCESS
The Department of Urology Resident Evaluation Committee (chaired by the program
director) will review the clinical and academic performance and progress of each resident
on a quarterly basis. Annually, the Department of Urology faculty will review the
performance and progress of the resident during the academic year so as to assist the
committee in determining his/her suitability for promotion or graduation. The program
director will meet with the resident at a minimum of every six months to discuss
performance evaluation. In the event that serious deficits are identified in the resident’s
performance, meetings with the program director should be more frequent. The resident
should be advised of deficits in performance by attendings with whom they work so as to
receive timely feedback and opportunity for remediation.
Department measures for resident evaluation are as follows:
1. Patient care and management on each rotation as documented by the faculty
survey forms. Major performance deficits will result in a warning and may
be grounds for probation.
2. Attendance at departmental academic conferences (Morbidity and Mortality,
Lecture Series, etc.) which are mandatory for residents. Failure to attend
more than 75% of any of these conferences will result in a warning and may
be grounds for probation.
3. Performance on the annual American Board of Urology In-Service Exam.
Failure to score above the 20th percentile will result in a warning and may be
grounds for probation.
4. Performance on the annual Department of Urology Mock Oral Examination.
Failure on either of these examinations will result in a warning and may be
grounds for probation.
5. Contributions to the academic and scholarly mission of the Department. This
will be evaluated by student and resident teaching, conference presentation
and participation, and overall faculty assessment surveys.
Major
performance deficits will result in a warning and may be grounds for
probation.
6. Compliance with all hospital and departmental record-keeping and
documentation requirements. This includes timely completion of operative
dictation, medical records, case lists (surgical operative logs), and Morbidity
and Mortality reports. A pattern of lateness and noncompliance will result in
a warning and may be grounds for probation.
7. Personal integrity, which includes strict avoidance of substance abuse, theft,
lying, cheating, and unexplained absences. Failure to follow this standard
will result in a warning and may be grounds for probation.
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When a resident receives a warning, a remedial program will be instituted in an attempt
to correct the particular deficit(s). Failure to meet departmental standards after a resident
has received a warning may result in a request to the Associate Dean for Graduate
Medical Education to convene a hearing to evaluate the resident for placement on
probation. Failure to meet departmental standards after a resident has been placed on
probation will result in his/her expulsion from the program. The department reserves the
right to summary expulsion of a resident from the program for severe infractions of
departmental standards. If a resident is placed on probation and/or recommended for
expulsion from the program, he/she may appeal in writing to the program director within
fourteen (14) days of notification. An attempt to resolve the appeal should be
accomplished within thirty (30) days. If the resident is not satisfied with the resolution
proposed by the program director, he/she may submit an appeal to the Associate Dean for
Graduate Medical Education, in accordance with the Due Process policies of the Medical
College of Ohio.
CALL/WORKING ENVIRONMENT
Each hospital provides residents with on-call sleeping, lounge, library, and meal
facilities. In-house resident call is not permitted to be more frequent than every third
night (on average) for the duration of the program. Residents are not to average more
than eighty (80) hours of work per week, barring exceptional patient care needs.
Residents are provided (on average) one day out of seven free of all clinical
responsibilities. The program director monitors working hours closely, but residents are
also expected to report when working hours are excessive. (See attached Policy)
CHIEF RESIDENTS
The chief residents are primarily responsible for ensuring timely preparation of the
resident call schedule, coordinating the visiting professor Case Management conferences,
correcting resident call and coverage conflicts, and, in general, responsible for addressing
administrative duties of the residency program operation under the supervision of the
program director.
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RESIDENT RESPONSIBILITIES
Communication:
A key to the successful practice of medicine in general, and urology in particular, is
prompt and effective communication with patients and their families and referring
physicians. In general, residents are expected to:
 Discuss diagnostic and therapeutic plans and risks with patients and their families.
 Communicate plans and progress of all patients with attending surgeons, including
any serious problems as they occur (including at night and on weekends).
 Notify referring physicians upon admission, operation, and discharge of their
patients from the hospital.
Medical Records:
Complete patient care documentation is a requirement, and dictation is to be done on a
timely basis. The following procedures are also outlined in the Medical College Hospital
Physician’s Manual:
A. The history and physical examination must be recorded in the patient’s chart
within 24 hours of the patient’s admission.
B. The discharge summary should include the following items in the order
listed:
1. Patient name.
2. Patient 6-digit number.
3. Date of discharge.
4. Narrative summary, which should be a short summary of the patient’s
hospitalization, including the reason for admission.
5. Hospital complications.
6. Consultations obtained.
7. Condition of patient at discharge.
8. Disposition.
9. Recommendations, including medications, diet, activity, and followup care.
Discharge summaries must be dictated within 24 hours after discharge.
C. All operative procedures must be dictated within 24 hours of surgery,
preferably immediately following the procedure.
D. All entries into the medical record must be legible and in black ink.
E. All verbal orders are to be signed within 24 hours.
F. All medical student notes must be countersigned by the resident or attending
physician within 24 hours.
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Referrals and Consultations:
Residents should respond promptly to all requests for patient referral or urologic
consultations. Residents should promptly contact the responsible attending physician and
the hospital Admitting Department, or the Urology Clinic when appropriate, to facilitate
the referral.
A faculty attending surgeon is assigned to urology/transplantation call each day. The
“on-call” period rotates at 8:00 a.m. For the purposes of assigning a responsible
attending, consult or referral is considered to be “received” at the time that a request is
made to a member of the Department of Urology (resident, attending, or office).
Consults directed to a specific attending are presented to that attending, not the attending
on call. In-patient consultations are to be seen by the senior resident on the day of
request. After evaluating the patient and writing an initial note, the senior resident should
contact the appropriate attending surgeon who will complete the consultation.
Emergency Room consults will be seen promptly under the direction of the senior
resident and will be discussed with or seen by the responsible surgical attending prior to
final disposition.
Consult/referral patients will remain assigned to the responsible attending surgeon unless
responsibility for the patient’s care is accepted by another attending surgeon.
Arranging of transfers between attendings in the Department of Urology will not be
delegated to residents, but will be done by direct communication between attendings.
Clinics
Residents should attend all clinics on services to which they are assigned. Every effort
should be made for a resident to see patients, both preoperatively and postoperatively, for
whom they are the responsible operating surgeon under faculty supervision. A resident
from the appropriate service must be present at the start of all clinics and remain for the
duration of the clinic until all patients have been seen, unless otherwise approved by the
attending surgeon. Residents should report to the appropriate attending surgeons
covering the clinic regarding all diagnostic and therapeutic decisions on outpatients. It is
the responsibility of the resident to write or dictate a clinic note, order appropriate
diagnostic studies, schedule inpatient ambulatory surgical procedures, and communicate
with referring physicians, unless otherwise handled by the attending surgeon.
Orders
Residents are responsible for all patient orders, including admission, preoperative,
postoperative, and discharge orders. Telephone orders must be signed as soon as
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possible, and no later than 24 hours after ordered. All orders must be dated and timed.
Discharge orders should be written on the day prior to the anticipated discharge.
Rounds
Residents are expected to round at least once daily. These rounds should endeavor to
appropriately incorporate the contribution of attending staff, nurses, and medical students
in efficient diagnostic assessment and therapeutic planning for patient care. A computer
printout of the service patient census, including name, hospital number, diagnosis, date of
admission, operative procedure and date, surgeon, and referring physician, should be
updated daily. The senior resident is expected to see that the progress of each patient is
discussed daily with an attending surgeon.
Progress Notes
Daily notes (dated and timed) should be entered into the progress note section of the
chart. Progress notes by medical students should be critiqued and must be countersigned
by the resident. Notes should be brief but informative about patient condition, planned
diagnostic or therapeutic measures, and discharge planning.
Preoperative Notes
For elective cases, the operating resident will review the chart (including X-rays, lab, and
pathology) and discuss the operative plan with the attending surgeon prior to the
operation.
For inpatient elective cases, a preoperative note must be written by the resident surgeon
in the progress section of the chart with 24 hours prior to operation and only after the
patient has been examined by the same resident. It should include:
 Preoperative diagnosis and basis for diagnosis.
 Planned operation and indications.
 Surgeon.
 Anesthesia.
 Pertinent laboratory data.
 Blood/X-ray requests.
 Operative risks and indications of risks.
 Potential complications discussed.
 Signed consent.
For outpatient elective cases, the charts will be reviewed the day prior to surgery and a
preoperative checklist completed. It should include:
1. History & Physical /Consent completed
2. Pertinent laboratory data
3. Blood/X-ray requests
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4. Consults obtained
Operating Room (OR) Schedule
The responsible resident should review the OR schedule daily to ensure that all planned
cases are listed. Residents should review the anatomy and technique of elective cases in
standard atlases or by videotape. If you have not read before an elective case, do not plan
to operate. If possible, briefly discuss the case with the attending surgeon on the day
prior to the operation.
Operating Room (OR) Etiquette
A resident should be present in the OR area 10 minutes before induction of anesthesia
(7:20 a.m. for 7:30 a.m. case). All anticipated instruments, supplies, and special
equipment should be requested of the scrub and circulating nurses. The entire operative
sequence should be briefly reviewed with the scrub nurse. Special anesthetic needs and
patient positioning should be reviewed with the anesthesiologist. The roles of the
operating surgeon and first and second assistants should be determined and clearly
understood preoperatively. Professional behavior is expected at all times in the OR.
Required preoperative preparation includes:
 Preoperative note and consent complete.
 Latest clinic note and lab results on chart.
 Relevant patient X-ray reports on chart.
 X-rays on view box.
Operative Notes:
Unless otherwise designated, the responsible resident should fill out an operative note
(dated and timed) in the progress note section immediately following operation, to
include:
 Preoperative diagnosis.
 Postoperative diagnosis.
 Operation.
 Surgeons and assistants.
 Anesthesia.
 Findings.
 Complications.
 Condition.
Of note, a simple diagram of the operation performed (when appropriate) is very helpful.
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Operative Report Dictation:
An operative note is dictated immediately upon completion of the operation. Usually this
task is delegated to the operating resident, although the attending may wish to dictate the
note himself/herself. The operative report should be brief but should cover all salient
points of the procedure, including:
 Patient data.
 Preoperative and postoperative diagnoses.
 Operative procedure.
 Operating surgeon and assistants.
 Anesthesia.
 Operative findings.
 Operative procedure.
 Sponge and needle counts.
 Condition of patient.
 Statement that “the attending surgeon was present for the entire procedure” or
“for all major portions of the procedure,” as the case may be.
Operative Experience Record:
All operative experience of residents is maintained on a computer database through the
ACGME web site. These procedures will be entered into your personal record and kept
on computer file, and you may review your experience at any time by requesting a
“procedure work sheet” from the Residency Office. http://www.acgme.org/caselogs
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University of Toledo
Department of Urology
Name of Policy:
Effective Date:
Supervising Lines of Responsibility
04/2010
Policy Statement
The Department of Urology Residency Program must ensure adequate supervision to facilitate
patient care
Purpose
To delineate how and when residents should contact supervisors to ensure patient
safety
1.
All physicians (including resident physicians) are authorized and expected to do
whatever is considered necessary to preserve life in the event of a life-threatening
emergency. In the event of a life-threatening emergency, resident physicians should
take whatever action deemed necessary to preserve life while someone else
summons help from any available senior resident or faculty member.
2.
All patients cared for in the UTMC Urology Residency Program are cared for under
the direction of a designated faculty attending urologist. The specific level of
faculty supervision will vary depending on the level of training and skill of the
resident, the complexity of the care rendered, and the wishes of the responsible
attending urologist. The level of supervision required for an individual procedure
will be determined on an individual basis between the resident and the responsible
faculty member unless a defined level of supervision is mandated by institutional or
service policy.
3.
Significant patient care decisions and events are to be discussed with the appropriate
attending urologist. If the responsible attending surgeon is unavailable, contact the
attending urologist on call for the appropriate service for the day. Although
residents are responsible for their individual actions and senior residents are
responsible for the performance of their service, overall responsibility for patient
care always rests with the attending urologist.
4.
Authority for supervision may be delegated, at the discretion of the attending
urologist, to more senior urology residents. In general, the senior urology resident
assigned to the service will be in charge of the service and is expected to assume a
leadership role. Except in emergencies, the “chain-of-command” of junior resident
 senior resident  attending urologist should be followed regarding patient care
decisions. Under some circumstances, junior residents may work directly with
attending surgeons. In these instances, the junior resident must keep the senior
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Department of Urology
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resident informed of significant events regarding the service. Individual resident
assignments are to be made by the senior resident at the start of each rotation.
5.
Attending urologists are responsible for ensuring that coverage is available for their
patients by another attending urologist during their absence.
Approved by:
Steven H. Selman, M.D.
______________________________ Chairman & Program Director
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EDUCATION
General:
Residents develop knowledge and judgmental skills though a combination of didactic
teaching in conferences and active participation in conferences and seminars, ward
rounds, self-directed reading, audiovisual instruction, and attendance at local, regional,
and national meetings. Attendance at teaching conferences is mandatory and attendance
is documented, as stipulated by the Residency Review Committee for Urology. All
conferences begin and end promptly at the appointed time. Seventy-five percent
attendance is required of all residents at required conferences.
Conference Schedule:
Day
Monday
Friday
Wednesday
Time
5:00 pm – 6:00 pm
7:00 am – 8:30 am
7:00am -8:30am
Conference
Urology Chapter Review
Campbell’s textbook &
Quiz
Journal Club
Pathology Review
M&M
Indications/Grand
Rounds
GU Tumor Board
Frequency
Weekly
Monthly
4th Friday of month
1st Wed
3rd Wed
2nd & 4th Wed
DEPARTMENT OF UROLOGY
RESIDENCY CONFERENCES
DESCRIPTIONS
****
1. M&M – Wednesday, monthly
M&M conferences cover all cases from the preceding calendar month, e.g. July M&M covers
June 1 – 30 time period) from each hospital rotation site (MCO, MCH, SVMMC, TTH).
Standardized forms case discussions are to be completed by urology residents from each
service and signed by faculty moderator.
ALL cases are to be listed on the form (including cases without M&M).
2. Grand Rounds – Wednesday, monthly
Each resident to present a case with images.
.
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3. Journal Club – Wednesday, monthly
Chief resident will assign journal articles as early as possible. All articles are to be read by
all residents to enhance discussion.
4. Chapter conferences – Monday, weekly
Entire year chapter assignments, from Campbell’s textbook. All residents are expected to
have read each chapter and discuss.
5. Pathology Conferences – Wednesday, monthly
Held 4th Friday of the month. Dr. Lius De Las Casas - moderator
6. AUA Update conference will be scheduled per Chief Resident, covering assorted topics
not covered in above lectures.
7. Quizzes – every Monday preceding conference
8. Technical Skills Lab – Monthly
9. Preoperative Patient Safety & Quality Assurance Conference – Weekly
10. Pediatric Indications - Weekly
Urology Library:
The Department of Urology maintains a library of major urological and surgical journals
and textbooks, instructional videotapes. All residents are encouraged to use the library as
a quiet study room. Materials should not be removed from the library.
Priorities for library use are:
1. Formal resident or student conferences.
2. Scheduled departmental meetings that cannot be accommodated in other
areas.
3. Informal educational meetings, lunches, or rounds.
4. Individual study.
Use of the library is scheduled through the Department of Urology administrative office (
ext 3584).
Residency Office and Lounge:
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The Urology Residency Office and Lounge are designed to provide an area for the
facilitation of preparation of conferences and other teaching experiences, computer
access for documenting procedures on the ACGME case log website, etc.
Society Membership:
Residents are encouraged to join appropriate professional societies such as the American
Urologic Association, North-Central AUA, and Ohio Urological Society. Attendance at
the Northwest Ohio Urologic meetings is required.
Resident Research Presentations and Urology Review Courses:
Residents are required to engage in clinical or laboratory research. With prior approval,
residents will be reimbursed for attending any meeting at which they present a peerreviewed paper. In addition, chief residents will be reimbursed for travel and expenses to
a major surgical meeting.
Medical Student Teaching:
Residents have a major role in teaching junior medical students assigned to their service.
It is the policy of the Department of Urology that medical students rotate in the
department for an educational opportunity and not in a service role. Thus, every effort
should be made to provide students with time to learn, read, and develop basic skills in
evaluation and management of surgical patients. Residents should make an effort to
teach students at every opportunity, including rounds, clinics, and in the operating room.
In the latter circumstances, students should participate only during selected parts of the
operation in which they can learn or perform simple procedures, such as suturing the
skin.
Students are expected to attend all lectures and major conferences. At no time should a
student miss a lecture or conference because of a commitment in the operating room or
on the wards.
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RESEARCH AND EDUCATIONAL PROJECTS
General:
Each resident is encouraged to carry out clinical research with a faculty mentor, and
submit the work for publication or presentation at a peer-reviewed meeting. Residents
who are contemplating a career in academic urology should consider preparing for
fellowship training.
Clinical Research:
Urology residents are encouraged to engage in clinical research during their training
under the supervision of a faculty member of their choice. Such research may involve a
chart review of a particular clinical problem, the report of a new operation or therapy, the
impact of the surgical skill lab on operative technique, etc. Whatever subject is chosen,
the resident should follow the steps necessary in carrying out quality research, including
proper IRB approval, a careful description of the problem, appropriate review of the
literature, definition of the variables to be recorded, gathering of data, data analysis,
appropriate statistical analysis, generating a paper for presentation or publication, and
solicitation of appropriate consultation and critique at each step of the process.
Laboratory Research:
Residents should choose a laboratory experience under an experienced investigator in a
urologic or other clinical discipline or in a basic science laboratory. The resident must
discuss funding for such research experience with the program director and, preferably,
should work in a laboratory funded by extramural grant support.
RESIDENT SELECTION
Selection:
Residents are selected for admission to the Department of Urology educational program
based on several factors, including:
1. Eligibility for appointment in accordance with UTMC GME policy.
2. Academic and research achievement.
3. Evaluation of clinical performance and recommendations.
4. Demonstrated commitment to a urologic career.
5. Proficiency in written and spoken English sufficient for patient care.
6. Personal interview.
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Except under special circumstances approved by the program director, all applications for
residency training are accepted through the ERAS system. Categorical positions are
filled through the NRMP and AUA Match in January. A complete
application includes a basic ERAS application, three recommendations, Dean’s letter,
transcript, USMLE score, ECFMG transcript (if applicable), and previous ABUITE
scores (if applicable). Selected applicants are invited for interview by e-mail or mail.
AMERICAN BOARD OF UROLOGY IN-TRAINING EXAMINATION (ABUITE)
Each year, all urology residents take the American Board of Urology In-Training
Examination (ABUITE) on the first Saturday in November. This multiple-choice test of
approximately 160 questions covers a wide variety of clinical and basic science topics in
urology. The examination permits evaluation of performance as a percentile compared to
PGY peers throughout the country. All residents should develop a systematic reading
program throughout their training (and professional career). Such self-directed learning,
Basic Science conferences, and Clinical Science conferences are all designed to assist
residents in solidifying their cognitive knowledge.
It is the goal of the Department of Urology to have residents perform at or above the
national average (50th percentile) on the In-Training Examinations. Residents who
perform at less than the 20th percentile are placed on academic warning status, and
repeated poor performance may result in grounds for probation, particularly if other
deficiencies exist.
Resident Evaluation of Faculty, Rotation & Program
Name of Policy: Resident Evaluation of Faculty, Rotation & Program
Date: 4/2010
Policy
Each resident will complete a confidential written evaluation of faculty and
rotation twice a year.
Purpose
These constructive critiques are used to improve educational opportunities and
faculty development, which will enhance resident training. In addition, the
Program Director meets with the urology residents individually and a resident –
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elected representative participates in the Urology faculty meetings to exchange
information and solicit constructive recommendations for improving the
residency. All evaluations by residents are valued and taken seriously and in confidence.
The evaluations are collected in a confidential manner and forwarded to the
Program Director with a confidential summary to each faculty member.
Approved by :
Steven H. Selman, M.D.
_______________________ Program Director & Chairman
STIPENDS
R1
$47,010
R2
$48,655
R3
$50,315
R4
$51,618
R5
$53,167
R6
$56,405
LICENSURE
Residents should complete the USMLE examination series (USMLE steps I, II, and III)
by the end of the R2 year. Residents who have not successfully passed steps I, II, and III
by the end of the R3 year may not continue on the residency program. A medical license
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is not required for participation in the residency program. All residents must obtain a
temporary Ohio license before beginning patient care at the Medical College Hospital or
any of the affiliated hospitals. Temporary licensure packets will be issued in the Spring
to allow enough time to process in order to begin residency on July 1.
MOONLIGHTING
NO moonlighting is allowed without written permission of the Program Director.
Department of Urology
Name of Policy : Moonlighting
Effective Date : July 1, 2006
Policy No : 005
Policy
“Moonlighting” is not formally recognized by the Urology Residency program of
the University of Toledo, College of Medicine, Moonlighting is defined as any
physician activity outside of the recognized residency training requirements.
Purpose
1. To assure that residency education continues to be a full – time
endeavor.
2. To assure that moonlighting does not interfere with the ability of the
resident to achieve the goals and objectives of the educational program.
3. To maintain compliance with the ACGME Institutional Requirements.
Procedure
There is NO moonlighting allowed for any resident of the Urology Residency
Program at the University of Toledo College of Medicine.
Approved by:
Steven H. Selman, M.D.
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__________________________Chairman, Department of Urology
Steven H. Selman, M.D.
__________________________Program Director, Department of Urology
IDENTIFICATION
The University of Toledo Medical Center and all affiliate hospitals require picture-type
identification badges to be worn by the house staff at all times. I.D. cards will be issued
by the campus police department.
DRESS
The expected dress for urology residents in the hospital includes:
 Gentlemen are expected to wear full-length trousers, dress shirt, tie, and a
white laboratory coat. Shorts are unacceptable.
 Ladies are expected to wear dresses, skirts or dress slacks and a blouse, and a
white laboratory coat. Shorts are unacceptable.
Scrub suits are not to be worn during the day except when occasionally necessary
“between cases” and then a white coat must be worn over the scrubs.
VACATION
Vacation time is granted as follows:
PGY-1
3 weeks
PGY 2 or above 4 weeks
15 working days
20 working days
First year residents will take their vacation time in three separate one-week blocks.
Second year residents or above will take their vacations in four one-week blocks. For
every five week days requested, two weekend days of vacation will be granted. All
vacation requests may be turned in to the Residency Office as of July 1 and will be
granted on a first-come, first-served basis. Only one resident may be away from a given
service during any given period. Deadline for all requests will be November 1. There
will be no vacations granted during the last two weeks of June without permission of the
Program Director. No vacations will be granted during the AUA or North-Central AUA
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meetings or in-service examination unless special approval is received from the Program
Director.
Residents who choose to interview for jobs or fellowships must do so during their allotted
vacation time. It is the residents’ responsibility to budget their vacation time so that they
have an appropriate number of days available for interviews. Leave for interviews must
be approved in advance with a leave request form.
Department of Urology
Name of Policy: Leave of Absence
Effective Date: 7/2007
Policy
To ensure that the residency program provides residents with a written policy
in compliance with ACGME and American Board of Urology requirements
concerning the effect of leave of absence on satisfying the criteria for
completion of the residency program.
Purpose
To ensure residents are aware of the effects concerning leaves of absence, for
any reason, satisfying the criteria for completion of the residency program and
to delineate restrictions and consequences of time away from resident training.
1. The resident is entitled to leaves of absence for vacation, health, medical
and professional reason. The University of Toledo’s policies regarding
leaves of absence are included in the University of Toledo policy.
2. The resident will be given three weeks ( 15 customary working days) of
vacation leave during year one ( 1 ) and ( 4 ) weeks ( 20 customary
working days) for two ( 2 ) and above. The vacation leave will not
accumulate from year to year.
3. The resident is allowed up to three ( 3 ) weeks ( 15 customary working
days ) of sick leave per year with pay. Sick leave will not accumulate
from year to year.
4. The resident may attend a national meeting, conference or seminar for
professional development purposes for up to seven ( 7 ) days with the
permission of the Program Director.
5. The American Board of Urology requires Urology residents to work a
minimum of (46) forty six weeks per year. That is, one year of credit must
include at least (46) forty six weeks of full-time urologic education.
Vacation or leave time may not be accumulated to reduce the total
training requirement. If a circumstance occurs in which a resident does
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6.
7.
8.
9.
not work the required (46)forty six weeks, the program director must
submit a plan to the American Board of Urology for approval on how
training will be made up, which may require an extension of the
residency. The program director will determine each year if this
requirement has been met.
The resident is entitled to leaves of absence for medical and other
reasons permitted by law.
Any circumstances outside the purview of this policy will be decided on
an individual basis by the Resident Education Committee.
The Department of Urology abides by the Institutional Policy Leave of
Absence including Maternity / Paternity Leave.
For additional questions any resident may have regarding a leave of
absence, shall be directed to the Human Resource Department at the
University of Toledo.
Approved by:
Steven H. Selman, M.D.
________________________ Chairman & Program Director
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I have read the University of Toledo (UTMC) Department of Urology Resident Manual,
including but not limited to the Goals and Objectives, Clinical Training, and Resident
Promotion Process for the General Urology Residency at MCO; I agree with and accept
these as a prerequisite to my training in this program.
_______________________________________
Signature
Date
_______________________________________
Type or Print Name
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