New Application: Urology
Review Committee for Urology
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
PROGRAM PERSONNEL AND RESOURCES
Program Director
Will the program director ensure that didactic conferences include: [PR II.A.4.s).(1)-(4)]
a)
b)
c)
d)
combined morbidity and mortality conferences for all participating sites ................. ☐ YES ☐ NO
urological imaging conferences .............................................................................. ☐ YES ☐ NO
urological pathology conferences ........................................................................... ☐ YES ☐ NO
journal review ......................................................................................................... ☐ YES ☐ NO
If “NO,” explain.
Click here to enter text.
Faculty
1. Local Site Directors for Participating Sites [PR II.A.4.b)]
Provide the name of the local site director and the number of hours per week devoted to the
program for each site participating in the program. Insert additional tables as required if more than
four sites participate with the program.
#1
Participating Site Number
Name of Local Site Director
Approximate hours per week devoted to residency program
Was the appointment of the local site director approved by the urology
residency program director?
Is the local site director responsible for the supervision of all educational
and clinical activities at this site?
#2
Participating Site Number
Name of Local Site Director
Approximate hours per week devoted to residency program
Was the appointment of the local site director approved by the urology
residency program director?
Is the local site director responsible for the supervision of all educational
and clinical activities at this site?
#3
Participating Site Number
Name of Local Site Director
Approximate hours per week devoted to residency program
Was the appointment of the local site director approved by the urology
residency program director?
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
Updated 9/2015
Page 1 of 10
#3
Participating Site Number
Is the local site director responsible for the supervision of all educational
and clinical activities at this site?
#4
Participating Site Number
Name of Local Site Director
Approximate hours per week devoted to residency program
Was the appointment of the local site director approved by the urology
residency program director?
Is the local site director responsible for the supervision of all educational
and clinical activities at this site?
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
2. Faculty
a) For each of the following areas of expertise, indicate which member(s) of the faculty completed
fellowship education and briefly describe how they will interact with the residents: [PR II.B.2.a)]
Area of expertise
Voiding dysfunction
Female urology
Reconstruction
Oncology
Calculus disease
Pediatrics
Sexual dysfunction
Infertility
Name of faculty
member(s)
Name
Name
Name
Name
Name
Name
Name
Name
Name of
fellowship
program
completed
Fellowship
Fellowship
Fellowship
Fellowship
Fellowship
Fellowship
Fellowship
Fellowship
Brief description of
interaction with
residents
Description
Description
Description
Description
Description
Description
Description
Description
b) Does at least one member of the faculty have expertise in the each of the following techniques:
[PR II.B.2.b)]
(1) Endo-urology .................................................................................................... ☐ YES ☐ NO
(2) Minimally invasive intra-abdominal and pelvic surgical techniques
(e.g., laparoscopy, robotic surgery) ................................................................. ☐ YES ☐ NO
(3) Major flank and pelvic surgery .......................................................................... ☐ YES ☐ NO
(4) Urologic imaging ............................................................................................... ☐ YES ☐ NO
(5) Microsurgery..................................................................................................... ☐ YES ☐ NO
If “NO,” explain.
Click here to enter text.
c) Will residents have clinical interaction with faculty members with expertise in: [PR II.B.2.c)]
(1)
(2)
(3)
(4)
Geriatrics .......................................................................................................... ☐ YES ☐ NO
Infectious disease ............................................................................................. ☐ YES ☐ NO
Renovascular disease ...................................................................................... ☐ YES ☐ NO
Renal transplantation........................................................................................ ☐ YES ☐ NO
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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(5)
(6)
(7)
(8)
Trauma ............................................................................................................. ☐ YES ☐ NO
Interventional radiology .................................................................................... ☐ YES ☐ NO
Plastic surgery .................................................................................................. ☐ YES ☐ NO
Medical oncology .............................................................................................. ☐ YES ☐ NO
If “NO,” explain.
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d) Is the faculty-to-resident ratio 1:2? [PR II.B.2.e)]
If “NO,” explain.
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Resources
1. Briefly describe the space and equipment available for resident education, including meeting rooms
and classrooms; office space; diagnostic, therapeutic and research facilities; and outpatient
facilities, clinics, and office space. [PR II.D.1.]
Limit response to 400 words.
Click here to enter text.
2. Indicate with an ‘X’ if equipment to perform the following procedures is available for each
participating site. [PR II.D.2.a)-c)]
Type of Equipment
Flexible cystoscopy
Site #1
☐
Site #2
☐
Site #3
☐
Ureteroscopy
☐
☐
☐
Percutaneous endoscopy
Percutaneous renal access
☐
☐
☐
☐
☐
☐
Shock wave lithotripsy
☐
☐
☐
Ultrasonography and biopsy
☐
☐
☐
Fluoroscopy
☐
☐
☐
Laparoscopy
☐
☐
☐
Laser therapy
Urodynamic evaluation equipment
☐
☐
☐
☐
☐
☐
Video imaging
☐
☐
☐
Other: specify
☐
☐
☐
Other: specify
☐
☐
☐
Other: specify
☐
☐
☐
Other: specify
☐
☐
☐
Other: specify
☐
☐
☐
Other: specify
☐
☐
☐
RESIDENT APPOINTMENTS
Eligibility Criteria
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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1. Is the educational program for the general surgery period developed by the program director of the
respective surgery residency program with the input and approval of the respective urology program
director? [PR III.A.1.a)]................................................................................................. ☐ YES ☐ NO
If “NO,” explain.
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2. Does your program require one year of prerequisite education in surgery, or two years?
[PR III.A.1.] .......................................................................................................................... ☐ 1 ☐ 2
3. Does the prerequisite education in surgery have a minimum of three months in general surgery, as
well as a minimum of three months in the core surgical rotations of critical care, vascular surgery, or
trauma? [PR III.A.1.a)] ................................................................................................. ☐ YES ☐ NO
Other Learners
Provide the information requested below regarding residents and/or fellows from other programs
assigned to rotations in the program. Add rows as necessary. [PR III.D.]
Type of Program
Name of Rotation
Length of Rotation
Number of
Residents/Fellows
Assigned
EDUCATIONAL PROGRAM
Patient Care
1. For each patient care experience at each level, describe resident responsibility under supervision
for total patient care, including admission, initial evaluation, diagnosis, selection and implementation
of therapy and management of complications. Include with this description resident responsibility for
continuity of care with patients; night/weekend duty; and long-term care, and address how the
program ensures that residents assume increasing responsibility. [PR IV.A.5.a).(2).(a)-(c)]
Click here to enter text.
2. Will residents receive instruction in each of the following core techniques: [PR IV.A.5.a).(2).(e)-(i)(vi)]
endo-urology .......................................................................................................... ☐ YES ☐ NO
major flank and pelvic surgery ................................................................................ ☐ YES ☐ NO
microsurgery .......................................................................................................... ☐ YES ☐ NO
minimally invasive intra-abdominal and pelvic surgical techniques, including laparoscopy and
robotics .................................................................................................................. ☐ YES ☐ NO
e) perineal and genital surgery ................................................................................... ☐ YES ☐ NO
a)
b)
c)
d)
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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f)
urologic imaging, including fluoroscopy, interventional radiology,
and ultrasound ....................................................................................................... ☐ YES ☐ NO
If “NO,” explain.
Click here to enter text.
Medical Knowledge
1. Are residents provided with didactic instruction in: [PR IV.A.3.a).(1)-(7)]
a)
b)
c)
d)
e)
f)
g)
calculus disease ..................................................................................................... ☐ YES ☐ NO
female pelvic medicine ........................................................................................... ☐ YES ☐ NO
infertility and sexual dysfunction ............................................................................. ☐ YES ☐ NO
pediatric urology ..................................................................................................... ☐ YES ☐ NO
reconstruction......................................................................................................... ☐ YES ☐ NO
urologic oncology ................................................................................................... ☐ YES ☐ NO
voiding dysfunction ................................................................................................. ☐ YES ☐ NO
If “NO,” explain.
Click here to enter text.
2. Will residents receive instruction in each of the following areas: [PR IV.A.5.b).(1).(a)-(u)]
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
o)
p)
q)
r)
s)
bioethics ................................................................................................................. ☐ YES ☐ NO
biostatistics ............................................................................................................ ☐ YES ☐ NO
calculus disease ..................................................................................................... ☐ YES ☐ NO
epidemiology .......................................................................................................... ☐ YES ☐ NO
evidence-based medicine ....................................................................................... ☐ YES ☐ NO
female pelvic medicine ........................................................................................... ☐ YES ☐ NO
infectious disease................................................................................................... ☐ YES ☐ NO
infertility and sexual dysfunction ............................................................................. ☐ YES ☐ NO
geriatrics ................................................................................................................ ☐ YES ☐ NO
medical oncology ................................................................................................... ☐ YES ☐ NO
patient safety and quality improvement .................................................................. ☐ YES ☐ NO
pediatric urology ..................................................................................................... ☐ YES ☐ NO
plastic surgery ........................................................................................................ ☐ YES ☐ NO
pre-operative, intra-operative, post-operative, and aspects of:
(1) endoscopic urology........................................................................................... ☐ YES ☐ NO
(2) major open flank and pelvic surgery ................................................................ ☐ YES ☐ NO
(3) microsurgery..................................................................................................... ☐ YES ☐ NO
(4) minimally-invasive intra-abdominal and pelvic surgical techniques, including laparoscopy
and robotic surgery ........................................................................................... ☐ YES ☐ NO
(5) urologic imaging, including fluoroscopy, interventional radiology, and ultrasound
......................................................................................................................... ☐ YES ☐ NO
radiation safety ....................................................................................................... ☐ YES ☐ NO
reconstruction......................................................................................................... ☐ YES ☐ NO
renal transplantation ............................................................................................... ☐ YES ☐ NO
renovascular disease ............................................................................................. ☐ YES ☐ NO
trauma .................................................................................................................... ☐ YES ☐ NO
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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t) urologic oncology ................................................................................................... ☐ YES ☐ NO
u) voiding dysfunction ................................................................................................. ☐ YES ☐ NO
If “NO,” explain.
Click here to enter text.
3. Describe the responsibility of the residents and members of the faculty in preparing and presenting
conferences. [PR II.A.4.t, CPR IV.A.3. and PR IV.A.5.b).(1)]
Click here to enter text.
Practice-based Learning and Improvement
1. Briefly describe one learning activity in which residents demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and life-long learning. [PR IV.A.5.c)] (Limit
response to 400 words)
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2. Briefly describe one planned learning activity in which residents engage to identify strengths,
deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set
learning and improvement goals; and identify and perform appropriate learning activities to achieve
self-identified goals (life-long learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)
Click here to enter text.
3. Briefly describe one planned quality improvement activity or project that will allow the resident to
demonstrate an ability to analyze, improve and change practice or patient care. Describe planning,
implementation, evaluation and provisions of faculty support and supervision that will guide this
process. [PR IV.A.5.c).(4)] (Limit response to 400 words)
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4. Briefly describe how residents will receive and incorporate formative evaluation feedback into daily
practice. (If a specific tool is used to evaluate these skills have it available for review by the site
visitor.) [PR IV.A.5.c).(5)] (Limit response to 400 words)
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5. Briefly describe one example of a learning activity in which residents engage to develop the skills
needed to use information technology to locate, appraise, and assimilate evidence from scientific
studies and apply it to their patients' health problems. [PR IV.A.5.c).(6)-(7)] (Limit response to 400
words)
The description should include:
 Locating information
 Using information technology
 Appraising information
 Assimilating evidence information (from scientific studies)
 Applying information to patient care
 Conducting a comprehensive literature search
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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Click here to enter text.
6. Briefly describe how residents will participate in the education of patients, families, students,
residents, and other health professionals. [PR IV.A.5.c).(8)] (Limit response to 400 words)
Click here to enter text.
Interpersonal and Communication Skills
1. Briefly describe one learning activity in which residents demonstrate interpersonal and
communication skills that result in the effective exchange of information and collaboration with
patients, their families, and health professionals. [PR IV.A.5.d)] (Limit response to 400 words)
Click here to enter text.
2. Briefly describe one learning activity in which residents develop competence in communicating
effectively with patients and families across a broad range of socioeconomic and cultural
backgrounds, and with physicians, other health professionals, and health related agencies. [PR
IV.A.5.d).(1)-(2)] (Limit response to 400 words)
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3. Briefly describe one learning activity in which residents develop their skills and habits to work
effectively as members or leaders of a health care team or other professional group. In the
example, identify the members of the team, responsibilities of the team members, and how team
members communicate to accomplish responsibilities. [PR IV.A.5.d).(3)] (Limit response to 400
words)
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4. Briefly describe how residents will be provided with opportunities to act in a consultative role to
other physicians and health professionals. [PR IV.A.5.d).(4)] (Limit response to 400 words)
Click here to enter text.
5. Briefly describe how residents will be provided with opportunities to maintain comprehensive,
timely, and legible medical records, if applicable. [PR IV.A.5.d).(5)] (Limit response to 400 words)
Click here to enter text.
Professionalism
Briefly describe the learning activity(ies), other than lecture, by which residents demonstrate a
commitment to carrying out professional responsibilities and an adherence to ethical principles,
including: compassion, integrity, and respect for others; responsiveness to patient needs that
supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society,
and the profession; and sensitivity and responsiveness to a diverse patient population, including
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. [PR IV.A.5.e).(1)-(5)]
(Limit response to 400 words)
Click here to enter text.
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 9/2015
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Systems-based Practice
1. Briefly describe the learning activity(ies) through which residents demonstrate an awareness of and
responsiveness to the larger context and system of health care, as well as the ability to call
effectively on other resources in the system to provide optimal health care. [PR IV.A.5.f)] (Limit
response to 400 words)
Click here to enter text.
2. Briefly describe the learning activity(ies) through which residents achieve competence in the
elements of systems-based practice: working effectively in various health care delivery settings and
systems, coordinating patient care within the health care system; incorporating considerations of
cost-containment and risk-benefit analysis in patient care; advocating for quality patient care and
optimal patient care systems; and working in interprofessional teams to enhance patient safety and
care quality. [PR IV.A.5.f).(1)-(5)] (Limit response to 400 words)
Click here to enter text.
3. Briefly describe an activity that fulfills the requirement for experiential learning in identifying system
errors and implementing potential systems solutions. [PR IV.A.5.f).(6)] (Limit response to 400
words)
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NIGHT FLOAT
How many weeks of night float will residents be assigned in each year of the program? [PR VI.G.6.a)b)]
URO-1
#
URO-2
#
URO-3
#
URO-4
#
INSTITUTIONAL DATA
Provide the following data for all participating sites listed in the Accreditation Data System (ADS) for the
most recent academic year.
General Urology
Transurethral
TRUS/prostate biopsy
Scrotal/inguinal surgery
Urodynamics (general urology)
Ultrasound (general urology)
Other (general urology)
Endourology/Stone Disease
Site #1
#
#
#
#
#
#
#
#
Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Site #2
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Site #3
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Site #4
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Shock wave lithotripsy
Ureteroscopy
Percutaneous
Percutaneous - kidney
Other (endourology/stone disease)
Other - kidney (endourology/stone disease)
Reconstructive Surgery
Male - penile/incontinence
Male - urethra
Female
Other reconstructive surgery - fistula
Other reconstructive surgery - kidney
Other reconstructive surgery - trauma
Other reconstructive surgery - ureter
Intestinal diversion
Other (reconstructive surgery)
Oncology
Pelvic - bladder
Pelvic - prostate
Pelvic - other
Retroperitoneal - RPLND
Retroperitoneal - kidney
Retroperitoneal - adrenal
Retroperitoneal - other
Other (oncology)
Pediatrics
Minor - endoscopic
Minor - hydrocele/hernia
Minor - orchiopexy
Minor - other
Major - kidney
Major - hypospadias
Major - ureter
Major - other
Radiologic
Fluoroscopy
Ultrasound (radiologic)
Urodynamics (radiologic)
Other - radiologic
Cystoscopy
Cystoscopy
Non-TRUS Biopsy Ultrasound Procedures
Scrotal (ultrasound)
Renal (ultrasound)
Pelvic (ultrasound)
Site #1
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Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Site #2
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Prostate (ultrasound)
Penile (ultrasound)
Site #1
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Urology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Site #2
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Site #3
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Site #4
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Updated 9/2015
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