AKRON GENERAL
MEDICAL CENTER
UROLOGY RESIDENCY
MANUAL
RAY A. BOLOGNA, MD, MBA
RESIDENCY PROGRAM DIRECTOR
KIMBERLY SLOAN STAKLEFF, PhD
RESIDENCY PROGRAM COORDINATOR
Rev. 5/5/2014, 1700
Akron General Medical Center
Urology Residency Manual
AGMC/NEOMED Department of Urology
Residency Manual Receipt
I, the undersigned, acknowledge that I can access the AGMC/NEOMED Department of Urology Residency
Manual at any time using the following web link:
http://www.neomed.edu/academics/medicine/departments/urology/neomed-affiliated-urology-residencyprogram/manual.
I understand that it is my responsibility to read and familiarize myself with the information in this manual. I
agree to abide by the policies and procedures of the NEOMED-affiliated Urology Residency Program as a
condition of my employment.
I understand that this manual is presented for informational purposes only and can be changed at any time
by the AGMC/NEOMED Department of Urology, with or without notice.
________________________________________
Resident Signature
__________________
Date
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Table of Contents
MISSION ........................................................................................................................................ 5
GOALS AND OBJECTIVES OF THE RESIDENCY PROGRAM .............................................. 5
ACGME CORE COMPETENCIES ............................................................................................... 6
GOALS AND OBJECTIVES FOR CORE COMPETENCIES...................................................... 9
RESIDENT EXPECTATIONS AT ADULT HOSPITALS ......................................................... 10
CRITERIA FOR SELECTION, EVALUATION, PROMOTION, AND DISMISSAL OF
RESIDENTS ................................................................................................................................. 12
RESIDENT RESIGNATIONS/TRANSFER RESIDENTS ......................................................... 13
GOALS AND OBJECTIVES FOR PGY-2 RESIDENT .............................................................. 14
JOB DESCRIPTION PGY-2 RESIDENT .................................................................................... 16
GOALS AND OBJECTIVES FOR PGY – 3 RESIDENT ........................................................... 17
JOB DESCRIPTION FOR PGY-3 RESIDENT ........................................................................... 19
GOALS AND OBJECTIVES FOR PGY – 4 RESIDENT ........................................................... 20
GOALS AND OBJECTIVES FOR PGY – 4 RESIDENT – ADVANCED ROBOTICS AND
LAPAROSCOPIC SURGERY ROTATION (YOUNGSTOWN) ............................................... 22
GOALS AND OBJECTIVES FOR PGY-4 RESIDENT- FEMALE PELVIC MEDICINE AND
RECONSTRUCTIVE SURGERY ............................................................................................... 24
GOALS AND OBJECTIVES FOR PGY-4 RESIDENT- PEDIATRIC ROTATION ................. 26
JOB DESCRIPTION FOR PGY-4 RESIDENT ........................................................................... 28
GOALS AND OBJECTIVES FOR PGY – 5 RESIDENT ........................................................... 29
JOB DESCRIPTION FOR PGY- 5 RESIDENT .......................................................................... 31
POLICY ON RESIDENCY WORK HOURS .............................................................................. 32
MONITORING WORK HOURS ................................................................................................. 33
MOONLIGHTING........................................................................................................................ 34
CROSS COVERAGE ................................................................................................................... 34
HANDOFF/SIGN-OUT POLICY................................................................................................. 34
FACULTY JOB DESCRIPTION ................................................................................................. 36
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MENTORING PROGRAM .......................................................................................................... 37
RESIDENT SUPERVISION ........................................................................................................ 38
CLINIC DESCRIPTIONS ............................................................................................................ 40
CONFERENCES .......................................................................................................................... 42
CONFERENCE DESCRIPTIONS ............................................................................................... 42
RESEARCH.................................................................................................................................. 43
MEDICAL STUDENT ROTATIONS .......................................................................................... 44
VACATION AND CONFERENCE TIME .................................................................................. 46
EDUCATIONAL ALLOWANCE ................................................................................................ 47
WEGRYN AWARD ..................................................................................................................... 48
RESIDENCY OFFICE.................................................................................................................. 49
RESIDENCY DIRECTOR RESIDENT EVALUATION FORM (SEMI-ANNUAL) ................. 50
NURSING & OR RESIDENT EVALUATION FORM (SEMI-ANNUAL) ................................ 51
CLINIC PATIENT EVALUATION FORM (RANDOM) ........................................................... 52
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MISSION
Our mission is to graduate compassionate, competent, and talented urologist. Urologists that are
prepared to care for patients, be lifelong learners and educators to their patients and peers.
GOALS AND OBJECTIVES OF THE RESIDENCY PROGRAM
The Department of Urology at Akron General Medical Center (AGMC) sponsors a fully
accredited urology residency program. This residency utilizes three teaching hospitals in Akron,
OH: Akron General Medical Center, Akron City Hospital (Summa), and Akron Children’s
Hospital (CHMC). The Graduate Medical Education Committees at both adult institutions
(AGMC and Summa) oversee the residency.
The mission of the urology residency program is to train qualified and board-certified urologists
for clinical practice. Mastery of the six core competencies (page 6), as designated by the
Accreditation Council for Graduate Medical Education (ACGME), forms the blueprint for this
community-based training. The wide variety of clinical material under the direction and
supervision of the faculty provides the environment for this post-graduate education. This is
supported by an extensive core curriculum as well as a comprehensive conference schedule.
Participation in research as well as preparing presentations for regional and national meetings are
also integral parts of this educational endeavor.
This residency receives the support of Northeast Ohio Medical University (NEOMED; formerly
NEOUCOM), as well as the financial and educational support of the three participating
institutions. These institutions have a long and illustrious history in graduate medical education.
The urology residency program offers two PGY-1 positions in the residency program, which is
an affiliated residency program of NEOMED. Training encompasses the entire scope of urology,
including urologic oncology, male infertility, endourology, minimally invasive surgery, and
female urology and incontinence. Rotations also include the opportunity to perform urodynamic
testing and to do either clinical or basic science research. The pediatric experience is extensive
and is included in rotations during the PGY-2 and PGY-4 years. There is a strong exposure to
reconstructive urology, neurogenic bladder, in utero diagnosis of genitourinary (GU) anomalies,
inguinal anatomy and pathology, and all forms of urologic imaging.
The program consists of one pre-urology year in general surgery and surgical intensive
care/vascular surgery at AGMC and Summa. The subsequent four years consist of one month
training in nephrology and training in adult and pediatric urology. The program fulfills the
American Board of Urology requirements for five years of post-graduate training required for
board certification.
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ACGME CORE COMPETENCIES
From the ACGME Program Requirements in Graduate Medical Education in Urology, effective
July 1, 2013:
The program must integrate the following ACGME competencies into the curriculum:
a)
Patient Care and Procedural Skills
Residents must be able to provide patient care that is compassionate, appropriate,
and effective for the treatment of health problems and the promotion of health.
Residents must be able to competently perform all medical diagnostic and surgical
procedures considered essential for the area of practice.
Residents:
 must demonstrate competence in providing direct patient care with
increasing levels of responsibility in patient management as they advance
through the program;
 must, under supervision, demonstrate competence in providing total care
of the patient, including initial evaluation, establishment of diagnosis,
selection of appropriate therapy, providing that therapy, and management
of complications;
 must demonstrate competence in providing continuity of patient care
through preoperative and postoperative clinics and inpatient contact.
When residents participate in preoperative and postoperative care in a
clinic or private office setting, the program director must ensure that the
resident functions with an appropriate degree of responsibility under
supervision; and
 must be given responsibility based upon the individual resident’s
knowledge, problem-solving ability, manual skills, experience, and the
severity and the complexity of each patient’s status.
 must demonstrate competence in the following core techniques:
o endo-urology;
o minimally-invasive intra-abdominal and pelvic surgical techniques
including laparoscopy and robotics;
o major flank and pelvic surgery;
o perineal and genital surgery;
o urologic imaging including fluoroscopy, interventional radiology,
and ultrasound; and,
o microsurgery.
b)
Medical Knowledge
Residents must demonstrate knowledge of established and evolving biomedical,
clinical, epidemiological and social-behavioral sciences, as well as the application
of this knowledge to patient care. Residents:
 must demonstrate knowledge of the following curricular topics:
o bioethics;
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o
o
o
o
o
o
o
o
o
o
c)
radiation safety;
biostatistics;
epidemiology;
geriatrics;
infectious disease;
renovascular disease;
renal transplantation;
trauma;
plastic surgery; and,
medical oncology.
Practice-based Learning and Improvement
Residents must 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.
Residents are expected to develop skills and habits to be able to meet the
following goals:
 identify strengths, deficiencies, and limits in one’s knowledge and
expertise;
 set learning and improvement goals;
 identify and perform appropriate learning activities;
 systematically analyze practice using quality improvement methods, and
implement changes with the goal of practice improvement;
 incorporate formative evaluation feedback into daily practice;
 locate, appraise, and assimilate evidence from scientific studies related to
their patients’ health problems;
 use information technology to optimize learning; and,
 participate in the education of patients, families, students, residents and
other health professionals.
d)
Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills that result in
the effective exchange of information and collaboration with patients, their
families, and health professionals.
Residents are expected to:
 communicate effectively with patients, families, and the public, as
appropriate, across a broad range of socioeconomic and cultural
backgrounds;
 communicate effectively with physicians, other health professionals, and
health related agencies;
 work effectively as a member or leader of a health care team or other
professional group;
 act in a consultative role to other physicians and health professionals; and,
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
e)
maintain comprehensive, timely, and legible medical records, if
applicable.
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities and an adherence to ethical principles.
Residents are expected to demonstrate:
 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
but not limited to diversity in gender, age, culture, race, religion,
disabilities, and sexual orientation.
f)
Systems-based Practice
Residents must 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.
Residents are expected to:
 work effectively in various health care delivery settings and systems
relevant to their clinical specialty;
 coordinate patient care within the health care system relevant to their
clinical specialty;
 incorporate considerations of cost awareness and risk-benefit analysis in
patient and/or population-care as appropriate;
 advocate for quality patient care and optimal patient care systems;
 work in interprofessional teams to enhance patient safety and improve
patient care quality; and,
 participate in identifying system errors and implementing potential
systems solutions.
The urology residency program utilizes the following methods to assess the residents’
performance in the six (6) core competencies listed above:
Patient Care:
-
Faculty Evaluation of Resident Performance
Semi-Annual Evaluation with Residency Director
Patient Evaluations of Residents (Clinic)
Wednesday Conference/Journal Club Participation
Nursing Staff Evaluation of Resident Performance
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Medical Knowledge:
- Faculty Evaluation of Resident Performance
- Semi-Annual Evaluation with Residency Director
- In-service Examination
- Wednesday Conference/Journal Club Participation
- Weekly Participation in Online Quizzes
Practice-based Learning:
- Faculty Evaluation of Resident Performance
- Semi-Annual Evaluation with Residency Director
- Participation in Research Projects
- Wednesday Conference/Journal Clubs Participation
- Medical Student Evaluations of the Residents
Interpersonal Skills/Communication:
- Faculty Evaluation of Resident Performance
- Nursing Staff Evaluation of Resident Performance
- Semi-Annual Evaluation with Residency Director
- Patient Evaluations of Residents (Pediatric Clinic)
- Wednesday Conference/Journal Club Participation
Professionalism:
-
Faculty Evaluation of Resident Performance
Nursing Staff Evaluation of Resident Performance
Semi-Annual Evaluation with Residency Director
Patient Evaluations of Residents (Pediatric Clinic)
Completion of Institutional Requirements (Compliance, Medical Records,
etc.)
Systems-based Practice:
- Faculty Evaluation of Resident Performance
- Nursing Staff Evaluation of Resident Performance
- Semi-Annual Evaluation with Residency Director
- Participation on Hospital/Medical School Committees
GOALS AND OBJECTIVES FOR CORE COMPETENCIES
The ACGME and American Board of Urology have developed milestones for residents to
achieve throughout residency training. Milestones have been created for each of the core
competencies. Please refer to the ACGME website for a complete description of the milestones.
Please note that your milestone achievement may not correspond with your level of training.
The Clinical Competency Committee will determine whether your individual progress warrants
advancement to the next level of training or graduation.
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RESIDENT EXPECTATIONS AT ADULT HOSPITALS

Morning rounds must be completed prior to the start of cases.

The patient list should be reviewed with the designated attending each day either at the
first case of the day or prior to 9am.

New consults and admissions from 8am to 5pm can be discussed with the designated
rounding attending or the consulted physician.

The decision for a discharge from the hospital should be made by 9am.

Home-going instructions need to be consistent with the attending physicians preference.
o Date of follow-up
o Activity
o Plan for drains or wound care
o Antibiotics
o Pain medication
o New medications
Operating Room

Cases will be assigned by the chief resident in a timely manner, providing the resident
with time to prepare for the case.

Each resident will have access to EHR so that the patient’s history can be reviewed prior
to the case.

The assigned resident will arrive prior to the start of the case and check that the H & P is
complete and the site is marked.

The attending and resident will discuss home-going instructions.

The attending and resident will discuss who will dictate the case.

At the completion of the case and paperwork, the resident will proceed to pre-surg to
assist with the next patient.
On-call

Consults must be communicated to the attending.

Consults must be put on the list.
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
Consults need to be signed out to the appropriate resident at that hospital.

If it is felt that someone may need to go to the operating room, appropriate pre-operative
steps must be taken:
o Consent
o NPO
o Labs/x-rays
o Schedule case
o Notify the attending and partner that maybe doing the case
o Communicate with the attending
 You can attempt to page us directly; however the answering services know
who is covering.
 An attending must be notified. If you cannot reach the consulted
attending, page Dr. Spear for ACH or Dr. Bologna for AGMC.

Communicating with the chief resident while on call is mandatory under the following
circumstances:
o House cases
o Foley placement/sp tube placement - junior residents can attempt coude catheter
followed by a wire and council tip catheter. If further instrumentation is needed,
the chief resident must be notified unless you are signed off for such procedures.
o Intra-operative consults
Floor calls

Patients in distress must be seen or the appropriate team called.

Urologic post-operative patients and patients known to the service with a urologic
problem, having catheter problems, or requiring catheter placement must be seen by the
urology resident.
Conference

The resident staff along with the assigned attending is responsible for the 7-8 am lecture.

Case presentations will be assigned by the chief resident.

The attending staff will maintain a list of “good” cases.

Weekly or monthly article review or walk rounds with Dr. Bologna, Dr. Spear, or other
assigned attending.
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CRITERIA FOR SELECTION, EVALUATION, PROMOTION, AND DISMISSAL OF
RESIDENTS
Criteria for Selection
All those interested in applying to the AGMC Urology Residency Program must do so through
ERAS. Application materials are due in early October each academic year.
An applicant should have a complete file before being considered. A complete file contains:
 Application
 Three Letters of Recommendation
 Medical Student Performance Evaluation (MSPE)
 Minimum USMLE Step 1 and 2 scores of 200 (or 2-digit equivalent score)
 Academic Transcript
 Curriculum Vitae
 Personal Statement
All applicants must be from accredited medical schools and must have graduated within three
years prior to start date.
In addition to fulfilling the criteria listed above, international graduates must have a valid
ECFMG certificate/J-1 Visa.
Our program participates in the American Urological Association (AUA) Residency Matching
Program for Urology and the National Residency Matching Program (NRMP). All those
interested in applying to our program should register with these matching programs.
Resident Evaluation
At the beginning of each academic year, the residents at each level are presented with job
descriptions for their residency levels. Each resident is also given a copy of the goals and
objectives for his/her specific residency level. Both the job description and the goals and
objectives are discussed with the resident at the beginning of the academic year by the residency
director.
The semi-annual evaluation by the residency director takes place in December and June. The
resident is evaluated on the basis of faculty evaluation forms in regards to his/her performance in
surgery and during patient interaction, as well as compliance with the core competencies. The
residency director reviews with the resident comments made by nursing and OR staff about
his/her performance, as well as random evaluations of resident performance by clinic patients
(evaluation templates on pages 44-45). This semi-annual review also includes a report on case
logs and all research activities. Finally, the resident’s strengths and weaknesses are discussed
with suggestions for improvement in the coming evaluation period.
During the December evaluation session, in-service scores are discussed with each resident.
Failure to achieve a 50th percentile rank on the Urology In-service Examination will mandate that
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the resident follow a study program as prescribed by the residency director. The report for the
semi-annual evaluation (template on page 43) will become part of the resident’s file and the
resident will be required to sign these reports.
Advancement of a resident to the next level of training is the responsibility of the residency
director. If the resident has received satisfactory evaluations, has progressed in scholarship and
professional growth, and has demonstrated progressive mastery of the six core competencies, the
resident will be advanced to the next level of training.
If a resident wishes to see his/her file, he/she should request permission from the program
director. The resident will be permitted to view their file under the supervision of the program
director or coordinator. No document may be removed from the file, nor will any copies made of
documents on file without express permission of the program director.
Suspension, Termination, or Failure to Renew Resident’s Contract
The urology residency program abides by the policies outlined in the AGMC House Officer
Manual.
USMLE Step 3
AGMC requires that all residents pass the USMLE Step 3 exam by the end of their PGY-2 year.
A PGY-3 contract will not be offered to any resident until he has successfully passed the USMLE
Step 3 exam.
The urology residency program requires that residents register for and take the Step 3 exam by
the end of their PGY-1 year. Residents are eligible to apply after they’ve completed 9 months of
residency training.
RESIDENT RESIGNATIONS/TRANSFER RESIDENTS
Any resident who is considering transferring to another urology residency program during the
urology portion of his training (PGY-2 through PGY-5) should contact the American Urological
Association and American Board of Urology to ensure no interruption in training. Please refer to
the American Urological Association website for urology resident contract information
(http://www.auanet.org/content/residency/program-vacancies.cfm). The American Board of
Urology also has requirements that a resident must abide by in order to sit for the Qualifying
Examination after completion of residency (http://www.abu.org/residencyRequirements.aspx).
The ACGME requires that the residency director provide verification of training and summative
performance evaluations for any residents transferring to another residency program prior to
completion (ACGME Program Requirements for Graduate Medical Education in Urology;
Requirement III.C.2). The transferring resident should provide the residency director with the
new program contact information as soon as possible so that documentation can be submitted in
a timely manner.
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GOALS AND OBJECTIVES FOR PGY-2 RESIDENT
The resident completing the first year of urologic training (PGY-2) should have the ability to:
Patient Care:
1. Perform accurate and thorough history and physical examinations on urology inpatients.
2. Assist on minor open surgical procedures.
3. Show competence in the use and assembly of all urologic endoscopic equipment.
Familiarity with this instrumentation is a necessity for the PGY-2 resident.
4. Evaluate Emergency Department consultations in cooperation with a more senior resident
or attending (also applies to Systems-based Practice competency).
5. Manage urology inpatients in pre- and post-operative care.
6. Evaluate patients in the ambulatory care clinics under the direct supervision of the chief
resident.
Medical Knowledge:
1. Demonstrate basic science and clinical knowledge: identify and discuss pathophysiology
of urologic disease, intelligently discuss diagnosis, evaluation and treatment of common
urologic disorders, apply knowledge to solve clinical dilemmas, understand rationale for
varied approaches to clinical problems.
2. Demonstrate up-to-date knowledge: seek new information in literature and cite when
appropriate, ask knowledgeable and well-informed questions.
3. Use knowledge and analytical thinking to address clinical questions.
Practice-Based Learning and Improvement:
1. Supervise and instruct medical students on basic urologic principles and common
urologic diseases.
2. Demonstrate progressive growth in those basic surgical and patient management skills
acquired in the pre-urology year.
3. Track and analyze practice to identify areas for improvement: use systematic approach
(chart or case analysis, surgical logs) to track own practice, compare own outcomes to
accepted guidelines and national or peer data, reflect on critical incidents to identify
strengths and weaknesses, monitor effects of practice changes and improvements.
4. Engage in ongoing learning: determine how learning deficits or weaknesses can be
addressed, seek feedback, do extra reading and surgical practice when needed, seek
information from literature, critically appraise research evidence for applicability to
patient care, use information technology to aid learning.
Interpersonal & Communication Skills:
1. Demonstrate responsibility for medical record keeping.
2. Relate to patients, faculty, fellow residents, medical students, and hospital staff in a
professional manner.
3. Work effectively with other members of the healthcare team.
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Professionalism:
1. Accept responsibility and follow through on tasks.
2. Practice within the scope of his/her abilities.
3. Respond to each patient’s unique characteristics and needs.
4. Demonstrate integrity and ethical behavior.
Systems-based Practice:
1. Initiate the workup of urologic problems in a systematic and cost-effective manner.
2. Work to promote patient safety: identify system causes of medical error, anticipate and
respond to patient care problems, adhere to surgical protocols that ensure patient safety,
accept input from patient care team.
3. Coordinate care with other health care providers.
4. Facilitate patient care in the larger healthcare community: understand different healthcare
delivery systems and medical practices, assure patient awareness of available care
options, make appropriate referrals, assist with arrangements and follow-up to ensure
appropriate care.
5. Recognize the importance of cultural diversity in formulating treatment plans and
assessing therapeutic outcomes.
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JOB DESCRIPTION PGY-2 RESIDENT
The PGY-2 resident in urology must have successfully completed a preliminary year as a general
surgery resident. This includes a rotation in the surgical intensive care unit (SICU). He/she is
qualified for clinic, Emergency Department, and floor duties under the supervision of more
senior residents or attending staff. The PGY-2 resident must show competence in all GU floor
procedures (catheter insertions, urethral dilatations, suprapubic tube insertions) before he/she can
perform such procedures without more senior supervision.
PGY-2 residents, under the supervision of PGY-3 residents, PGY-4 residents, chief residents or
teaching attending staff members, have the following primary responsibilities:
A.
B.
C.
D.
E.
F.
Admitting history and physicals on all urology in-patients.
Work rounds on all hospitalized urology patients and consultations.
Responding to Emergency Department consultations.
Performing uncomplicated endoscopic surgical procedures.
Assisting on minor urologic open surgical procedures.
Primary call responsibility as assigned by chief resident. (Refer to page 32 for the
Policy on Residency Work Hours.)
G. Evaluation and treatment of urology clinic patients.
H. Other duties as may be assigned by more senior residents.
I. Other duties as may be assigned by members of the attending staff.
J. Supervision of medical students.
K. Attendance at all educational conferences unless specifically dismissed by the
residency director or on vacation.
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GOALS AND OBJECTIVES FOR PGY – 3 RESIDENT
The resident completing the second year of urology training (PGY-3) should demonstrate the
ability to:
Patient Care:
1. Perform accurate and thorough history and physical examinations on urology in-patients.
2. Perform uncomplicated endoscopic surgical procedures and have an in-depth
understanding of the endoscopic instrumentation.
3. Assist on open surgical procedures.
4. Perform minor urologic surgical procedures.
5. Evaluate Emergency Department consultations and initiate appropriate work-up (also
applies to Systems-based Practice competency).
6. Evaluate in-patient consultations and convey findings to more senior residents or
attending staff in an accurate and organized fashion (also applies to Systems-based
Practice, Interpersonal & Communication Skills, and Professionalism competencies).
7. Manage urology in-patients in all phases of pre- and post-operative care.
8. Evaluate patients in the ambulatory care clinics (also applies to Systems-based Practice
competency).
Medical Knowledge:
1. Demonstrate basic science and clinical knowledge: identify and discuss pathophysiology
of urologic disease, intelligently discuss diagnosis, evaluation and treatment of common
urologic disorders, apply knowledge to solve clinical dilemmas, understand rationale for
varied approaches to clinical problems.
2. Demonstrate up-to-date knowledge: seek new information in literature and cite when
appropriate, ask knowledgeable and well-informed questions (also applies to Practicebased Learning and Improvement).
3. Use knowledge and analytical thinking to address clinical questions.
Practice-Based Learning and Improvement:
1. Supervise and instruct medical students on basic urological principles and common
urological diseases.
2. Demonstrate progressive growth in those basic surgical and patient management skills
acquired as a PGY-2.
3. Track and analyze practice to identify areas for improvement: use systematic approach
(chart or case analysis, surgical logs) to track own practice, compare own outcomes to
accepted guidelines and national or peer data, reflect on critical incidents to identify
strengths and weaknesses, monitor effects of practice changes and improvements.
4. Engage in ongoing learning: determine how learning deficits or weaknesses can be
addressed, seek feedback, do extra reading and surgical practice when needed, seek
information from literature, critically appraise research evidence for applicability to
patient care, use information technology to aid learning.
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Interpersonal & Communication Skills:
1. Demonstrate responsibility for medical record keeping.
2. Relate to patients, faculty, fellow residents, medical students, and hospital staff in a
professional manner.
3. Work effectively with other members of the healthcare team.
Professionalism:
1. Accept responsibility and follow through on tasks.
2. Practice within the scope of his/her abilities.
3. Respond to each patient’s unique characteristics and needs.
4. Demonstrate integrity and ethical behavior.
Systems-based Practice:
1. Initiate the workup of urologic problems in a systematic and cost-effective manner.
2. Work to promote patient safety: identify system causes of medical error; anticipate and
respond to patient care problems, adhere to surgical protocols that ensure patient safety,
accept input from patient care team.
3. Coordinate care with other health care providers.
4. Facilitate patient care in the larger healthcare community: understand different healthcare
delivery systems and medical practices, assure patient awareness of available care
options, make appropriate referrals, assist with arrangements and follow-up to ensure
appropriate care.
5. Recognize the importance of cultural diversity in formulating treatment plans and in
assessing therapeutic outcomes.
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JOB DESCRIPTION FOR PGY-3 RESIDENT
The PGY-3 resident in urology must have successfully completed the preliminary surgical year as
well as the first year of urologic training. This resident is now qualified for all clinic, Emergency
Department, and floor consultations as well as procedures in which competence has been shown.
PGY-3 residents, under the supervision of PGY-4 residents, chief residents or teaching attending
staff members, have the following primary responsibilities:
A. Admitting history and physicals on all urology in-patients.
B. Work rounds on all hospitalized urology patients and consultations.
C. Evaluation of in-patient consultations.
D. Responding to Emergency Department consultations.
E. Performing uncomplicated endoscopic surgical procedures.
F. Assisting on minor urologic open surgical procedures.
G. Primary call responsibility as assigned by chief resident. (Refer to page 32 for the
Policy on Residency Work Hours.)
H. Evaluation and treatment of urology clinic patients.
I. Other duties as may be assigned by more senior residents.
J. Other duties as may be assigned by members of the attending staff.
K. Supervision of medical students.
L. Attendance at all educational conferences unless specifically dismissed by the
residency director or on vacation.
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GOALS AND OBJECTIVES FOR PGY – 4 RESIDENT
The resident completing the third year of urologic training (PGY- 4) should demonstrate the
ability to:
Patient Care:
1. Perform accurate and thorough history and physical examinations on pediatric
urologic patients.
2. Evaluate in-patient pediatric urology consultations and initiate proper work-up (also
applies to Systems-based Practice competency).
3. Evaluate Emergency Department pediatric urology consultations and initiate proper
management of genitourinary problems. Special attention is given to the resident’s
evaluation of acute scrotal pain and swelling in the pediatric and adolescent patient (also
applies to Systems-based Practice competency).
4. Perform common minor pediatric urologic surgical procedures with supervision. The
resident must demonstrate a comprehensive understanding of inguinal anatomy (also
applies to Medical Knowledge competency).
6. Perform more complicated urologic procedures with attending or chief resident
assistance, and first-assist on complex surgical cases.
7. Evaluate and treat adult and pediatric patients in the ambulatory care setting.
o Spend one day per week in pediatric ambulatory setting to achieve competency in
evaluating:
o Voiding Dysfunction
o UTI
o Genital Anomalies
o Hematuria
o Spend one month on adult ambulatory rotation to achieve competency in
evaluating:
o Female Incontinence/Voiding Dysfunction
o Diseases of the Prostate
o Hematuria
o Erectile Dysfunction
o UTI
8. Gain surgical experience in pediatrics.
o Inguinal
o Flank
o Pelvic
o Endoscopic
o Genital/Urethral Reconstruction
Medical Knowledge:
1. Demonstrate basic science and clinical knowledge: identify and discuss pathophysiology
of urologic disease; intelligently discuss diagnosis, evaluation and treatment of common
urologic disorders; apply knowledge to solve clinical dilemmas; understand rationale for
varied approaches to clinical problems.
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Demonstrate up-to-date knowledge: seek new information in literature and cite when
appropriate; ask knowledgeable and well-informed questions.
3. Use knowledge and analytical thinking to address clinical questions.
2.
Practice-Based Learning and Improvement:
1. Supervise PGY-3 and residents rotating from other services.
2. Supervise and instruct medical students.
3. Complete a pediatrics paper.
4. Demonstrate competence in those surgical and management skills acquired as a PGY-3.
Interpersonal & Communication Skills:
1. Demonstrate responsibility for medical record keeping.
2. Relate to patients, faculty, fellow residents, medical students, and hospital staff in a
professional manner.
3. Work effectively with other members of the healthcare team.
Professionalism:
1. Accept responsibility and follow through on tasks.
2. Practice within the scope of his/her abilities.
3. Respond to each patient’s unique characteristics and needs.
4. Demonstrate integrity and ethical behavior.
Systems-based Practice:
1. Initiate the workup of urologic problems in a systematic and cost-effective manner.
2. Work to promote patient safety: identify system causes of medical error; anticipate and
respond to patient care problems; adhere to surgical protocols that ensure patient safety;
accept input from patient care team.
3. Coordinate care with other health care providers.
4. Facilitate patient care in the larger healthcare community: understand different healthcare
delivery systems and medical practices; assure patient awareness of available care
options; make appropriate referrals; assist with arrangements and follow-up to ensure
appropriate care.
5. Recognize the importance of cultural diversity in formulating treatment plans and in
assessing therapeutic outcomes, especially as it pertains to the pediatric patient and
family.
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GOALS AND OBJECTIVES FOR PGY – 4 RESIDENT – ADVANCED ROBOTICS AND
LAPAROSCOPIC SURGERY ROTATION (YOUNGSTOWN)
The resident completing their third year of urologic training (PGY-4) in addition to the general
goals and objectives the resident should demonstrate the ability to:
Patient Care:
1. Perform accurate and thorough history and physical examinations on urologic patients.
2. Evaluate in-patient urology consultations and initiate proper work-up (also applies to
Systems-based Practice competency).
3. Perform more complicated urologic procedures with a focus on laparoscopic surgery with
and without robotic assistance.
4. Perform complex laparoscopic procedures with attending physician as first assistant and
primary surgeon. The resident will progress through procedures by first performing basic
tasks. After mastering these tasks, he/she will advance to more complex tasks with the
ultimate goal of completing the entire procedure.
5. Gain surgical experience in general adult and pediatric urological surgery including a
focus on:
 percutaneous renal access
 complex, flexible ureteroscopic procedures
 scrotal / inguinal surgery
6. Perform daily rounds on post-operative patients and discuss patients with attending
physician.
7. Arrive for surgery / rounds at or before 6:30am on Monday. The resident will spend the
evening in the provided call quarters at St. Elizabeth's Health Center and see emergent
consultations during the evening. He / she will round the following morning, assist in
surgical procedures and be dismissed by the attending physician after cases are complete
to return to duties in Akron.
Medical Knowledge:
1. Demonstrate basic science and clinical knowledge: identify and discuss pathophysiology
of urologic disease; intelligently discuss diagnosis, evaluation and treatment of common
urologic disorders; apply knowledge to solve clinical dilemmas; understand rationale for
varied approaches to clinical problems.
2. Demonstrate up-to-date knowledge: seek new information in literature and cite when
appropriate; ask knowledgeable and well-informed questions.
3. Use knowledge and analytical thinking to address clinical questions.
Practice-Based Learning and Improvement:
1. Supervise PGY-3 and residents rotating from other services.
2. Supervise and instruct medical students.
3. Assist in the development and possible completion of a robotic/laparoscopic paper.
4. Demonstrate competence in those surgical and management skills acquired as a PGY-3.
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Interpersonal & Communication Skills:
1. Demonstrate responsibility for medical record keeping.
2. Relate to patients, faculty, fellow residents, medical students, and hospital staff in a
professional manner.
3. Work effectively with other members of the healthcare team.
Professionalism:
1. Accept responsibility and follow through on tasks.
2. Practice within the scope of his/her abilities.
3. Respond to each patient’s unique characteristics and needs.
4. Demonstrate integrity and ethical behavior.
Systems-based Practice:
1. Initiate the workup of urologic problems in a systematic and cost-effective manner.
2. Work to promote patient safety: identify system causes of medical error; anticipate and
respond to patient care problems; adhere to surgical protocols that ensure patient safety;
accept input from patient care team.
3. Coordinate care with other health care providers.
4. Facilitate patient care in the larger healthcare community: understand different healthcare
delivery systems and medical practices; assure patient awareness of available care
options; make appropriate referrals; assist with arrangements and follow-up to ensure
appropriate care.
5. Recognize the importance of cultural diversity in formulating treatment plans and in
assessing therapeutic outcomes, especially as it pertains to the pediatric patient and
family.
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GOALS AND OBJECTIVES FOR PGY-4 RESIDENT- FEMALE PELVIC MEDICINE
AND RECONSTRUCTIVE SURGERY
The resident completing their third year of urologic training (PGY-4) in addition to the general
goals and objectives the resident should demonstrate the ability to:
Patient Care:
1. Perform and accurate history and physical exam for including a general pelvic floor
evaluation.
2. Is able to discuss and manage treatment options for urinary incontinence and overactive
bladder, including mid-urethral slings and InterStim therapy.
3. Is able to counsel patients and understand basic treatment options for anal incontinence
and defecatory dysfunction and treatment.
4. Diagnose, evaluate council, understand the treatment options, and perform conservative
and surgical treatment options for pelvic organ prolapse including vaginal and abdominal
approaches.
5. Diagnose, evaluate, council, understand the treatment options, and perform surgical
options for urogenital fistulas and urethral diverticulum.
6. Diagnose, evaluate, council, and understand the treatment options for Painful Bladder
Syndrome.
7. Diagnose, evaluate, council, understand the treatment options, and treat urinary tract
infections.
Medical Knowledge:
1. Resident will have a good understanding of the following:
a. Pelvic floor anatomy and physiology.
b. Urinary incontinence and overactive bladder treatments.
c. Anal incontinence and defecatory dysfunction treatment.
d. Pelvic organ prolapse including staging and treatment options.
e. Urogenital fistulas and urethral diverticula including risk factors, treatment
options, and potential complications.
2. Resident will have a good understanding of painful bladder syndrome including diagnosis
and management.
3. Resident will have a good understanding of urinary tract infections including evaluation
and treatment options.
4. Resident will have a good understanding of neuro-urology including urodynamic testing,
terminology, management of autonomic dysreflexia, conservative and surgical
management of the neurogenic bladder.
Practice-based Learning and Improvement:
1. While on the Female Pelvic Medicine rotation the resident will be responsible for
presenting a urodynamic based lecture and an update on female pelvic medicine with
associated cases.
2. The resident will be required to attend urologic quality meetings with Dr. Bologna and
present a quality Interpersonal Communications Skills& Improvement :
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1. Resident will be expected to work well with other providers including urodynamic
technicians, physician extenders, and staff.
2. Resident will be expected to effectively communicate treatment options and surgical
consents with patients and their family.
3. based article for review at conference or journal club.
Interpersonal & Communication Skills:
1. Demonstrate responsibility for medical record keeping.
2. Relate to patients, faculty, fellow residents, medical students, and hospital staff in a
professional manner.
3. Work effectively with other members of the healthcare team.
Professionalism:
1. Accept responsibility and follow through on tasks.
2. Practice within the scope of his/her abilities.
3. Respond to each patient’s unique characteristics and needs.
4. Demonstrate integrity and ethical behavior.
System Based Practice:
1. Resident will be competent in using the computer system to obtain information and
communicate with patient and referring physician.
2. Resident will understand the health care economics of treatment options for female pelvic
medicine.
3. Resident will work to coordinate patient care within the health care system including
physical therapists, case managers, and social workers.
4. The resident will be required to maintain professionalism within the office with faculty,
staff, and patients. Since this is an office based rotation, increased emphasis will be on
staff interaction, billing, and coding.
5. Recognize the importance of cultural diversity in formulating treatment plans and in
assessing therapeutic outcomes, especially as it pertains to the pediatric patient and
family.
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GOALS AND OBJECTIVES FOR PGY-4 RESIDENT- PEDIATRIC ROTATION
The resident completing their third year of urologic training (PGY-4) in addition to the general
goals and objectives the resident should demonstrate the ability to:
Patient Care:
1. The resident will be able to gather information, order appropriate pre-operative/diagnostic
testing, and develop a differential diagnosis for pediatric urology patients.
2. The resident will be able to make appropriate clinical decisions based on patient
presentation and testing and understand the risks and benefits of different conservative
and surgical treatment options.
3. The resident will be able to identify and treat common intra- and post- operative
physiologic alterations and complications in infants and children.
4. The resident will be able to plan, create, and close basic surgical wounds in children.
5. The resident will be able to plan and perform basic endoscopy and laparoscopy in
children.
Medical Knowledge:
1. Resident will demonstrate an understanding of common pediatric diseases including
phimosis, hydronephrosis, undescended testis, stone disease, pediatric urologic cancers,
embryology, and neuro-urology.
2. Resident will demonstrate an understanding of related fields and their impact on pediatric
urology including nephrology and endocrinology.
Practice-based Learning and Improvement:
1. The resident will demonstrate self-assessment and acknowledge his or her limitations
during the pediatric rotation.
2. The resident will present pediatric clinical practice guidelines at the pediatric conference.
3. The resident will assist in organizing the monthly pediatric conference and other pediatric
educational events.
Interpersonal and Communication Skills:
1. The resident will effectively communicate with families and be able to perform informed
consent.
2. The resident will effectively interact with the child during patient encounters.
3. The resident will treat all members of the team with respect and will communicate all
consults and patient/family’s concerns with the attending staff.
4. The resident will be able to capably and consistently deliver complete, key, and timely
information organized in accordance with the established EMR protocols and standards.
Professionalism:
1. While on the pediatric rotation the resident will demonstrate integrity, altruism,
compassion, and individual responsibility to the team.
2. The resident will maintain patient confidentiality at all times.
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System-based Practice:
1. The resident works across the health delivery system for the benefit of children including
nurses, pharmacists, and social workers.
2. The resident understands the unique needs of children and their families and assists in
discharge planning.
3. The resident incorporates cost-benefit awareness and risk-benefit awareness when
discussing treatment options.
4. The resident will enhance patient safety by presenting a quality related article at the
pediatric journal club and transition care appropriately to the on-call resident.
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JOB DESCRIPTION FOR PGY-4 RESIDENT
The PGY-4 resident in urology will have completed the preliminary surgical year as well as two
years of urologic training. This would qualify the resident for all clinic, Emergency Department,
and floor duties at both the adult and pediatric hospitals. This resident also will be qualified for
urologic procedures of a more complicated nature including lithotripsy, radiographic procedures,
urodynamic procedures, and invasive endourology. All procedures must be in the presence of the
chief resident or attending staff unless clinical competence has been demonstrated and
documented.
PGY-4 residents, under the supervision of the chief residents or teaching attending staff
members, have the following primary responsibilities:
A. Admitting history and physicals on all urology in-patients.
B. Work rounds on all hospitalized urology patients and consultations.
C. Evaluation of in-patient consultations.
D. Responding to Emergency Department consultations.
E. Complex endoscopic surgical procedures.
F. Assisting on major urologic open surgical procedures.
G. Primary, supervisory, and Children’s call responsibility as assigned by chief resident.
(Refer to page 32 for the Policy on Residency Work Hours.)
H. Evaluation and treatment of urology clinic patients.
I. Other duties as may be assigned by more senior residents.
J. Other duties as may be assigned by members of the attending staff.
K. Supervision of PGY-3 urology and rotating residents from other services.
L. Supervision of medical students.
M. Care and treatment of pediatric urology patients and the pediatric urology clinic
(with pediatric teaching attendings).
N. Attendance at all educational conferences unless specifically dismissed by the
residency director or on vacation.
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GOALS AND OBJECTIVES FOR PGY – 5 RESIDENT
The resident completing the fourth year of urology training (PGY- 5) should demonstrate the
ability to:
Patient Care:
1. Perform advanced endoscopic procedures.
2. Perform major urologic open surgical procedures. Emphasis is placed on systematic and
methodical approach to all surgical procedures. The resident must show an in-depth
understanding of anatomy (also applies to Medical Knowledge competency).
3. Completely evaluate and manage in-patient urologic consultations (also applies to
Systems-based Practice competency).
4. Evaluate and direct all activity in the ambulatory care clinics. The resident must
demonstrate a systematic approach to patients in the ambulatory setting and demonstrate
an understanding of efficiency and economy of time with clinic patients (also applies to
Systems-based Practice competency).
Medical Knowledge:
1. Demonstrate basic science and clinical knowledge: identify and discuss pathophysiology
of urologic disease, intelligently discuss diagnosis, evaluation and treatment of common
urologic disorders, apply knowledge to solve clinical dilemmas, understand rationale for
varied approaches to clinical problems.
2. Demonstrate up-to-date knowledge: seek new information in literature and cite when
appropriate, ask knowledgeable and well-informed questions.
3. Use knowledge and analytical thinking to address clinical questions.
Practice-Based Learning and Improvement:
1. Evaluate history and physical examinations of junior residents for content and accuracy.
2. Supervise all residents during work rounds and conduct rounds in an efficient and
educational manner.
3. Demonstrate competence in those surgical and management skills acquired as a PGY-4.
Interpersonal & Communication Skills Demonstrate responsibility for medical record keeping.
1. Relate to patients, faculty, fellow residents, medical students, and hospital staff in a
professional manner.
2. Work effectively with other members of the healthcare team.
Professionalism:
1. Accept responsibility and follow through on tasks.
2. Practice within the scope of his/her abilities.
3. Respond to each patient’s unique characteristics and needs.
4. Demonstrate integrity and ethical behavior.
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Systems-based Practice:
1. Initiate the workup of urologic problems in a systematic and cost-effective manner.
2. Work to promote patient safety: identify system causes of medical error; anticipate and
respond to patient care problems, adhere to surgical protocols that ensure patient safety,
accept input from patient care team.
3. Coordinate care with other health care providers.
4. Facilitate patient care in the larger healthcare community: understand different healthcare
delivery systems and medical practices, assure patient awareness of available care
options, make appropriate referrals, assist with arrangements and follow-up to ensure
appropriate care.
5. Carry out administrative duties for the urology service to include:
a. On-call schedules
b. Vacation assignments
c. Conference planning
d. Journal club assignments
e. Surgical assignments
f. Curriculum development
6. Recognize the importance of cultural diversity in formulating treatment plans and in
assessing therapeutic outcomes.
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JOB DESCRIPTION FOR PGY- 5 RESIDENT
The PGY-5 resident, or chief resident, in urology will have completed all the preliminary
urologic training (3 years) as well as the preliminary surgical year. This resident will have
received a medical school teaching appointment (Instructor in Urology). As such, this resident
will serve at an attending level on work rounds, conferences, and in the outpatient clinics. The
chief resident must demonstrate current clinical competence in the performance of all urologic
floor procedures as well as more complex procedures that have been outlined in previous
urologic training years.
PGY-5 residents, or chief residents, under the supervision of the residency director, department
chairmen, and/or teaching attending staff members, have the following primary responsibilities:
A. Administrative duties for the urology service to include:
1. Monthly call schedule (with residency coordinator).
2. First approval of junior resident paid time off.
3. Junior resident service rotation (approved by residency director).
4. Primary resident dispute arbitration.
5. Enforcement of department policies for resident staff.
6. Organization/content of Journal Club (with teaching attending).
7. Assignments to residents for teaching conferences and grand rounds (with
teaching attending moderator).
8. Curriculum development (with Academic Committee).
B. Direct supervision of all urology residents.
C. Supervision of admissions, work rounds and all consultations.
D. Advanced endoscopic surgical procedures.
E. Performing major urologic open surgical procedures (with teaching
attending).
F. Supervisory and Children’s call responsibility.
G. Administration, care and supervision of urology clinic patients.
H. Other duties as may be assigned by the residency director.
I. Supervision of PGY-4 urology and rotating residents from other services.
J. Supervision of medical students.
K. Attendance at all educational conferences unless specifically dismissed by the
residency director or on vacation.
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POLICY ON RESIDENCY WORK HOURS
Resident Work Hours
The AGMC Urology Residency Program complies with the ACGME guidelines on resident work
hours. These guidelines are listed below:
1. Duty hours must be limited to 80 hours per week, averaged over a four-week period,
inclusive of all in-house call activities and all moonlighting.
2. Time spent in the hospital by residents on at-home call must count towards the 80-hour
maximum weekly hour limit. The frequency of at-home call is not subject to the everythird-night limitation, but must satisfy the requirement for one-day-in-seven free of duty,
when averaged over four weeks.
3. Residents must be scheduled for a minimum of one day free of duty every week (when
averaged over four weeks). At-home call cannot be assigned on these free days.
4. Intermediate-level residents [URO-1 and URO-2 or PGY-2 and PGY-3] should have 10
hours free of duty, and must have eight hours between scheduled duty periods. They must
have at least 14 hours free of duty after 24 hours of in-house duty.
5. Residents in the final years of education [URO-3 and URO-4 or PGY-4 and PGY-5]
must be prepared to enter the unsupervised practice of medicine and care for patients over
irregular or extended periods.
a. This preparation must occur within the context of the 80-hour, maximum duty
period length, and one-day-off-in seven standards. While it is desirable that
residents in their final years of education have eight hours free of duty between
scheduled duty periods, there may be circumstances [such as: required
continuity of care for a severely ill or unstable patient, or a complex patient
with whom the resident has been involved; events of exceptional educational
value; or, humanistic attention to the needs of a patient or family] when these
residents must stay on duty to care for their patients or return to the hospital with
fewer than eight hours free of duty.
b. Circumstances of return-to-hospital activities with fewer than eight hours away
from the hospital by residents in their final years of education must be monitored
by the residency director.
6. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours
of continuous duty in the hospital. Programs must encourage residents to use alertness
management strategies in the context of patient care responsibilities. Strategic napping,
especially after 16 hours of continuous duty and between the hours of 10:00 pm. and
8:00a.m., is strongly suggested.
a. It is essential for patient safety and resident education that effective transitions in
care occur. Residents may be allowed to remain on-site in order to accomplish
these tasks; however, this period of time must be no longer than an additional four
hours.
b. Residents must not be assigned additional clinical responsibilities after 24 hours
of continuous in-house duty.
c. In unusual circumstances, residents, on their own initiative, may remain beyond
their scheduled period of duty to continue to provide care to a single patient.
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d. Justifications for such extensions of duty are limited to reasons of required
continuity for a severely ill or unstable patient, academic importance of the events
transpiring, or humanistic attention to the needs of a patient or family.
 Under those circumstances, the resident must:
a. appropriately hand over the care of all other patients to the team
responsible for their continuing care; and,
b. document the reasons for remaining to care for the patient in
question and submit that documentation in every circumstance to
the residency director.
c. The residency director must review each submission of additional
service, and track both individual resident and program-wide
episodes of additional duty.
When monitoring work hours, the ACGME requires that averaging hours be done by individual
clinical rotation or by four-week blocks. Rolling averages are not permitted when monitoring
duty hours (ACGME e-Bulletin, April 2004).
MONITORING WORK HOURS
The standard workdays for AGMC urology residents are as follows:
Mon., Tues., Thurs., Fri.: 7am-5pm
Wed.: 6am-5pm
Sat: 7am-9am
Two residents (PGY 2-5) will be assigned each month to keep track of their hours (standard
workday and on-call). At the end of the month, the assigned residents will be notified to
complete a survey regarding work hours. Survey reports will be reviewed by the residency
coordinator and submitted to the program director if violations occur.
The residency director and residency coordinator prospectively review the call schedule on a
monthly basis to ensure compliance with the guidelines for on-call hours listed above.
It is the resident’s duty to report to the chief resident the in-house activity from the previous night
of call. The chief resident has the authority to dismiss the resident or modify that day’s duty
hours. All such actions must be reported to the residency coordinator for purposes of
documentation. Should there be a disagreement regarding early dismissal or modification of
hours, the residency director’s decision would be final.
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MOONLIGHTING
The general rules concerning moonlighting are covered in the Akron General Medical Center
House Officer Manual. Urology residents must comply with these rules completely without
exception.
In addition to these general rules, the Department of Urology has specific rules concerning the
residents and outside remunerative activities. In accordance with the requirement that
moonlighting must be approved by the residency director, it is the standing rule that
moonlighting is not permitted for any urology resident. In the rarest of circumstances, the
residency director may permit limited moonlighting.
CROSS COVERAGE
In the event that an unexpected absence for a resident occurs (pregnancy, illness, approved
personal absence), the policies of the ACGME still apply:
1. Residents must be provided with 1 day in 7 free from all educational and clinical
responsibilities, averaged over a four-week period, inclusive of call.
2. Duty hours must be limited to 80 hours per week, averaged over a four-week period,
inclusive of all in-house call activities.
3. No new patients may be accepted after 24 hours of continuous duty, except in outpatient
continuity clinics.
If the decreased complement of residents does not provide for adequate manpower, it is the
responsibility of the chief residents to contact the residency office and arrange coverage in
conjunction with the residency director and the residency coordinator. In keeping with
departmental policy, a strenuous night of call should result in that resident being sent home
early and the chief resident or excused resident must contact the residency office so that
appropriate documentation can be maintained.
HANDOFF/SIGN-OUT POLICY
The assigned resident to each respective hospital will cover their hospital until 5:00pm each
weekday and cover the weekends until morning rounds are finished.
The sign-out process begins with afternoon rounds when the junior and senior resident will both
participate in the process. When afternoon rounds are complete and all issues have been
addressed, it is the junior resident’s responsibility to contact the resident on-call for the night and
discuss all the patients at their respective hospital.
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After sign-out, the junior resident on-call becomes responsible to cover all consults and answer
questions regarding urology patients. The junior resident on-call has a senior resident on back-up
call who is always available to answer questions as well.
The following morning it is the responsibility of the junior resident on-call to contact the
residents covering each hospital to discuss any new patients or issues that arose during the night.
Weekend coverage works in the same fashion. The resident making morning rounds at each
hospital will sign-out to the junior resident on-call. The following morning, the junior resident
on-call will then contact the resident making morning rounds at each hospital and discuss any
issues and new patients to the service.
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FACULTY JOB DESCRIPTION
Qualifications
1. Board certified (or eligible) by the American Board of Urology. An eligible member
must become certified within three years of completion of residency or relinquish faculty
appointment.
2. Appointed in good standing to the staff of an institution participating in the program.
3. Requirements for faculty based at AGMC or Summa in addition to requirements of
hospital credentialing.
a. Attend one conference per month.
b. Attend one journal club per year.
c. Attend faculty meetings.
d. Assist resident in preparing for assigned didactic lecture.
e. Assist resident in scholarly activity (research, quality, or patient safety).
f. Attend one regional or national conference a year.
g. Examples: AUA, NCS, Ohio urologic, post-graduate day, visiting professor.
h. Complete resident evaluations twice a year for entire program.
i. Complete resident evaluations for your assigned monthly rotation.
j. Assist with completion of office based evaluations of residents in offices.
k. Participate in mentor program when asked.
Faculty who fail to meet the above requirements will no longer be considered teaching faculty.
They will be case log faculty. The residents will be permitted to cover teaching cases in the
operating room. However, the residents will not be responsible for seeing emergency room and
floor consults.
Faculty who fail to meet the above requirements will no longer be considered teaching faculty.
They will be case log faculty. The residents will be permitted to cover teaching cases in the
operating room. However, the residents will not be responsible for seeing emergency room and
floor consults.
Evaluation
Each faculty member will be evaluated by the entire resident staff on a yearly basis and the
composite information will be part of the faculty member’s file after discussion with the
residency director. As dictated by the ACGME, all faculty members must be evaluated on a
yearly basis.
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MENTORING PROGRAM
On November 13, 2008 the mentoring program was instituted for the Department of Urology in
anticipation of the upcoming seventh competency: surgical and technical skills. The faculty
members were all enlisted to participate in the mentoring program as a way of evaluating each
resident’s progress through the milestones of surgical competence.
The milestones were presented to the faculty and unanimously approved for each level of
surgical training. Achieving surgical competence for various cases is to be documented by the
surgery checklists that each resident is to present to the attending surgeon after a case. Resident
performance will be evaluated by the attending surgeon and this evaluation will be shared with
the residency director and the resident’s mentor. The mentor will be asked to meet with the
resident monthly and during that meeting a discussion of surgical progress is recommended as
well as the other elements of mentoring: the resident’s sense of accomplishment, his future plans,
expectations, performance evaluation in areas other than surgery, and any areas that the resident
finds troublesome.
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RESIDENT SUPERVISION
The faculty is responsible for supervision of all residents in the Department of Urology. The
residents are evaluated by the entire faculty and these written evaluations are part of the
residents’ permanent files. Performance is discussed with the residents formally at the semiannual review with the residency director. There is a clear structure for supervision in all areas
of training and both faculty and residents understand this structure. The structured supervision
also provides a clear line of communication that can proceed in a step-wise fashion up to the
residency director.
Ambulatory Care: The chief resident is the first line of supervision in the clinics. He assigns
patients to the junior residents and reviews their management. He also has his own patient
population. All surgery is cleared through the chief resident. There is always a faculty member
physically present in the clinics to aid in junior resident supervision or to offer advice to the chief
resident. Clinic sessions are not held without faculty supervision.
Direct Supervision: The faculty member is present in the clinic and will see the patient
directly with the resident.
Inpatient Care: Residents make daily work rounds prior to the surgical schedule and discuss their
management with the patients’ attending physicians. The chief resident serves as attending for
the house service with the local education directors acting as faculty support for these patients.
Although the residents are responsible for orders and progress notes, their actions are discussed
with the attending physician daily.
Direct and Indirect Supervision: Some faculty will round with the residents. Faculty are
always available by phone and can provide direct supervision if necessary. An average of
three faculty members is on call each night, weekend, and holiday.
Oversight Supervision: All consults and concerning changes in patient status are called
directly to the faculty member on consult or the faculty member on call. The faculty
member will review the patient’s care and provide feedback.
Surgery: The Department of Urology has as its strength an abundance of surgical cases that are
the subject matter of resident training. All consortium hospitals require the attending to be
present for all cases. Faculty supervision is mandatory during the critical part of cases. The
faculty member may be in the department but not physically in the room for the remaining part of
the cases. Consortium hospitals do not allow an attending to run multiple rooms, so direct
supervision is the rule in all cases.
Direct Supervision: All operative cases require direct supervision for the majority of the
case.
Indirect Supervision: Indirect supervision may take place in the event of an emergent or
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urgent need for urologic intervention prior to the faculty’s arrival or after the critical
component of a case.
As described in the goals and objectives and job descriptions for each level of residency, the
resident is supervised in a progressive manner as he learns various urologic procedures.
Competency proceeds in an orderly fashion starting with instrumentation and endoscopy and
progressing through minor surgery up to major surgical interventions. Competency at each level
is documented and must be demonstrated before the resident is allowed to progress to the next
level of training. This evaluation and documentation form is part of the resident’s permanent file
and is done by the faculty.
Call Schedule: The call schedule is structured so that a junior resident is always on call with a
senior resident. This structure is never varied. The junior resident has the responsibility of
discussing any questionable cases with the more senior resident on call. There is also an open
line of communication to the patient’s attending physician (or a member of his group) who is
always available for consultation in emergency and after hours cases.
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CLINIC DESCRIPTIONS
Adult Clinics
The urology clinics at both adult institutions (Summa and AGMC) have been privatized. This
has resulted in an improvement in the “clinic ambience” in that these outpatient facilities are run
in a fashion parallel to a private office. Patients’ appointments are more sensitive to the patients’
time. Efficiency has improved and the experience has provided a more accurate exposure to
“office” urology for the residents.
Radiology, laboratory and endoscopic facilities are in the office suite or in close proximity. One
clinic remains geographically on the hospital campus (Summa) while the other is a satellite
location (AGMC).
The outpatient clinics are the main, but not only, exposure to ambulatory evaluation and care for
the urology residents. Besides providing such exposure, the goal is to establish ambulatory
methods and efficiencies for each resident, thus preparing him/her for private practice. Focus is
on patient education, methodical and efficient evaluation and conscientious follow-up. Accurate
record keeping is also emphasized, as is legible handwriting.
The ambulatory care setting serves as an opportunity to achieve competency in systems-based
practice of urology. This is the first exposure of the residents to billing and coding practices.
Interaction with the billing secretary in each office is encouraged. Communication with referring
physicians is an important goal/objective of this experience.
The adult urology clinics are essentially the domain of the chief residents. A chief resident is
always present during clinic sessions and oversees the outpatient care provided to patients by the
junior resident staff. The chief resident participates on all decisions for surgery and discusses the
management plans for the remaining clinic patients.
An attending staff member is always in clinic. That attending will staff any surgery scheduled
from clinic.
The chief resident, as part of his/her own service in association with the attending who has
staffed the clinic and the junior resident, follows all patients admitted from the clinic.
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Pediatric Clinic
The residents participate in a privatized clinic at Akron Children’s Hospital. The pediatric
urology clinic day is Tuesday. Residents see patients independently, but a pediatric urology
attending is available for consultation. Radiology, endoscopy and laboratory facilities are
available within the hospital. The pediatric clinic also provides ambulatory training for pediatric
and family practice residents. This experience provides instruction on outpatient pediatric
urology practice with the major emphasis on:
a.
b.
c.
d.
Appropriate history and physical exam as part of a focused genitourinary work-up.
Parent education for the child’s condition.
Appropriate and cost-effective testing.
Accurate and thorough documentation in the office record.
The residents and attending pediatric urologists also see patients together on a preceptor model
on non-clinic days if surgery is not scheduled. The clinic provides a variety of parent education
materials. Emphasis is on communication with and instruction of parents and families.
The PGY-4 resident follows all clinic patients as inpatients and participates in the follow-up
visits to the ambulatory facility.
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CONFERENCES
Resident attendance at all conferences is mandatory. The only exceptions are vacations,
meetings, or emergent patient responsibility.
Attendance is recorded for both residents and faculty at all weekly Wednesday conferences and
monthly journal clubs. These records are part of the yearly review for faculty by the residency
director. A member of the teaching faculty must regularly attend Wednesday conferences and
journal clubs in order to maintain teaching status. Attendance is reviewed with each faculty
member at the yearly evaluation with the residency director.
CONFERENCE DESCRIPTIONS
Core Curriculum Conference is every Wednesday at 7am. Faculty members are required to
volunteer as moderators for topics of specific interest. The list of topics encompasses the entire
breadth of urology, as well as other pertinent topics including geriatrics, practice management,
medico-legal issues, and topics outlined in the ACGME list of core competencies. Residents are
assigned online quizzes to complete prior to conference each week.
Case Presentation and Radiology Conference is the primary teaching conference of the
residency program. This occurs during the 8:00 hour on the third Wednesday of the month. The
resident staff presents current or recent cases to the fellow residents and faculty. Discussion of
the appropriate work-up and management is the focus of this conference. All residents must
attend and all faculty members are strongly urged to attend. One or two attendings will be
assigned as faculty moderators for each scheduled conference to ensure some participation. A
short didactic presentation by a resident reviews the current literature of interesting or unusual
cases. Questions from the floor attempt to mimic oral board format. In addition, the residents
interpret imaging studies from current or recent cases.
M & M Conference is held monthly. The residents present all complications and/or deaths to
the general urology staff. If necessary the department chairs convey written action to the
attending physician involved.
Journal Club is held on the 3rd Monday of the month. Residents are assigned 5-10 articles, all
of which are open for discussion. Attendings rotate as faculty moderators of journal club.
Pediatric Radiology/Urology/Nephrology (RUN) Conference is held on the 1st Wednesday of
the month at Children’s Hospital. All cases from Children’s Hospital are presented to the entire
faculty of both urology and radiology. Nephrologists also attend. Residents are asked to read the
imaging studies; faculty provides discussion.
Pathology Conference is a half-hour session held monthly. A senior pathology resident reviews
pathology slides with the residents and attending faculty. The goal of the pathology conference is
to educate urology residents in the essentials of urologic pathology and to prepare graduating
residents for national board examinations. In addition, Dr. Ray Clarke, Chairman of Pathology at
Summa, is available for individual tutoring sessions on a case-by-case basis.
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RESEARCH
It is recognized by the Department of Urology that scholarly activity and investigation are an
integral part of the education of the urology resident. For this reason the Department of Urology
has designated a Director of Adult Urology Research and a Director of Pediatric Urology
Research. The major function of these two positions is to provide guidance and organization to
all research activities in which the residents participate. Dr. Raymond Bologna is the Director of
Adult Urology Research and Dr. Daniel McMahon is the Director of Pediatric Urology Research
for the urology residency program.
Kimberly Stakleff, PhD is the Urology Resident Coordinator for Akron General Medical Center
and provides most of the guidance to residents and medical students participating in research
studies. She attends weekly didactic conference and to generate ideas for future research and
discuss research in progress, abstract submission deadlines, etc. In addition, she attends journal
club to help residents and faculty members critically review articles from a research standpoint.
She is also available to provide didactic instruction on research design, methods, statistics, and
manuscript/presentation preparation.
Each resident is required to complete at least one urology project during his/her training in order
to be permitted to attend the AUA Annual Meeting during the PGY-4 year. Residents will be
encouraged to submit their research work for presentation at regional and national meetings.
Financial support is available for the attendance at such meetings should the research be
accepted.
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MEDICAL STUDENT ROTATIONS
M3 Rotations
The NEOMED Department of Urology offers a one- or two-week elective for M3 students during
their eight-week Surgery rotation. The M3 elective is offered on all three campuses
(Youngstown, Canton, and Akron). The goal of this rotation is to provide an introduction for the
student into the surgical subspecialty of urology and to acquaint the student with: 1) the scope of
urology as a surgical subspecialty including surgical, inpatient, emergency room and ambulatory
care exposure; 2) to offer an exposure to various diseases of the genitourinary tract, their
pathophysiology, evaluation and treatment; 3) to achieve basic understanding of various urologic
imaging techniques; 4) to review the anatomy and physiology of the genitourinary tract.
The chief resident in urology serves as the supervisor for this M3 rotation and, as such, is the
major evaluator of student performance. The department chairman also evaluates student
performance. There is no on-call requirement for this rotation.
M4 Rotations
The NEOMED Department of Urology offers a four-week elective to the M4 student. This
elective is geared toward those students showing a serious interest in pursuing a urologic
residency. This four-week elective is offered only on the Akron campus under the approval of
the residency director.
The goals of this elective are to: 1) increase the student’s understanding of the scope of urology.
Responsibility includes histories and physicals on in- and outpatients, ambulatory care
evaluation, and participation in surgical cases; 2) initiate the student into reading about specific
urologic diseases and problems; 3) to achieve a deeper understanding of the anatomy,
physiology, and pathophysiology of urologic disease.
Requirements of this M4 rotation include: 1) participation in the on-call schedule; 2) daily rounds
and duties as dictated by the chief resident; 3) surgical scrubbing; 4) participation in all GU
conferences and journal clubs; 5) a PowerPoint presentation during Wednesday Grand Rounds
on a focused urologic topic as directed by the chief resident or attending supervisor. The chief
residents are responsible for evaluating and communicating medical student performance to the
residency director.
For those students who anticipate applying to the residency program, this rotation will serve as an
“audition rotation.” A formal interview will not be offered to any rotating student. However, the
rotating students are welcome to return to the department at any time during the recruitment
season to participate in conference, journal club, visiting professor programs, etc.
All rotating students who apply to the residency program will spend at least one day with each
member of the recruitment committee (Dr. Bologna, Dr. Spear, and Dr. Nasrallah). An exit
interview with any of these three attendings will be scheduled with a review of the student’s
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ERAS application if available. The student’s performance throughout the rotation, as well as
input from attending faculty and residents, will be strongly considered during the ranking
process.
This elective must be approved by the residency director who, along with the chief resident,
provides the supervision and evaluation of the student. The student should contact Kimberly
Stakleff, Urology Residency Coordinator, at (330) 535-5173.
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VACATION AND CONFERENCE TIME
All residents are entitled to three weeks of vacation per AGMC policy. In addition to vacation,
residents are allowed conference time at the residency director’s discretion. Listed below are the
conferences budgeted by Medical Education (AGMC) for residents.
Conference
AUA Basic Science
CCF Preceptorships
AUA Annual Meeting
AUA North Central
Meeting
Permitted to attend
PGY 2
Rotating assignments
PGY 4 – must meet
research requirement in
order to attend
Any resident whose
abstract has been accepted
for presentation
Also, residents may attend the American Academy of Pediatrics Section on Urology Meeting
with funding from source(s) other than Medical Education or the Department of Urology.
Permission to attend any other conference must be obtained by the residency director.
Other Benefits for Residents
Urology residents are provided with several other benefits as part of their training.
1. Moving Loan – up to $2000 for PGY 1; must be repaid by end of 1st year through
payroll deduction ($40/pay = $1000; $80/pay = $2000)
2. Health Club Membership – free membership to on-site gym
3. Board Review - $1600 for PGY 5; to be used for AUA Review Course in Dallas
4. Education Allowance – see table on page 40
5. Campbell’s – residents can purchase Campbell’s at the end of the PGY-1 year.
Receipts are to be submitted to the coordinator for reimbursement.
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EDUCATIONAL ALLOWANCE
This table lists suggestions of what educational money can be used for on a yearly basis.
Educational money is to be used for books, software, palms, boards, certificates/licenses, and
conferences. All purchases must be approved by the residency director.
PGY-2 $950
*$35 fee for training certificate renewal
*USMLE Step 3 should be completed by end of PGY-2 year; fee is around $655.
PGY-3 $950 + Basic Sciences Conference
*$35 fee for training certificate renewal
PGY-4 $1100 + AUA Annual Meeting (if research requirement has been met)
*$35 fee for training certificate renewal
*If ACLS needs to be renewed for post-graduate requirements, the balance of PGY-4 educational
funds can be used to cover course expenses.
PGY-5 $1100 + $1600 for board review course (1 course only)
*Board registration fee is $1300 – use educational allowance to cover most of the fee.
*If Board Review falls after June 30, residents can only be reimbursed for expenses incurred
before graduation from residency, e.g., prepaid hotel, airfare, and/or ground transportation.
Medical Education has funds separate from the educational allowance to cover costs for the
following:
1. AUA In-service Exams – yearly
2. ACLS Course – PGY 1
3. AUA Update Series – yearly
4. AUA Dues/Journal of Urology – yearly
5. Surgical Loupes – PGY 2
6. AUA SASP
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WEGRYN AWARD
Mrs. Theresa E. Wegryn created the Dr. John F. Wegryn Urology Resident Award Fund in
September 2010 to provide financial assistance through a life enrichment grant to Urology
resident physicians participating in the five-year training program at Summa Health System.
The award memorializes Dr. “Jack” Wegryn, a respected and accomplished area urologist who
passed away in June 2010. He was a graduate of the urology residency program at Akron City
Hospital (enrolling in 1961). Dr. Jack was a Diplomat of the American Board of Urology, Asst.
Professor of Urology at NEOUCOM (now NEOMED), Chief of Urology Staff at St. Thomas
1973-1993 and Vice President of St. Thomas Medical Staff 1979-1993. He received Summa
Health System’s Physician Recognition Award in 1999. The first Dr. John F. Wegryn Urology
Resident Award(s) was made in 2011.
Awards will be made to support life enriching grants upon the recommendation of the Urology
Department Chair and System Vice President for Medical Education, in consultation with the
Urology Residency Director. These awards can be used to support the resident in areas such as
daycare, to provide funds for spousal travel to medical conferences and other special needs. Each
year, two $5000 awards or one $10,000 award will be given. Residents who receive an award
may reapply for the award after one year. No repayment by any awardee is required. However,
the award will be considered taxable income to the resident and reportable on IRS form 1099MISC. All urology residents (PGY-1 through PGY-5) are eligible for the award.
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RESIDENCY OFFICE
The residency office employs a full-time residency coordinator to assist the residency director
and urology residents. The coordinator is also available to assist other attending faculty with
matters pertaining to the residency program. Some of the duties performed by the coordinator
include:
 Assisting the residency director with implementation of institutional policies
(AGMC, Summa, Akron Children’s, NEOMED)
 Assisting the residency director with implementation of policies mandated by the
ACGME and AUA
 Developing with residency director and maintaining the appropriate
documentation for PIR and RRC visits
 Maintaining resident and alumni files/database
 Serving as liaison between medical education departments (AGMC, Summa,
Akron Children’s) and residency program
 Coordinating/scheduling departmental meetings and conferences
 Planning department special events, such as chiefs’ dinner party
 Assisting with recruitment by scheduling/organizing interviews, compiling
interview data
 Scheduling all medical student rotations
 Assisting chiefs with annual and on-call schedules
 Preparing applications for category 1 CME credit, collecting evaluations, and
maintaining CME records
 Coordinating journal clubs with pharmaceutical representatives
 Dispersing/compiling resident evaluations
 Handling monetary requests and residency budget
 Providing employment/residency training verification
 Serving as contact person for post-residency placement
 Assisting residents with coordination of research and maintaining appropriate
documentation
 Developing and maintaining department web pages at NEOMED, AGMC, and
Summa
 Serving as centralized contact for Youngstown, Canton, and Akron campuses.
Contact Information for Residency Office:
AGMC Urology Residency Program
320 West Exchange Street
Akron, OH 44302
Phone: 330-535-5173
Fax: 330-535-5174
Email: Kimberly.Stakleff@akrongeneral.org
Cell: 330-715-7904
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RESIDENCY DIRECTOR RESIDENT EVALUATION FORM (SEMI-ANNUAL)
Semi – Annual Residency Evaluation
Resident Name:
A. Performance Evaluation
B. Competency Evaluation
Patient Care –
Medical Knowledge –
Practice-based Learning –
Interpersonal Skills and Communication –
Professionalism –
6. Systems-based Practice –
1.
2.
3.
4.
5.
C. Summary Evaluation
Raymond Bologna, MD
Residency Director
Resident
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NURSING & OR RESIDENT EVALUATION FORM (SEMI-ANNUAL)
Resident:
Date of Evaluation:
Department:
Signature:
Although this survey will be part of the resident’s semiannual evaluation, your comments are strictly confidential.
Please return the form promptly to the residency office (fax: 330-543-8621).
Please score from 1-5; comments are appreciated for scores of 1 or 5.
I. Professionalism
1
2
3
4
Looks and acts
immature
5
Appearance and
behavior reflect
maturity and compassion
Comments:______________________________________________________________
II. Behavior
1
2
3
4
Temperamental;
impolite
5
Calm, in control;
kind to others
Comments:______________________________________________________________
III. Dependability
1
2
3
4
Slow to respond;
work is incomplete
5
Responds rapidly,
courteously;
does job completely
Comments:______________________________________________________________
IV. Interpersonal Skills
1
2
3
4
Confrontational,
sarcastic; hard to
get along
5
Pleasant, polite, respectful
Comments:______________________________________________________________
V. Handwriting
1
2
3
4
Illegible
5
Very clear
Comments:______________________________________________________________
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CLINIC PATIENT EVALUATION FORM (RANDOM)
PATIENT EVALUATION OF RESIDENT PHYSICIAN
Please circle the names of the physician(s) who participated in your care today:
Michael Gangel, MD
Odinaka Akunne, MD
Rhys Irvine, MD
Naveen Arora, MD
Date of your visit: ________
Joshua Nething, MD
Christopher Lohr, MD
Ryan Pastena, MD
Kalpit Patel, MD
Where did you visit: _________________________
Please checkmark your responses to the statements below.
Strongly
Disagree
1. My doctor made my care and well being a priority.
2. My doctor made my family and me feel comfortable
during my visit.
3. My doctor was respectful and considerate.
4. My doctor responded to my needs, feelings, or
wishes.
5. I clearly understood what my doctor explained to
me about my condition and/or treatment.
6. My doctor spent an adequate amount of time with
me.
7. My doctor was willing to answer questions and
provide explanations.
Please provide any additional feedback about your visit today.
Thank you for taking the time to complete this evaluation.
Please return this form to the front desk.
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Disagree
Not
Sure
Agree
Strongly
Agree