GOALS & OBJECTIVES DUKE UROLOGY RESIDENCY PROGRAM

Transcription

1 GOALS & OBJECTIVES DUKE UROLOGY RESIDENCY PROGRAM The Duke Urology program is a 4 year program which utilizes the format of 1 year of General Surgery and 4 years of Clinical Urology. In addition our residents are strongly encouraged to take advantage of an additional unaccredited year of research. The educational philosophy of the division of urology incorporates the intent to provide the highest quality of education in order to develop and maintain full competency in the field of urologic surgery for its resident physicians as well as paramedical personnel, visiting physicians and medical students. Our philosophy assures that every patient contact, emergence of new scientific data and interpersonal interaction is an opportunity to learn and improve the delivery of urological care and provide educational opportunities that will lead to the development of future leaders, both in the private practice and the academic setting. Our residency coordinator monitors conference attendance and offers assistance in tracking the residents operative experiences. Moreover, an adequate amount of dedicated office space has been allocated for our urology residents. In addition, our recent renovation has allowed for the establishment of additional urology resident space as well as a dedicated resident library. By structuring the parent institution with full-time geographic faculty and supplementing that experience with selected affiliated institutions, the additional goal of wide exposure to various practice patterns in order to prepare the residents for future practice outside a tertiary institution is achieved. An additional goal of providing residents with a sense of total patient responsibility (i.e. Continuity of care) is achieved through clinical experience, incorporating initial evaluation and care planning, operative experiences and post-operative care both in the inpatient and outpatient arenas with close attending surgeon input, supervision and follow up, augmented by a mentor system. Moreover, we have expanded our rotations which allow the resident to experience and compare different patient populations and health care delivery systems, full continuum of care including pre-operative evaluation, surgical intervention and post-operative follow-up. The residents experience complete continuity of care and manage patients under direct supervision through the entire outpatient and inpatient urologic experience during these clinical rotations. This program incorporates laboratory and clinical research during the pgy3 year with the philosophy that a year of research will promote life-long, critical examination and intelligent advancement of urologic care, regardless of the practice situation. In addition, the philosophy of the program includes the hope that we will be able to provide teachers for future generations without hampering the educational goals and training of those residents who do not choose a career in an academic environment. The overall goal is that graduating urologic residents have the ability to execute sound clinical decisions, diagnosis, treatment choices, and establish appropriate long-term

2 care with regard to current standards of practice, cost containment, individual patient needs and compassion. They will demonstrate competency in each of the 6 ACGME Competencies (patient care, medical knowledge, practice based learning and improvement, interpersonal and communication skills, professionalism and systems based practice) as pertinent to the specialty of urology. The specific goals and objectives of each resident assignment follow: PGY 1 AND PGY2 ROTATIONS ON GENERAL SURGERY The accredited urology residency begins in PGY 2 per ACGME. In the twelve months of PGY 1, mandatory rotations are: Surgical intensive care unit (beginning in For those starting in , they will spend one month in SICU during PGY 2 in ) Vascular surgery rotation at VA Medical Center, Durham Pediatric surgery General surgery at Duke and Durham Regional Hospital Thoracic Surgery Emergency Room The PGY 2 residents spend four months in General Surgery to gain exposure to SICU, pediatric surgery, and transplant surgery. This will be changing to only a month on transplant surgery and a month in SICU in , and just one month of transplant surgery beginning in The months no longer spent in General Surgery will become part of the PGY 2 Urology Consult/Pediatrics Rotation. The Urology Program has no Goals and Objectives for these General Surgery rotations since they are covered by the General Surgery Residency Program. PG2 CONSULT / PEDIATRIC UROLOGY ROTATIONS PGY2 urology residents are required to rotate on the consult and pediatric urology services for 4 months. Separate objectives have been developed to reflect the diverse nature of these two rotations. All of the urology attending staff members supervise the urology consult service providing expertise and clinical experience in the diagnosis and management of various urologic conditions. We need to add something about Peds Urology here

3 Goals Consult Rotation The educational goals for the consult rotation are for residents to develop skills in working with Urology physicians and colleagues from other services and contribute their expertise in urology to the multidisciplinary care of a patient. Objectives Consult: All attending staff members will supervise this rotation, provide expertise and clinical experience in all aspects of urologic training. By the end of this rotation residents will: Patient care 1. Demonstrate skills for urologic history taking, physical examination of urologic structures, recognition of associated illness, and formulation of tentative diagnoses and treatment options. 2. Select urologic diagnostic tests and procedures with regard to appropriateness, expected data, limitations, contraindications, and associated costs. Medical knowledge 1. Describe general management of patients in acute urinary retention. 2. Describe the appropriate work up of patient with hematuria 3. Describe specific management of patient with various urologic injuries. 4. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds. Interpersonal and communication skills 1. Present data succinctly in morning rounds. 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. 4. Work effectively with other members of the team, 5. Obtain appropriate informed consent 6. Write comprehensive medical records 7. Learn skills to facilitate effective consultation 8. Recognize situations in which particular respectfulness and sensitivity is necessary such as when taking sexual history, or working with patients with different sexual preferences, transgendered patients etc. Practice-based learning and improvement

4 1. Analyze complications encountered during consult rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of students and other healthcare professionals. 4. Access and critically appraise relevant surgical literature and apply to patients 5. Teach more junior residents and medical students Systems-based learning 1. Manage the urology consult patients in a multidisciplinary setting. 2. Understand the role of the members of the urology team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Identify sources of errors and near misses 4. Work at divisional level to decrease the risks of medical errors and near misses 5. Understand appropriate techniques of coding for urology consults and its impact on reimbursement Professionalism 1. Be sensitive to the issues unique to urology consult patients by gaining and understanding of social, emotional, and physical limitations when managing routine urologic problems. 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Participate in improving the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities Goals: Pediatrics The educational goal for the pediatric rotation which takes place during the second clinical year is for residents to develop skills in working with the unique diagnoses and presentations in children and to relate to children, their parents and their families. Objectives Pediatrics: Pediatric Faculty John Wiener, MD. Sherry Ross, MD Cynthia Camille, CPNP. [Pediatric Urology Nurse Practitioner] Joanne Tello, RN [Urotherapy/Urodynamics Specialist]

5 Patient care 1. Participate in the clinic evaluation and management including pre and postoperative care of pediatric urology patients as well as adults with congenital uropathies. 2. Participate in in-patient care of pediatric urology patients, including development confidence in writing orders on pediatric patients. 3. Participate in pediatric urology consultative services in the newborn nursery, neonatal ICU, pediatric ICU, pediatric wards, operating rooms, emergency department, and other locations where our services are requested. Provide short and long term management of the consult patients. 5. Participate in surgery on pediatric urology patient commiserate with your level of technical ability. 6. Obtain a proper and thorough history from a child and his/her family. 7. Conduct a proper and thorough physical examination on neonates, infants, and children. 8. Participate in conducting urodynamic studies on infants and children. 9. Display basic surgical techniques of tissue handling, suturing, knot tying pertinent to the care of infants and children Medical Knowledge 1. Recite fluid management/nutritional principles in pediatric patients. 2. Apply specific medication restrictions in pediatric patients. 4. Evaluate and manage children with neurogenic bladder, voiding dysfunction, and enuresis. 5. Describe appropriate timing for correction of congenital urology malformations. 7. Acquire a basic understanding of genitourinary embryology 8. Interpret sonograms, voiding cystourethrography, and nuclear renography 9. Acquire knowledge through: a. Independent reading b. Discussion in clinic, ward rounds, operating room, and at conferences. Interpersonal and Communication Skills 1. Synthesize and present data and formulate plan of care succinctly with faculty, nurses, and residents on morning and/or evening rounds. 2. Write comprehensive progress notes, admission orders, and consultation notes legibly, promptly, and succinctly 3. Perform discharge summaries and occasional operative and clinic notes accurately and succinctly. 4. Establish good doctor/patient, parent & family therapeutic relationships 5. Demonstrate understanding of establishing rapport with pediatric patients, parents and their families

6 6. Work effectively with all members of the team including nurses, secretaries, clinic staff, and or team. Practice-based Learning and Improvement 1. Review the patient s history, indications for surgery, and the steps of the surgical procedure of each patient before commencing each surgical day. 2. Learn and practice new surgical and endoscopic skills as it relates to reconstructive and pediatric urology and improve existing skills through selfdirected practice 3. Access and critically appraise relevant urologic literature and apply knowledge to patient care Systems-based learning 1. Identify sources of complications, errors, and near misses and present appropriate cases at morbidity and mortality conference. 2. Work at divisional level to decrease those risks 3. Manage pediatric urology patients in a multidisciplinary setting with other pediatric providers 4. Apply skills of working in a multidisciplinary team specifically to Spina bifida patients. 5. Recognize the role of the members of the pediatric urology team. Professionalism 1. Demonstrate conscientiousness and personal responsibility in being accountable for patients and their families 2. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 3. Display sensitivity to the issues unique to pediatric urology including those related to pregnancy, post-natal, early childhood, and adolescent disease and maldevelopment and the stresses these problems cause to parents and other family members. 5. Dress appropriately. 6. Interact with hospital staff, patients, and colleagues courteously. 7. Complete medical records on time 8. Attend conferences bedside rounds, clinic and surgical duties, answer pages, and complete other required responsibilities on time. 9. Be fair and timely in assignment of call schedule duties to fellow residents.

7 PGY-2 ASHEVILLE VAMC ROTATION: Residents rotate to the Asheville vamc for 4 months during their PGY4 year. The design of this rotation places emphasis on continuity of care. Residents see patients in an outpatient clinic setting initially, participate in the surgical management of the patient if indicated, and then follow these patients post-operative and non-operative course in the outpatient clinic as well. The residents are supervised by local faculty both in the clinical and surgical setting. Attending staff members, who supervise this service, provide expertise and clinical experience in all aspects of urologic training Dane Weil, M.D. Leonard Verges, M.D. Goal: The educational goal for the Asheville VAMC rotations which takes place during the PGY2 year is to appreciate the unique systems issues involved in caring for our Veterans population and to participate in urology experiences outside of large teaching hospital with greater direct interface with attendings without layers of housestaff Objectives Asheville VAMC Rotation: Patient Care 1. Describe the preoperative work up necessary to have a patient ready for urologic surgery. 2 Understand and describe post- operative routines for patient management. 3. Evaluate patients in the outpatient clinic-based setting for routine urologic conditions 4. Perform digital prostate examination 5. Perform cystoscopic procedures and prostate biopsy 6. Describe post-operative nutritional issues. 7. Outline the basic workup for routine urologic issues (hematuria lower urinary tract symptoms, erectile dysfunction, nephrolithiasis, elevated PSA). Medical Knowledge 1. Describe indications for routine endoscopic and open urologic procedures. 2. Describe basic surgical procedures such as circumcision, hydrocelectomy, prostate biopsy 3. Describe risk factors for development of benign and malignant urologic conditions 4. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds.

8 Interpersonal and Communication Skills 1. Present data succinctly in ward rounds. 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. 4. Work effectively with other members of the team 5. Perform safety time outs 6. Obtain appropriate informed consent 7. Complete accurate medical records 8. Learn skills to facilitate effective consultation. Particularly to this rotation, Residents will interact with established providers who completed their training many years ago. Practice-based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Access and critically appraise relevant surgical literature and apply to patients 4. Interact on the front line with experienced consulting physicians, as opposed to a primarily house officer-run services at Duke and the Durham VAMC 5. Develop self-paced studying agenda in this off-site rotation, along with interaction with co-resident. Systems-based Learning 1. Work effectively in an equal access healthcare system 2. Learn nuances of electronic medical record. 3. Recognize the role of all members of the Asheville VAMC urology team including, nursing staff members, referring doctors, and other surgical staff members. 4. Acquire basic understanding of pre operative approval process for undergoing endoscopic and basic urologic procedures. 5. Identify sources of errors and near misses 6. Work at institutional level to decrease the risks of medical errors and near misses 7. Understand the leadership role of the Veterans Hospital System in patient safety

9 Professionalism 1. Display sensitivity to the issues unique to the VAMC patients by gaining and understanding of social, emotional, and physical limitations unique to the veteran population 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities PGY-3 RESEARCH YEAR The entire 3 rd year is spent in scientific pursuit working one-on-one with a senior faculty member (mentor). Goals: The educational Goals are for the resident to experience and appreciate for the role of the physician scientist and participate in the generation and dissemination of new knowledge. Objectives Patient Care Recognize the multiple issues in urology which need greater elucidation and which include scholarly opportunities in basic translational and clinical research. Medical Knowledge 1. Apply basic biostatistical tools necessary for analysis of research data 2. Contrast the difference between parametric and non-parametric and when to use means and when to use medians 3. Describe and interpret a p-value 4. Describe and utilize odds ratios, hazard ratios, and confidence intervals 5. Compare the differences between linear and logistics regression 6. Describe time to event analyses 7. Outline the process of basic hypothesis testing 8. Describe what an IRB is and what is its role in medical research 9. Obtain IRB or IACUC clearance to perform the chosen research for the year 10. Acquire knowledge through: a. Independent reading

10 b. Lectures given by Dr. Freedland c. Hands-on use of statistical software under the mentorship of the primary research year mentor Interpersonal and Communication skills 1. Provide written report of proposed research in advance of starting the research year 2. Attend all monthly lab residents meeting to provide feedback to the speakers and learn about presentation skills 3. Present data twice during the year in the monthly lab residents meeting 4. Present data succinctly but yet cover the topic fully 5. Provide an oral end of the year presentation to the faculty regarding research performed during the year 6. Submit primary research articles in the peer-reviewed literature Practice-based learning and Improvement 1. Conduct literature search to evaluate prior research performed 2. Use this knowledge to shape the proposed research 3. Conduct appropriate interactions with experienced researchers to help shape research question 4. Stay abreast of the latest in the research literature that is directly pertinent to the research being performed that would require alterations in the research plan Systems-based Learning 1. Learn how to work effectively in a research laboratory 2. Learn nuances of medical research 3. Understand the role of medical research in shaping the current and future practice of medicine 4. Acquire basic understanding of the research method including hypothesis testing 5. Identify sources of errors in medical research and how to avoid them. Professionalism 1. Be sensitive to the issues unique to medical research by gaining and understanding of social, emotional, and physical limitations unique to medical research 2. Learn to interact with people of differing backgrounds and educations including career research assistants 3. Understand the ethical issues involved in research on human subjects or animals, and the regulations regarding their safety, 4. Identify potential conflicts of interest which can come about from various funding sources for research

11 5. Dress appropriately 6. Follow all regulatory rules regarding workplace safety 7. Interact with research staff and colleagues courteously. 8. Demonstrate conscientiousness and personal responsibility in being accountable for the research being performed 9. Participate in improving the research experience through thoughtful evaluation and input regarding the mentors, didactics, and collaborators 10. Be prompt at research record keeping including keeping an up-to-date research note book 11. Attend all required conferences and other required responsibilities PGY-4 DURHAM VAMC ROTATION: Residents rotate to the Durham VAMC for 4 months during their second clinical year of urology. The design of this rotation places emphasis on continuity of care. Residents see patients in an outpatient clinic setting initially, participate in the surgical management of the patient if indicated, and then follow these patients post-operative course in the outpatient clinic as well. The residents are supervised by duke urology faculty both in the clinical and surgical setting. Attending staff members, who supervise this service, provide expertise and clinical experience in all aspects of urologic training Craig Donatucci, MD Michael Ferrandino, MD Michael Andrews, MD Stephen Freedland, MD Cary Robertson, MD Philip Walther, MD Goals: The educational goals for the Durham VA Rotation are as follows: Objectives Durham VAMC Rotation: Patient Care 1. Perform adequate preoperative work up necessary to have a patient ready for urologic surgery. 2. Manage patients utilizing appropriated post- operative routines 3. Evaluate, diagnose and manage routine urologic conditions in an outpatient setting 4. Competently perform the prostate examination 5. Competently perform cystoscopic procedures and prostate biopy 6. Anticipate and manage post- operative nutritional issues.

12 7. Work up patients with minimal attending direction for routine urologic issues (hematuria lower urinary tract symptoms, erectile dysfunction, nephrolithiasis, elevated PSA). Medical Knowledge 1. Describe indications for routine endoscopic and open urologic procedures. 2. Describe basic surgical procedures such as circumcision, hydrocelectomy, prostate biopsy including management of common complications 3. Describe risk factors for development of benign and malignant urologic conditions as well as strategies which may mitigate these risks 4. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds. c. Self directed additional training, including surgical simulation and work in the Surgical Education Laboratory. Interpersonal and Communication skills 1. Present data succinctly in morning rounds. 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. 4. Display leadership of teams. 5. Perform safety time outs. 6. Obtain appropriate informed consent 7. Write comprehensive medical records 8. Learn skills to facilitate effective consultation Practice-based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of students and other healthcare professionals. 4. Access and critically appraise relevant surgical literature and apply to patients 5. Appropriately interact with consulting services Systems-based Learning 1. Learn how to work effectively in an equal access healthcare system 2. Master use of electronic medical record. 3. Understand the role of the members of the Durham VAMC urology team including, nursing staff members, referring doctors, and other surgical staff members. 4. Acquire basic understanding of pre operative approval process for undergoing endoscopic and basic urologic procedures.

13 5. Identify sources of errors and near misses 6. Work at institutional level to decrease the risks of medical errors and near misses Professionalism 1. Display sensitivity to the issues unique to the VAMC patients by gaining and understanding of social, emotional, and physical limitations unique to the veteran population 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities PGY4 CONSULT / AMBULATORY CARE PGY4 urology residents are required to rotate on the consult and ambulatory care urology services for 4 months. All of the urology attending staff members supervise the urology ambulatory care rotation providing expertise and clinical experience in the diagnosis and management of various urologic conditions These goals will be met by the resident rotating on a regular basis with all of the urologic faculty of duke university medical center in the outpatient arena, emergency ward, and inpatient consultation. All Urology faculty will be utilized to make best advantage of their common knowledge and their individual special interests and talents. Goals: The educational goals for the ambulatory care rotations which take place during the PG4 clinical year is to develop fine tuning of knowledge and skills, progressive confidence, and increasing independence: Objectives Ambulatory Care: Patient Care 1. Largely independently take the urology history, perofrm physical examination of urologic structures, recognize associated illness, and formulate of tentative diagnoses and treatment options. 2. Select urologic diagnostic tests and procedures with regard to appropriateness, expected data, limitations, contraindications, and associated costs. 3. With progressive independence perform skillfully: endoscopy, urethral manipulation, and retrograde diagnostic studies and unilateral stent placement.

14 4. Demonstrate consistency in necessary preoperative and postoperative outpatient management. Medical Knowledge 1. Manage patients with various urologic disorders including stone disease, sexual disorders, urologic cancer, urinary incontinence, urologic trauma. 2. Manage the appropriate work up of patient with hematuria 3. Select specific management of patient with various urologic injuries. 4. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds. c. Self assessment of proficiency and identification of an individualized plan of learning. Interpersonal and Communication Skills 1. Present data succinctly in morning rounds. 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. 4. Work effectively with and -lead other members of the team 5. Obtain appropriate informed consent 6. Write comprehensive medical records 7. Learn skills to facilitate effective consultation 8. Recognize situations in which particular respectfulness and sensitivity is necessary such as when taking sexual history, or working with patients with different sexual preferences, transgendered patients etc. Practice-based Learning and Improvement 1. Analyze complications encountered during consult rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of students and other healthcare professionals. 4. Access and critically appraise relevant surgical literature and apply to patients 5. Teach more junior residents and medical students 6. Represent the Urology Program/Division at Hospital and Health System Committees which affect patient care and residency education. Systems-based Learning 1. Manage the urology consult patients in a multidisciplinary setting. 2. Support the roles of the members of the urology team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Identify sources of errors and near misses

15 4. Work at divisional level, hospital and health system levels to decrease the risks of medical errors and near misses 5. Understand appropriate techniques of coding for urology consults and its impact on reimbursement of patients with a variety of payors Professionalism 1. Display sensitivity to the issues unique to urology consult patients by gaining and understanding of social, emotional, and physical limitations when managing routine urologic problems. 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Participate in improving the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities PGY4 ENDOUROLOGY & SEXUAL MEDICINE ROTATIONS PGY4 urology residents are required to rotate on the endourology, and sexual dysfunction / infertility services for 4 months. Patient care is provided by the resident and endourology / sexual medicine Fellows. Separate objectives have been developed to reflect the diverse nature of these subspecialties. Attending staff members, who supervise this service, provide expertise and clinical experience in endourology and sexual dysfunction to the team on this rotation. Craig Donatucci, MD [Sexual Medicine] Glenn Preminger, MD [Endourology] Michael Ferrandino, MD [Endourology] Goal Endourology Rotation: The educational goal for the endourology rotation is to understand the complex geographic, physical emotional, psychosocial and urologic aspects necessary for management of patients and families with these conditions, especially those living within the stone belt are as follows: Objectives Endourology Rotation: Patient care 1. Outline the preoperative work up necessary to have a patient ready for endourologic surgery. 2. Implement post- operative routines for patient management.

16 3. Anticipate the most common complications and management of these complications related to endourologic surgical procedures. 4. Manage post- operative nutritional issues. 5. Participate in pre and post-operative patient care and by operating room participation, as well as shock wave lithotripsy. Medical Knowledge 1. Describe indications for endourologic procedures 2. Contrast various endoscopes, cameras, baskets, guidewires and other accessory instrumentation necessary to perform endoscopic, urologic procedures. 3. Recognize the most common medical conditions associated with kidney stone disease, as well as the appropriate medical management of urinary calculi. 4. Conduct a metabolic evaluation for kidney stone formers, evaluate and interpret the results of the metabolic evaluation and provide appropriate directed medical therapy 5. Describe the most common endourologic procedures including cystoscopy, retrograde pyelograms, ureteroscopy (with and without stone fragmentation, percutatneous stone removal, percutaneous endopyelotomy, TURP, TURBT, endoureterotomy, and endoscopic fragmentation of bladder and continent reservoir stones. 6. Use the holmium laser, select various power settings and understand basic laser safety. 7. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds. Interpersonal and Communication Skills 1. Present data succinctly in morning rounds. 2. Write progress notes, admission orders, and discharge summaries promptly 3. Establish good doctor / patient therapeutic relationships. 4. Work effectively with other members of the team 5. Perform safety time outs 6. Obtain appropriate informed consent 7. Write comprehensive medical records 8. Learn skills to facilitate effective consultation 9. Recognize situations in which particular respectfulness and sensitivity is necessary such as when taking sexual history, or working with patients with different sexual preferences, transgendered patients etc Practice-based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of students and other healthcare professionals.

17 4. Access and critically appraise relevant surgical literature and apply to patients 5. Teach more junior residents and students Systems-Based Learning 1. Manage the endourology and kidney stone patients in a multidisciplinary setting. 2. Support the role of the members of the endourology team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Acquire basic understanding of pre operative approval process for undergoing endourologic procedures. 4. Identify sources of errors and near misses 5. Work at divisional level to decrease the risks of medical errors and near misses 6. Understand appropriate techniques of coding and its impact on reimbursement Professionalism 1. Be sensitive to the issues unique to the endourology / kidney stone patients by gaining and understanding of social, emotional, and physical limitations to the endourology / kidney stone patient. 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Participate in improving the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities Objectives Sexual Medicine Rotation Patient Care 1. Perform the preoperative work up necessary to have a patient ready for sexual dysfunction surgery. 2. Utilize appropriate post-operative routines for patient management. 3. Anticipate the most common complications related to sexual dysfunction surgical procedures and how to prevent/mitigate them. 4. Participate in pre operative, intraoperative and post-operative patient care. Medical knowledge 1. Know normal human sexual function and fertility and the consequences both for the patient and significant other, or disorders in these functions. 2. Outline the outpatient evaluation of erectile dysfunction, peyronie s disease, and infertility and employ the full spectrum of medical and surgical treatment for these problems.

18 3. Acquire competency in the technical nuances of patient selection for the placement of penile prosthetic devices. 4. Anticipate the intra-operative complications which can occur and learn appropriate preventive and corrective measures. 5. Acquire familiarity with the spectrum of operative techniques used in the treatment of peyronie s disease, and select the techniques best suited for the individual patient 6. Provide proper post-operative care of patients with peyronie s disease. 7. Conduct medical and surgical evaluations of the infertile male, and learn appropriate surgical skills and medical treatments to deal with the correctable causes. 8. Describe the techniques used to acquire spermatozoa for assisted reproduction for those couples who suffer from infertility. 9. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds. Interpersonal and Communication Skills 1. Present data succinctly in morning rounds. 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. 4. Work effectively with other members of the team, 5. Perform safety time outs 6. Obtain appropriate informed consent 7. Write comprehensive medical records 8. Learn skills to facilitate effective consultation 9. Recognize situations in which particular respectfulness and sensitivity is necessary such as when taking sexual history, or working with patients with different sexual preferences, transgendered patients etc Practice-Based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of students and other healthcare professionals. Systems-Based Learning 1. Manage the sexual dysfunction and infertility patients in a multidisciplinary setting. 2. Understand the role of the members of the sexual dysfunction and infertility team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Acquire basic understanding of pre operative approval process for undergoing sexual dysfunction and infertility procedures.

19 Professionalism 1. Be sensitive to the issues unique to the sexual dysfunction and infertility patients by gaining and understanding of social, emotional, and physical limitations to the patient with erectile dysfunction. 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities PGY-5 PEDIATRIC UROLOGY ROTATION PGY5 urology residents are required to rotate on a pediatric urology service for 4 months. Patient care is provided by the resident with some assistance by the pgy2 urology residents. Attending staff members and nursing specialists who supervise this service, provide expertise, and clinical experience in pediatric urology on this rotation are: Pediatric Faculty John Wiener, MD. Sherry Ross, MD Cynthia Camille, CPNP. [Pediatric Urology Nurse Practitioner] Joanne Tello, RN [Urotherapy/Urodynamics Specialist] Goals: Education goals for this rotation are as follows: Goals: Pediatric Rotation The educational role of the pediatric rotation is to gain familiarity with urologic conditions which affect the pediatric population and the significant differences in management in this age group and when working with parents and families in addition to the patient Objectives Patient Care 1. Evaluate and manage pediatric urology patients as well as adults with congential uropathies in the clinic setting, including postoperative care. 2. Participate in in-patient care of pediatric urology patients 3. Develop competence and confidence in writing orders on pediatric patients. 4. Provide pediatric urology consultative services in the newborn nursery, neonatal icu, pediatric icu, pediatric wards, operating rooms, emergency department, and other locations where our services are requested as well as short and long term management of the consult patients

20 5. Provide telephone and electronic triage and management of pediatric urology patients with their families and their health care providers. 6. Perform surgery on pediatric urology patients with demonstration of competency in routine and complex procedures. 7. Obtain a proper and thorough history from a child and his/her family including the Special detailed histories related to pre-natal hydronephrosis, urinary tract infection, voiding dysfunction, neurogenic bladder, and enuresis. 8. Conduct a proper and thorough physical examination on neonates, infants, and children. Specific skills in the genital exam are required. 9. Conduct and interpret urodynamic studies on infants and children. Medical Knowledge 1. Recite fluid management/nutritional principles in pediatric patients. 2. Identify specific medication restrictions in pediatric patients. 3. Recognize pre-natal considerations in evaluating the newborn patient. 4. Describe the evaluation and management of children with neurogenic bladder, avoiding dysfunction, and enuresis 5. Select the appropriate timing for correction of congenital urology malformations. 6. Choose the appropriate surgical procedure for management of hypospadias, undescended testes, and vesicoureteral reflux. 7. Acquire an extensive understanding of genitourinary embryology 8. Acquire proficiency in reading sonograms, voiding cystourethrography, and nuclear renography 9. Acquire knowledge through: a. Independent reading b. Discussion in clinic, ward rounds, operating room, and at conferences. Interpersonal and Communication Skills 1. Synthesize and present data and formulate plan of care succinctly with faculty, nurses, and residents on morning and/or evening rounds. 2. Provide accurate plan of care to on-call team. 3. Write comprehensive progress notes, admission orders, and consultation notes legibly, promptly, and succinctly 4. Perform discharge summaries and occasional operative and clinic notes accurately and succinctly. 5. Establish good doctor/patient & family therapeutic relationships 6. Demonstrate proficiency in establishing rapport with pediatric patients and their families 7. Demonstrate teaching skills in conducting pediatric urology conferences 8. Provide leadership for PG 2 rotating on the pediatric urology team 9. Work effectively with all members of the team including nurses, secretaries, clinic staff, and or team.

21 Practice-based Learning and Improvement 1. Review the patient s history, indications for surgery, and the steps of the surgical procedure of each patient before commencing each surgical day. 2. Demonstrate innovative surgical and endoscopic skills as it relates to reconstructive and pediatric urology and improve existing skills through self-directed practice 3. Access and critically appraise relevant urologic literature and apply to patients 4. Teach residents in urology and other services, students, and other healthcare professionals about pediatric urology Systems-Based Learning 1. Identify sources of complications, errors, and near misses and present appropriate cases at morbidity and mortality conference. 2. Work at divisional, hospital and health system levels to decrease those risks 3. Manage pediatric urology patients in a multidisciplinary setting with other pediatric providers, (including Spina bifida patients). 4. Demonstrate effective leadership skills in leading members of the pediatric urology team and demonstrate leadership. 5. Master appropriate techniques of coding and pre-operative approval process and anticipate its impact on reimbursement Professionalism 1. Demonstrate conscientiousness and personal responsibility in being accountable for patients and their families 2. Participate in improving the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 3. Display sensitivity to the issues unique to pediatric urology including those related to pregnancy, post-natal, early childhood, and adolescent disease and maldevelopment and the stresses which these problems to parents and other family members. 4. Dress appropriately. 5. Interact with hospital staff, patients, and colleagues courteously. 6. Be timely in medical record completion, conference attendance, bedside rounds, clinic and surgical duties, answering pages, and other required responsibilities. 7. Be fair and timely in assignment of call schedule duties to fellow residents.

22 PGY-5 SURGICAL ONCOLOGY: PGY5 SURGICAL ONCOLOGY ROTATION PGY5 urology residents are required to rotate on the service for 4 months. Patient care is provided by the resident and the urologic oncology fellow. Separate objectives have been developed to reflect the diverse nature of this subspecialty, with particular emphasis on minimally invasive oncologic techniques. Attending staff members, who supervise this service, provide expertise and clinical experience in female and reconstructive urology to the team on this rotation. Thomas Polascik, M.D. Cary Robertson, M.D. Philip Walther, M.D. Goals: educational goals for these rotations are as follows: Goals: Surgical Oncology Rotation The educational goals of the Surgical Oncology rotation are for residents to learn the prevention, early identification, and management of patients with various urologic malignancies and care for these patients within appropriate multidisciplinary teams. Objectives: Patient care 1. Conduct an appropriate diagnostic evaluation of the urologic oncology patient 2. Perform the preoperative work up necessary to have a patient ready for appropriate extirpative and ablative surgery. 3. Implement post-operative routines for patient management. 4. Anticipate and manage common complications related to urologic oncologic surgery and treatment 5. Participate in pre and post-operative patient care and operative management. 6. Gain proficiency in the performance of laparoscopic and ablative urology surgery. 7. Gain proficiency in the performance of major open urologic oncologic surgery, including prostatectomy, radical and partial nephrectomy and retroperitoneal lymph node dissection. Medical Knowledge 1. Recognize indications for operative interventions for cancers of the kidney, ureter, prostate, and testes. 2. Contrast the various open and minimal invasive approaches to these interventions. 3. Demonstrate understanding of the principles of laparoscopic procedures and cryosurgery. 4. Compare non-surgical alternatives and adjunctive therapies [including hormonal, chemotherapy, and immunotherapy] for the management of urologic cancers.

23 5. Acquire knowledge through: a. Independent reading. b. Discussion in clinics, ward rounds, and teaching conferences. c. Coordinate monthly Tumor Board conferences Interpersonal and Communication Skills 1. Synthesize and present data and formulate plan of care succinctly with faculty, nurses, and residents on morning and/or evening rounds. Provide accurate plan of care to on-call team. 2. Write comprehensive progress notes, admission orders, and consultation notes legibly, promptly, and succinctly 3. Dictate discharge summaries and occasional operative and clinic notes accurately and succinctly. 4. Establish good doctor/patient & family therapeutic relationships 5. Establish rapport with pediatric patients and their families 6. Demonstrate effective teaching skills in conducting pediatric urology conferences 7. Work effectively with all members of the team including nurses, secretaries, clinic staff, and or team. Practice-Based Learning and Improvement 1. Review the patient s history, indications for surgery, and the steps of the surgical procedure of each patient before commencing each surgical day. 2. Perform appropriate surgical and minimally invasive procedural skills as they relate to urologic oncology 3. Access and critically appraise relevant urologic literature and apply to patients 4. Teach other services, students, and other healthcare professionals about urologic oncology Systems-Based Learning 1. Assist in the coordination of care of urologic oncology patients in a multidisciplinary setting with members of the Division of Medical Oncology and Department of Radiation Oncology. 2. Understand the role of the members of the team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Acquire basic understanding of pre operative approval process for undergoing extirpative, ablative, and minimally invasive procedures. 4. Identify sources of errors and near misses 5. Work at divisional, hospital and health system levels to decrease the risks of medical errors and near misses 6. Develop greater understanding of appropriate techniques of coding and its impact on reimbursement

24 Professionalism 1. Display sensitivity to the issues unique to oncology patients and their families by gaining and understanding of social, emotional, and physical limitations to such patients. 2. Demonstrate particular respectfulness to complications of oncologic surgery, including incontinence and erectile dysfunction. 3. Dress appropriately. 4. Interact with hospital staff, patients and colleagues courteously. 5. Demonstrate conscientiousness and personal responsibility in being accountable for patients 6. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 7. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities. PGY-5 ASHEVILLE VAMC ROTATION: Residents rotate to the Asheville VAMC during their PGY5 year for a four month period. The design of this rotation places emphasis continuity of care. Additionally, the senior resident oversees the development of the junior resident. Residents see patients in an outpatient clinic setting initially, conduct the surgical management of the patient if indicated, and then follow these patients post-operative or non-operative course in the outpatient clinic as well. The residents are supervised by local urology faculty both in the clinical and surgical setting. Attending staff members, who supervise this service, provide expertise and clinical experience in all aspects of urologic training Dane Weil, M.D. Leonard Verges, M.D. Goal: Educational goals for this rotation are as follows: 1. To place emphasis on continuity of care from the clinic to the OR to the clinic again, and 2. To allow for increased independence by providing the opportunity for the senior resident to oversee the development of the junior resident, (while supervised by Urology faculty members).

25 Objectives Asheville VAMC Rotation: Patient care 1. Demonstrate advanced competency in the preoperative assessment of the urologic patient. 2. Demonstrate effective post-operative routines and complex patient management. 3. Provide comprehensive outpatient clinic-based evaluation for routine urologic conditions 4. Acquire more advanced surgical skills for open and endoscopic urologic diseases 5. Conduct the workup for routine urologic issues (hematuria lower urinary tract symptoms, erectile dysfunction, nephrolithiasis, elevated PSA) and develop appropriate treatment algorithms for the diagnoses., with greater independence Medical Knowledge 1. Describe indications for endoscopic and open urologic procedures and alternatives to their use. 2. Describe more complex surgical procedures such as major extirpative and reconstructive procedures including their complications, prevention and management. 3. Describe risk factors for development of benign and malignant urologic conditions and how to prevent or mitigate these risks 4. Understand the appropriate incorporation of radiation therapy, immunotherapy, and chemotherapy in the management of urologic malignancies and the common adverse complications from these approaches 5. Acquire knowledge through: a. Independent reading. b. Discussion in clinics and ward rounds. Interpersonal and Communication Skills 1. Synthesize data to develop effective patient care plan 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. 4. Work effectively with other members of the team, 5. Perform safety time outs 6. Obtain appropriate informed consent 7. Write comprehensive medical records 8. Further develop skills to facilitate effective consultation 9. Orchestrate appropriate patient care as the team leader of junior resident and nurses. 10. Appropriately interact with consulting services, particularly senior established providers who completed their own training many years ago.

26 Practice-Based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education junior resident and consulting teams. 4. Access and critically appraise relevant surgical literature and apply to patients 5. Learn to work with experienced consulting physicians, as opposed to a primarily house officer-run services at Duke and the Durham VAMC 6. Develop self-paced studying agenda in this off-site rotation, along with interaction with co-resident. Systems-Based Learning 1. Master working relationships in an equal access healthcare system at all administrative levels. 2. Develop leadership skills as the team leader for the members of the Asheville VAMC urology team including, junior resident, nursing staff members, and secretarial staff. 3. Acquire knowledge of the pre operative approval process for all endoscopic and urologic procedures. 4. Identify sources of errors and near misses 5. Work at institutional level to decrease the risks of medical errors and near misses Professionalism 1. Display sensitivity to the issues unique to the VAMC patients by gaining and understanding of social, emotional, and physical limitations unique to the veteran population 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Improve the residency experience through thoughtful evaluation and input regarding the rotation and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities.

27 PGY-6 RECONSTRUCTIVE UROLOGY AND ADMINISTRATIVE ROTATION: PGY6 RECONSTRUCTIVE UROLOGY AND ADMINISTRATIVE ROTATION PGY6 urology residents are required to rotate on the reconstructive and female urology service for 4 months. Patient care is provided by the resident and female and reconstructive urology fellow. Separate objectives have been developed to reflect the diverse nature of this subspecialty. Attending staff members, who supervise this service, provide expertise and clinical experience in female and reconstructive urology to the team on this rotation. George Webster, M.D. Cindy Amundsen, M.D. [Dept. of Ob/Gyn] Andrew Peterson, M.D. [to start Oct. 1, 2010] Goals: Reconstructive / FEMALE UROLOGY ROTATION The educational goals for this rotation are to develop urologic expertise in the care of urologic conditions unique women and reconstructive urologic surgery. Objectives: Patient Care 1. Evaluate and diagnose women with urinary incontinence and pelvic prolapse, male urethral stricture disease, and bladder dysfunction 2. Perform the preoperative work up necessary to have a patient ready for appropriate reconstructive/incontinence surgery. 3. Implement post- operative routines for patient management. 4. Describe the most common complications and management of these complications related to incontinence and reconstructive procedures 5. Participate in pre operative, intra-operative and post-operative patient care Conduct and interpret with proficiency video-urodynamic evaluation of patients with incontinence and bladder dysfunction. Medical Knowledge 1. Describe indications for operative interventions for female urinary incontinence and pelvic prolapse, male urethral stricture disease, and bladder dysfunction 2. Compare the various procedures for correction of these disorders, including prosthetic materials [injectables, mesh, slings, and artificial urinary sphincters.] 3. Describe most common risk factors conditions associated with female and male incontinence, pelvic prolapse, and bladder dysfunction. 4. Describe non-surgical alternatives for the management of incontinence, prolapse, and bladder dysfunction 5. Interpret video-urodynamic studies and apply information to patient management decisions 6. Acquire knowledge through:

28 d. Independent reading. e. Discussion in clinics and ward rounds and urodynamic conference. Interpersonal and Communication Skills 1. Demonstrate leadership in conducting ward rounds with junior residents and medical students. 2. Serve as a role model to other residents in good doctor / patient therapeutic relationships. 3. Work effectively with other members of the health care team, including nurses, physician extenders, medical students, secretarial staff 4. Perform safety time outs 5. Supervise completion of comprehensive medical documentation by junior residents and medical students. 6. Supervise junior residents in providing consultative services requested by other physicians in Emergency Department and Hospital. 7. Provide effective formative and summative feedback to learners Practice-Based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of junior residents, medical students and other healthcare professionals. 4. Access and critically appraise relevant surgical literature and apply to patients 5. Coordinate teaching conferences with Program Directors guidance 6. Evaluate the effectiveness of teaching conferences in learners learning new knowledge and improving patient care outcomes Systems-Based Learning 1. Coordinate the care of female incontinence and prolapse patients in a multidisciplinary setting with members of the Division of Urogynecology. 2. Recognize and support the roles of the other members of the team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Work collaboratively with other members of the health care team, such as the Ostomy Nurses, to coordinate care and teaching of patients undergoing urinary reconstructive procedures. 4. Acquire basic understanding of pre operative approval process for undergoing incontinence and reconstructive procedures. 5. Identify sources of errors and near misses 6. Work at divisional level to decrease the risks of medical errors and near misses 7. Develop greater understanding of appropriate techniques of coding and its impact on reimbursement

29 Professionalism 1. Display sensitivity o the issues unique to incontinence, prolapse, and reconstructive patients by gaining and understanding of social, emotional, and physical limitations to such patients. 2. Demonstrate particular respectfulness to female patients with incontinence and prolapse disorders. 3. Dress appropriately. 4. Interact with hospital staff, patients and colleagues courteously. 5. Demonstrate conscientiousness and personal responsibility in being accountable for patients 6. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 7. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities 8. Be a role model to junior residents and medical students PGY-6 MINIMALLY INVASIVE UROLOGY AND ONCOLOGY ROTATION: PGY6 MINIMALLY INVASIVE UROLOGY AND ONCOLOGY ROTATION PGY6 urology residents are required to rotate on the service for 4 months. Patient care is provided by the resident and the urologic oncology fellow. Separate objectives have been developed to reflect the diverse nature of this subspecialty, with particular emphasis on minimally invasive oncologic techniques. Attending staff members, who supervise this service, provide expertise and clinical experience in female and reconstructive urology to the team on this rotation. Judd W Moul, M.D. Brant Inman, M.D. Michael Ferrandino, M.D. Goal: Advanced Oncology Rotation The educational goals for this rotation are: to assume progressively greater independence in the diagnosis and management of patients with urologic cancer and to serve as a greater resource for other services in the co management of these patients. Objectives: Patient care 1. Conduct an appropriate diagnostic evaluation of the urologic oncology patient independently and with little necessary input 2. Peform an appropriate preoperative work up necessary to have a patient ready for appropriate extirpative surgery. 3. Implement post- operative routines for patient management.

30 4. Anticipate the most common complications; prevent and management f these complications related to urologic oncologic surgery 5. Participate to a greater and more independent extent in pre and post-operative patient care and operative management. 6. Demonstrate mastery in the performance of laparoscopic and robotic urology surgery and the prevention and management of complications. 7. Demonstrate mastery in the performance of major open urologic oncologic surgery, including cystectomy with continent urinary diversion, prostatectomy, radical and partial nephrectomy and the prevention and management of complications. 8. Perform reconstructive procedures following extirpative surgery. 9. Understand the role of palliative care, hospice and other end of life care Medical Knowledge 1. Describe indications for operative interventions for cancers of the kidney, ureter, bladder, prostate, testes, urethra, and penis. 2. Compare the various open and minimal invasive approaches to these interventions. 3. Demonstrate the complete understanding of the principles of laparoscopic and robotic surgery. 4. Describe non-surgical alternatives and adjunctive therapies [including hormonal, chemotherapy, and immunotherapy] for the management of urologic cancers. 5. Acquire knowledge through: a. Independent reading. b. Discussion in clinics, ward rounds, and teaching conferences. Interpersonal and Communication Skills 1. Demonstrate leadership in conducting ward rounds with junior residents and medical students. 2. Serve as an effective role model to other residents in good doctor / patient therapeutic relationships. 3. Work effectively with other members of the health care team, including nurses, physician extenders, medical students, secretarial staff 4. Perform safety time outs 5. Supervise completion of comprehensive medical documentation by junior residents and medical students. 6. Supervise junior residents in providing consultative services requested by other physicians in Emergency Department and Hospital. 7. Provide effective formative and summative feedback to learners Practice-Based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice.

31 3. Facilitate education of junior residents, medical students and other healthcare professionals. 4. Access and critically appraise relevant surgical literature and apply to patients Systems-Based Learning 1. Coordinate care of urologic oncology patients in a multidisciplinary setting with members of the Division of Medical Oncology and Department of Radiation Oncology. 2. Understand the role of the members of the team including, fellows, nursing staff members, referring doctors, and other surgical staff members. 3. Work with other members of the health care team, such as the ostomy nurses, to coordinate care and teaching of patients undergoing urinary reconstructive procedures. 4. Acquire basic understanding of pre operative approval process for undergoing extirpative, ablative, and minimally invasive procedures. 5. Identify sources of errors and near misses 6. Work at divisional, hospital and health system level to decrease the risks of medical errors and near misses 7. Develop greater understanding of appropriate techniques of coding and its impact on reimbursement Professionalism 1. Display sensitivity to the issues unique to oncology patients and their families by gaining and understanding of social, emotional, and physical limitations to such patients. 2. Demonstrate particular respectfulness to complications of oncologic surgery, including incontinence and erectile dysfunction. 3. Dress appropriately. 4. Interact with hospital staff, patients and colleagues courteously. 5. Demonstrate conscientiousness and personal responsibility in being accountable for patients 6. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 7. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities 8. Serve as a role model to junior residents and medical students.

32 PGY-6 DURHAM VAMC ROTATION: Residents rotate to the Durham VAMC for 4 months during their PGY6 year. The design of this rotation places emphasis on continuity of care. Additionally, the chief resident oversees the development of the junior resident. Residents see patients in an outpatient clinic setting initially, conduct the surgical management of the patient if indicated, and then follow these patients postoperative course in the outpatient clinic as well. The residents are supervised by duke urology faculty both in the clinical and surgical setting. Attending staff members, who supervise this service, provide expertise and clinical experience in all aspects of urologic training Craig Donatucci, MD. Michael Ferrandino, MD. Michael Andrews, MD Stephen Freedland, MD Cary Robertson, MD Philip Walther, MD Goals: The educational goals for the Durham VAMC Rotation are: 1. To place emphasis on continuity of care from the clinic to the OR to the clinic again, and 2. To allow for increased independence by providing the opportunity for the Chief resident to oversee the development of the junior resident, (while supervised by Urology faculty members). Objectives Durham VAMC Rotation: Patient Care 1. Demonstrate expertise in the preoperative assessment of the urologic patient. 2. Implement effective post-operative routine and complex patient management. 3. Conduct complete outpatient clinic-based evaluation for routine urologic conditions with minimal attending input 4. Master surgical skills for open and endoscopic urologic diseases 5. Master the diagnostic workup for routine urologic issues (hematuria lower urinary tract symptoms, erectile dysfunction, nephrolithiasis, elevated PSA).and develop appropriate treatment algorithms.

33 Medical Knowledge 1. Describe indications for complex endoscopic and open urologic procedures. 2. Describe advanced surgical procedures such as major extirpative and reconstructive procedures. 3. Develop proficiency with minimally invasive techniques (ie: robotics and laparoscopy) 4. Describe risk factors for development of benign and malignant urologic conditions 5. Understand the appropriate incorporation of radiation therapy and chemotherapy in the management of urologic malignancies and the common adverse effects and their management 6. Acquire knowledge through: a Independent reading. b Discussion in clinics and ward rounds. Interpersonal and Communication Skills 1. Synthesize data to develop effective patient care plan 2. Write progress notes, admission orders, and discharge summaries promptly. 3. Establish good doctor / patient therapeutic relationships. Especially for more challenging patients (poor adherence, angry, hostile, somatiziation disorders) 4. Work effectively with other members of the team, 5. Perform safety time outs 6. Obtain appropriate informed consent 7. Write comprehensive medical records 8. Master skills to facilitate effective consultation 9. Orchestrate appropriate patient care as the team leader of junior resident, nurses and physician extenders Practice-Based Learning and Improvement 1. Analyze complications encountered during rotation by presenting them at morbidity and mortality conference. 2. Conduct literature search to evaluate and improve current practice. 3. Facilitate education of students and other healthcare professionals, junior residents, and consulting teams. 4. Access and critically appraise relevant surgical literature and apply to patients 5. Appropriately interact with consulting services

34 Systems-Based Learning 1. Master working relationships in an equal access healthcare system at all administrative levels. 2. Master leadership skills as the team leader for the members of the Durham VAMC urology team including, junior residents, nursing staff members, and physician extenders. 3. Acquire expert knowledge of the pre operative approval process for all endoscopic and urologic procedures. 4. Identify sources of errors and near misses 5. Work at institutional level to decrease the risks of medical errors and near misses Professionalism 1. Display sensitivity to the issues unique to the VAMC patients by gaining and understanding of social, emotional, and physical limitations unique to the veteran population 2. Dress appropriately. 3. Interact with hospital staff, patients and colleagues courteously. 4. Demonstrate conscientiousness and personal responsibility in being accountable for patients 5. Improve the residency experience through thoughtful evaluation and input regarding the rotations, didactics, and faculty 6. Be prompt at medical record keeping, conference attendance, bedside rounds, answering pages and other required responsibilities.