Urology Residency
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Urology Residency

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Policies, Procedures, Responsibilities, Schedules

Policies and Proceudres

Call Schedule

  • Chief Resident is responsible for the call schedule.
  • ACGME rules
    • Max 80-hour per week average over 4 weeks.
    • Presumed hours 6am - 6pm
    • 1 in 7 days free of patient care responsibilities averaged over a 4 week period.
    • Call no more frequently than every 3rd night averaged over a 4 week period.
    • 24-hour limit for on-call duty in house.  Additional 6-hours for transfer of care.  No new patients or OR cases during that 30-hours.
    • 10-hour minimum rest between duty periods.
    • Please tell us if you have been up all night or are about to break one of the other rules.
    • If you are asked to go home, PLEASE LEAVE.
    • Hours will be logged into e-value and need to be logged no later than 7 days after the end of month.  This will be monitored by Allison Sillers and Walter Wallace. 
      • The GME policy for reporting non-compliance & administrative action is the following:
        • a)  "A standard threshold for administrative action in response to reporting non-compliance is adopted across all DHMC programs with the following thresholds and administrative actions:"
        • b)  "For duty hours calendars not completed within seven days of month's end an e-mail, notification of non-compliance will be automatically sent to the resident, the residency coordinator and the program director."
        • c)  "Receipt of three notifications of reporting non-compliance in any given academic year will generat e a letter of concern from the director of GME to be placed in the resident's QA file citing a pattern of reporting non-compliance that reflects negatively on the residents physician's professionalism."
        • d)  Continued reporting non-compliance following receipt of a letter of concern will trigger a review by the GME duty hours subcommittee and may result in disciplinary action up to and including dismissal."
        • e)  "The GME confidential system will be available for confidential reporting and/or guidance regarding issues related to duty hours.  The system will forward all reports to the designated resident representative on the duty hours committee."
        • f)  "A specific question addressing the issue of faculty encouraging residents to misrepresent their duty hours, work beyond their hours, or otherwise violate duty hours requirements should be incorporated into the vehicle used by residents to evaluate faculty in every DHMC program.  If for any reason a resident is uncomfortable utilizing this option then the GME confidential system should be used as a confidential avenue for reporting this issue."
  • On-call room is available.
  • Call may be taken from home (30-minute rule).
  • The resident covers both hospitals (MHMH and VA).  Rounds are made with the attending on the weekend days at both hospitals.  The resident should also make afternoon/evening rounds.
  • Any resident who switches call is responsible to notify either Allison Sillers or the Administrative Assistant with changes.  The Administrative Assistant then notifies the operator, etc.
  • If any resident leaves the hospital for any reason during the day the office secretaries and the Chief Resident should be notified.
  • It is the responsibility of the Chief/Senior Resident to post EACH day, on the call board, who is on call for that day.  This is the person with the on-call beeper.  The person listed on the board will be responsible to take emergent calls.  If they are in the OR the attending needs to release the resident to deal with the emergency.  If the board is empty the Chief Resident will be called.
  • Moonlighting
    • Neither condoned nor condemmed.  Residency is considered a full time commitment.
    • You must have the program director's permission.
    • Permission will not be given if you score less than the 50% ile on the inservice.

Clinic

  • Timeliness.  Please start on time.  It is not the nurses' responsibility to page you.
  • If you start with a patient and then need to leave, let the appropriate attending know so that the patient is not left waiting.  Delaying 1 patient often delays all the the remaining patients in the clinic.
  • Dress--avoid scrubs.  Look professional.
  • Noise (confidentiality)
  • CIS note.  If you write this as you go and have to leave you can then forward the note to the attending.  When you write your note check CIS for more information if needed.  Accurately summarize past pertinent data if a return patient.  The resident is responsible to complete the office note into CIS following the appointment.  You may need to complete your notes after clinic to stay on time.
  • Clinic notes will attest to the level of involvement of the resident and the faculty.
  • Notify the appropriate secretary via the CIS worklist of any and all follow-ups, including the appropriate testing and/or labs to be arranged.  Including all pertinent information including the diagnosis.
  • Billing sheet should reflect what you did.  The attending must then sign it.
  • All patients booked into the clinic must have an attending back-up.  If you are booking a clinic appointment it is your job to identify the attending when the patient is booked.
  • Attempt to maintain continuity -  ideally the same resident and the same attending should be seeing the patient.
  • Cystos - the attending must be present for the pertinent portion (this is the entire case for a diagnostic cysto).

Clinic Trips and Meetings

New Hampshire Urologic Society

  • Dinner meeting twice a year in Manchester.  Residents are welcome to attend.  Please discuss cases suitable for presentation with the attending of record.

Annual American Urological Association / New England Section American Urological Assoiciation, Others

  • Residents are encouraged to submit abstracts following discussion with the appropriate faculty.  Generally residents are given permission to attend a meeting if their abstract is accepted.  Prior to submitting abstracts for meetings in exotic locations check with the program Director/Section Chief.  Attendance is at the discretion of the Program Director and/or Section Chief.  If approved this does not count against vacation time.

Review Courses/Industry Sponsored Courses

  • A resident may use vacation time to attend any course or meeting where they are not presenting.   Residents should submit a time away slip for meetings and courses and consideration will be given on a case by case basis to allow a resident to attend without using vacation time.  Funding will not be provided from the section to pay for any portion of the costs for such meetings/courses.

International Electives

  • Residents may be permitted to do electives in underserved/developing nations.  The resident will be asked to submit a proposal to the program director.  The proposal will outline the purpose of the elective,  information about the sponsoring instituition and supervising urologist and proposed length of the trip. Residents may be asked to use vacation time to cover all or part of the proposed time away. 

Meeting/Driving Expences

  • Expenses for the AUA and for New England Section will be provided if the resident has a paper accepted.  Residents are expected to book airfares well in advance. The instituition's rules for reimbursement will apply.
  • Mileage to and from Concord for the Concord rotation is not provided.

Dress Code

  • Appropriate dress is essential when in contact with patients and visitors.

Educational Conferences

  • Residents are required to attend the weekly GU Conferences and Radiology Conference.  These conferences start at 7:00am and 8:00am sharp.
  • The Concord resident will attend the Wednesday morning conferences
  • M&M - held monthly.
    • Residents will track M&M's and compile a list each month.  Ideally the resident involved with the case should present the case and brief discussion of how the M&M could have been avoided.  Every M&M should be listed on a separate M&M sheet and the discussion portion of the sheet filled out after the conference.  All of the sheets for the month are then submitted to the Residency Coordinator. 
    • The Chief Resident at DHMC will assign one resident to present a short talk on a specific M&M each month.

Radiology

  • The Chief Residents are responsible to assure that there are adequate cases to present each week.  There should be at least 1 case presented weekly from the VA.
  • 1st Wednesday of the month is Pedi.  Resident on the Pedi Service is responsible to pick/present cases.
  • Cases are submitted to the radiology resident in advance.
  • Please remember to present a mix of cases and present to the Intern, Junior Radiology Residents, Medical Students, etc.

Urodynamic Conference - held monthly.

Tumor Board - held weekly.

  • Residents should attend.

Journal Club - held twice per month

  • Residents should have reviewed all assigned articles.
  • Submit your articles to the Residency Coordinator on time.
  • The 1st journal club of the month is the Journal of Urology. Articles are presented by residents and faculty.
  • The 2nd journal club of the month is presented by the residents and other journals are presented. The Chief Resident assigns the journals.

Combined GYN/Uro Conference - Fifth Wednesday of the month.

  • The resident on  Dr. Gormley's service will pick 2 cases and present them.  Please discuss the cases with Dr. Gormley 1 week prior to the conference.

The Section of Urology traditionally hosts 2 Visiting Professors each year.  The Urology Residents are expected to prepare and present cases of interest.  Cases must be discussed with the appropriate attending prior to presentation.  The Urology Residents are expected to attend dinner with the Visiting Professor on one evening during his/her visit.

Evaluations

  • Resident evaluation is an on-going process.  Residents are in constant contact with faculty on a daily basis.  Formal evaluations occur every 6 months.  The first one is done once the Inservice results are back.  Standardized residency evaluation forms are completed by each faculty member every 3 - 6 months.  A 360 degree evaluation is performed to evaluate professionalism and communication skills.  A resident is expected to meet average standards in his/her professional, technical and ethical performance.  The Program Director discusses resident performance with each individual every 6 months, making certain that the resident has appropriate professional growth and skills to proceed to the next year.  Similarly to enter the Chief Resident year a resident must have obtained an appropriate level of performance in the opinion of the majority of faculty members.  Items evaluated in the resident evaluation forms include basic medical knowledge, case log, clinical judgment, administrative skills, technical competence and personal attributes.
  • Operative evaluations are also performed on index cases.  You may not be told when it will be done however you can only be evaluated on a case that you have previously participated in.
  • Faculty members are evaluated annually.  Residents anonymously complete a faculty assessment form which addresses characteristics and attributes that include teaching ability, availability and role modeling.  Blinded information is assembed by the Residency Coordinator and presented for review to the Program Director.  Each faculty member meets with the Program Director to review and discuss not only the evaluation of the faculty by the residents, but also the scholarly activities of the faculty.
  • The Urology Section performs a yearly internal program review with faculty and residents whereby various elements of the program are assessed for satisfactory completion of the educational goals.  Residents complete a program evaluation form annually which addresses the extent to which the residents' educational goals and objectives are fulfilled with special concern regarding the balance between the ducational and service components of the program.
  • The residents are required to take the AUA In-Service.  Performance is reviewed at a faculty meeting in order to direct attention to areas of apparent weakness.  Faculty are encouraged to sit the In-Service to better understand what is on the exam.  Resident scores will be kept on file in the resident's personnel file.  The AUA Self Assessment Exam is available to all residents.

In-House and Same Day Surgery Patients

  • History and Physical Examinations:  Done by the intern or the resident.
  • Discharge Summaries:  The resident is responsible for the timeliness and accuracy of the discharge summaries.
  • Discharge Orders:  It is the responsibility of the resident to insure that the discharge form is filled out accurately and to discharge patient.  The resident shall notify the appropriate secretary of all post-discharge follow-ups via CIS work-list with all pertinent information.
  • Rounding:  The Urology Residents round in the a.m. hours as a team on all in-patients and on all consults that have active issues.  Every resident should know what is happening with every patient.  A note will be written on all patients.  Resident assigned to a specific attending round with that attending  in the p.m.  If you must leave prior to evening rounds please check with the attending that you are assigned to.
  • It is the attending's responsibility to sign out the patients to the attending on call.  The resident on call should be familiar with all in-house patients and consults.
  • Consultations:  In-house consultations are performed by the on-call resident.  Ideally you should discuss the case with the attending prior to finishing your note.
  • Emergency room consults go directly to the resident on-call.
  • After consults have been seen, they should be discussed with the on-call faculty.  Unless emergent, consults do not take precedence over clinic patients.
  • Telephone Documentation:  Outside telephone conversations with patients and other providers regarding patient management should be documented and incorporated into the medical record.  All scripts should be entered under medications in CIS.
  • Re-appointments following discharge (either Same Day Surgery or in-house) or emergency room consult:  The responsible resident must communicate with the appropriate secretary what the follow-up appointment will be.  Surgical forms, x-ray and laboratory requisitions must be completed.  You must indicate who the attending back-up is.

Interns/Students

  • Residents orient intern and medical students to the service.  New medical students should not be sent directly to the clinic.  The Senior Resident is responsible to introduce interns and medical students to the Administrative Assistant, Residency Coordinators, secretaries, nurses and faculty.  The Senior Resident shall notify the Surgical Coordinator, of any upcoming vacation plans of the intern while on the Urology rotation.

Laboratory and X-Ray Results

  • The resident requesting laboratory or x-ray testing should document on the requisition their name and the attendings name.  If the resident follows-up on the results it must be documented in CIS.

Lockers

  • OR lockers are assigned to all new residents.  These lockers are assigned for the length of residency.

Memberships

  • Section pays membership dues to the American Urological Association, Inc. which includes the Journal of Urology.  The Residency Coordinator processes this payment.  If you receive an invoice at your home address please bring it to her for payment and processing.

Office Resources and Personnel

  • Computers are located in the Residents' Office.  Please do not use the secretaries computers.  DHMC has a very strict computer user policy. We are obligated to adhere to this policy.
  • Support personnel are available to assist residents and faculty.  The Surgical Coordinator is avaiable to assist with pre-op, surgical bookings and precertification.

Operating Room

  • Operative Note Dictation:  Discussed and assigned in the Operating Room.  Ideally op notes are dictated the day that the case is done.  Cases are also logged into the ACGME website.

Physician Orders

  • History and Physicals (Pre-op):  Are done by the resident or intern.  The Same Day Program Physician Record is to be filled out or a preop note written in CIS and the consent is to be done.  See the Surgical Coordinator before seeing the patient to obtain the surgical date, procedure to be done and to review specific directions that are written on the  booking sheet.  It is also useful to review the urologists notes in CIS.  After the H&P has been completed direct the patient to Pre-Admission Testing if this is required.  The service sheet needs to be filled out and given to the nurses.  If the attending saw the patient on the same day that you are doing the H&P give the service sheet to them.
  • SWL Protocols:  KUB pre-op if the stone is visible.  Recent noncontrast CT scan or renal ultrasound for nonopaque renal stones that will be visualized by ultrasound.  Any patient with a stent will receive Gentamycisn 80-mg IV OCTOR.  Patients are all sent home with a narcotic for pain meds.  Stented patients are sent home with 3 days of antibiotics (macrobid or bactrim).
  • Radical Prostatectomy Pre-Op Instructions:  Only clear liquids 48-hours prior to surgery.  Fleets enema prep kit #3 at 2pm.  Nothing by mouth (solids or liquids) after midnight the evening prior to surgery.
  • PV Sling Protocol:  Emphasize:  They will stay in the hospital overnight and most likely go home on the day after surgery.  They should practice performing clean (not sterile) self-intermittent catheterization at home prior to surgery.  (The urology nurses instruct patients in how to do this).  They will initially have a vaginal pack and foley catheter which will usually be removed the day following the surgery.
    • Pre-Op Orders:  No lab work (if young and healthy), ECG and CXR if required by anesthesia or complicated medical disease present.  TEDS and venodynes OCTOR.  Kefzol, 1gm, OCTOR.  (If heart valve or artificial joint than Ampicillin and Gentamicin).
    • Post-Op Orders:  Antiemetic given in the OR. Ambulate ASAP and D/C venodynes when ambulating.  IVF at not more than maintenance.  Regular diet, Toradol 30-mg IV, q6h x 3 doses (not PRN), 1st dose on arrival of PACU (if patient is frail or over 65 then 15-mg IV q 6-hours).  Percocet, 1-2 tabs, po q 4-hours, PRN, Kefzol, 1gm, IV q 8-hours x2 doses post-op (not x 24-hours).  No post-op labs unless there was an unusual amount of bleeding.
  • TRUS (Transrectal ultrasound with biopsy):  Patient is given a "Transrectal Prostate Biopsy" brochure with information.  Patient given a prescription for #6 Cipro, 500-mg tablets, 1 tablet at bedtime the night before biopsy, 1 tablet the morning of biopsy and 2 tablets daily for 2 days post biopsy.  Patient to administer a Fleets enema one hour before leaving home.  Inform patient to cease all medications that contains aspirin or blood thinners 7 days prior to ultrasound.
  • Urine Results:  Urine results anticipated to come in on the weekend will be the responsibility of the resident on-call.  The nurses inform the resident on-call on Friday which patients have outstanding results to be addressed on Saturday or Sunday.  Treatments will be documented in CIS (both on the patient's drug list and as a phone note in CIS).

Recruitment

Residents

  • Attendance at both the interview days and the evening social event is mandatory for all residents.

Faculty

  • Generally you will meet with prospective candidates over lunch.
  • Feedback is appreciated.

Resident Responsibilities

See Below

Resident Rotations

See Below

Surgery

  • To Book an Emergency Case:
    1. Call the OR control desk at 3-3100
    2. Call the Anesthesiologist on call (pager 2509).
    3. Call the Same Day Surgical Unit
    4. Give the Surgical Coordinator a booking sheet with the CPT code so she can book the admission reservation in the computer.
    5. Do H&P and send patient to Pre-Admission Testing/Healthquiz if needed.
  • To Book and Urgent Case for the Operating Room for the Next Day:
    • If before 11:30am give booking sheet to the Surgical Coordinator.
    • If after 11:30am
      1. Call the OR control desk at 3-3100
      2. Call the Anesthesiologist on call (pager 2509)
      3. Call the Same Day Surgical Unit
      4. Give the Surgical Coordinator a booking sheet so she can book the admission reservation in the computer.
      5. Do H&P and send patient to Pre-Admission Testing.
  • To book an emergency admission call the Admitting Office for availability of a room and then give the Surgical Coordinator a booking sheet to book the admission reservation in the computer.

Surgical Log

  • The residents will be responsible to input all of their surgical experiences in the ACGME website accurately and in a timely manner.  It is anticipated that your log is submitted each Friday for the preceding week.  The Residency Coordinator and/or the Program Director will episodically review the logs.  A grace period of 7-8 days is allowed.  If a resident is greater than 8 days out of compliance they will do that number of additional days at the end of their residency.  You will be notified by e-mail regarding the number of days that you owe the program.  This will be cumulative over the years that you are in the program.
  • The Chief Resident's surgical log must be completed on the last day that they operate.  They will then meet with the Program Director to sign the log before leaving DHMC at the end of their urology residency.

TDX

  • Residents are assigned a TDX (long distance telephone access code) upon arrival at DHMC.

Vacation

  • Residents are allowed twenty-one (21) days of vacation per year, inclusive of weekends.  A vacation request form should be filled out and submitted for approval at least 30-days in advance in order to address clinic schedules.  Only one resident's request will be approved at a time, unless extenuating circumstances exist.  Residents will discuss the request with the Chief Resident before submitting the request to the Program Director.  When a clinic resident is away the 2nd year resident's clinic schedule may be cleared in order for him/her to assist in the OR.
  • It is the expectation that all residents (including Chief Residents) will work up to July 1st at their present PGY level.  Chief residents who are doing a fellowship will be granted vacation time to move prior to July 1st.  Generally no other vacation request will be approved the last 2-weeks of June of the first 2-weeks of July.

Resident Responsibilities

First Year

Learning in the first year will forcus on office urology, diagnostic procedures and the acquisition of surgical skills with emphasis on endoscopy.

Office Urology

  1. General Objective:  Understand the essentials of office urology.  Know the scope of "office urology", including office consultations, diagnostic procedures and therapeutic modalities practical in an office setting including sexual counseling.
  2. Patient Evaluation:  Develop competence in the following skills.
    1. History and physical examination
    2. Urine studies:
      1. Routine urinalysis
      2. Residual urine measurement
    3. Semen analysis
    4. Urologic radiology (interpretation)
    5. Urologic instrumentation:
      1. Cystoscopy
  3. Office Therapy
    1. Acquire skills in identifying and treating urologic disease in the office, including:
      1. Benign prostatic hypertrophy
      2. Bladder outflow obstruction
      3. Calculus disease
      4. Cancer of the bladder
      5. Cancer of the kidney
      6. Cancer of the penis
      7. Cancer of the prostate
      8. Cancer of the renal pelvis and ureter
      9. Cancer of the testes
      10. Cancer of the urethra
      11. Testicular maldescent
      12. Cystic disease of the kidney
      13. Enuresis
      14. Epispadias and exstrophy
      15. Erectile dysfunction
      16. Fistulae
      17. Genitourinary tract infections
      18. Hypospadias
      19. Incontinence
      20. Infertility
      21. Intersex
      22. Neurogenic bladder
      23. Non-bacterial cystitis, prostatitis and urethritis
      24. Obstructive uropathy
      25. Priapism
      26. Renovascular hypertension
      27. Trauma
      28. Ureteropelvic junction obstruction
      29. Urethral stricture
      30. Urinary diversion
      31. Vesicoureteral reflux
      32. Acute scrotum
    2. Acquire skill in performing the folloing procedures:
      1. Cystoscopy/urethroscopy
      2. Removal of stents
      3. Urethral dilation
      4. Local therapy (instillation of medication) including treatment of complications
      5. Catheter care, including:
        1. Nephrostomy tube care and changes
        2. Cystostomy tube care and changes
        3. Urethral catheter care and changes
        4. Ureterostomy tube care and changes
      6. Stoma care
      7. Wound care
      8. Vasectomy

Diagnostic Procedures in Clinical Urology

  1. General Objective:  Acquire the knowledge to understand:
    1. The clinical setting in which diagnostic procedures are indicated.
    2. The appropriate diagnostic maneuvers for definition of specifically named disease states, and the potential value, limitations and hazards of each diagnostic maneuver.
    3. The physiologic basis for each diagnostic procedure.
    4. The results of each study.  Demonstrate proficiency in explaining the hazards, costs, risks and benefits to the patient.
  2. Urinalysis
    1. Know the items that may be examined during urinalysis and the disease oriented implication of any abnormality.  This list may include:  specific gravity, proteinuria, glucosuria, hematuria, bacteriuria, pyuria, crystaluria, and casts.
    2. Know the general disease states that may involve the urinary tract, the abnormalities of urinalysis that may accompany these disease states and the reasons for these abnormalities.  This list may include:  inflammatory disease, malignant disease, calculus disease, diabetes mellitus, diabetes insipidus, and renal tubular acidosis.
  3. Post Void Residual
    1. Know how to measure a post-void residual with a catheter and with ultrasound.  Understand the limitations or risks of both these methods.
    2. Know the general disease states that may involve the urinary tract, the emptying disorders that may accompany these disease states and the reasons for these abnormalities.  This list may include:  neurogenic disease, bladder outlet obstruction, and diabetes insipidus.
  4. Semen Analysis
    1. Know the criteria that may be examined during semen analysis and the implications of any abnormality.
  5. Urologic Radiology
    1. Know the forms of contrast imaging techniques available for diagnostic evaluation of the urinary tract, the indications for, limitations and hazards of each procedure.
      1. IV excretory urography
      2. Retrograde pyelography
      3. Cystography
      4. Retrograde urethrography
      5. Antegrade percutaneous pyelogram
      6. Ileal loop-o-gram
      7. Voiding cystourethrography
      8. CAT scan
      9. MRI scan
      10. Angiography and venocavography
      11. Vasography
      12. Cavernosography
    2. Understand the methodology, indications and hazards of ultrasonography of the urinary tract and male genitalia.
    3. Undrstand the principles, methodology, indications and hazards of radioisotope studies of the urinary tract and male genitalia, and be able to interpret the results of these studies.
      1. Renal scans
      2. Measurement of renal function
      3. Localization of inflammatory lesions
      4. Bone scans
  6. Understand the Indications for a Urodynamic Assessment
    1. Cystometrogram
    2. Urine flowmetry
    3. Pelvic floor EMG
    4. Voiding/pressure studies
    5. Urethral pressure profile

Surgical Skills

  1. General Objective:  Understand the principles, methodology, indications and hzards of the following procedures and perform them with supervision.
    1. Cystoscopy and urethroscopy
    2. Urethral dilation
    3. Urethral or vesical biopsy
    4. Fulguration of minor lesions
    5. Transurethral resection of small bladder tumors
    6. Internal urethrotomy
    7. Retrograde and antegrade urethrograms
    8. Injection of bulking agents for incontinuence or reflux
    9. Litholapaxy
    10. SWL
    11. Urethral meatotomy
    12. Insertion of cystocath
    13. Open suprapubic cystostomy
    14. Circumcision
    15. Penile biopsy
    16. Testicular biopsy
    17. Vasectomy
    18. Vasotomy and vasography
    19. Cystolithotomy
    20. Drainage of abscess
    21. Orchiectomy - scrotal or inguinal
    22. Epididymectomy and excision of epidymal tumors
    23. Ligature of spermatic veins for varicocele
    24. Surgery for hydrocele or spermatocele
    25. Testicular prosthesis
    26. Excision of renal cyst-open or laparoscopic
    27. Penile irrigation for priapism
    28. Open renal surgery-including simple nephrectomy, renal biopsy
    29. Laparoscopy-for testicular maldescent, simple nephrectomy

Second Year

Learning in the 2nd year will focus on transplantation, research, ultrasound, urodynamics and pathology.

Transplantation

  1. General Objective:  To become familiar with the biology of histocompatibility, the process of donor and recipient selection, renal perfusion and preservation and the procedure of transplantation.  In addition the resident should be competent in the techniques of donor nephrectomy.
  2. Evaluation
    1. Donor Evaluation:  Discuss criteria of selection and management:
      1. Living related donors
        1. The significance of histocompatibility testing
        2. Methods of assessment; history, physical, laboratory tests, radiographic studies
      2. Cadaver Donors
        1. The role of histocompatibility testing
        2. Diseases precluding kidney donation
        3. Methods used to optimize renal function prior to nephrectomy
        4. Determination of brain death
    2. Recipient Evaluation
      1. Risk factors
      2. Alternate forms of treatment
      3. Indications for pre-transplant nephrectomy
      4. Evaluation of the lower urinary tract
  3. Surgical Techniques
    1. Renal Perfusion and Preservation:  Should understand the following:
      1. The reason for flushing and cooling
      2. The major techniques of renal perfusion and preservation
      3. The composition of a satisfactory perfusate
      4. Approaches for improving renal viability
    2. Surgery
      1. Acquire competence in the proper technique of live and cadaver donor nephrectomy.
      2. Acquire competence in the technique of vascular anastomosis in transplantation including:
        1. Uncomplicated adult transplant
      3. Acquire competence in methods of urinary tract restoration including ureteroneocystostomy and ureteropyelostomy.
  4. Complications
    1. Surgical Complications:
      1. Acquire competence in the management of post-operative surgical complications including ureteric obstructin, necrosis, fistula, and lymphocele.
    2. Rejection:
      1. Understand the mechanism of rejection, its clinical manifestations and diagnosis.
      2. Understand the methods (including their complications) used for the prevention and treatment of rejection.

Specialties

Radiology

  1. General Objective:  Understand the methodology, indications and hazards and be able to perform and interpret the results of ultrasonography of the urinary tract and male genitalia.
    1. TRUS and biopsy
    2. Renal biopsy

Urodynamics

  1. General Objective:  Understand, be able to perform and interpret a urodynamic assessment.
    1. Cystometrogram
    2. Urine flowmetry
    3. Pelvic floor electromyography
    4. Voiding/pressure studies
    5. Urethral pressure profile

Pathology

  1. General Objective:  Using gross and microscopic features become proficient in identifying and differentiating the following:
    1. Kidney cancer
    2. Ureter and renal pelvis
    3. Bladder cancer
    4. Prostate cancer
    5. Penile lesions
    6. Testicular cancer
    7. Urethral lesions
    8. Adrenal lesions

Research

  1. General Objective:  The resident should understand the purpose of research and be familiar with the use of reference material in managing clinical problems.  The resident shall complete at least one research project.
    1. Demonstrate ability to find answers to questions via literature search and review
    2. Demonstrate ability to formulate a research plan to answer questions
    3. Demonstrate understanding of basic statistical methods
    4. Be able to critically review journal articles and clinical trials
    5. Submit a research proposal to a funding agency
    6. Be familiar with the ethical principles of human/animal experimentation
    7. Submit a research proposal to a human or animal rsearch review committee
    8. Demonstrate ability to perform and complete a given research project
    9. Acquire techniques of data presentation:
      1. Slide design
      2. Oral presentation or poster presentation
      3. Journal article

Third Year

The third year resident will continue to hone his/her diagnostic skills and his/her skills in office urology.  He/she will also increase their operative load.

Surgical Skills

  1. General Objective:  The resident should understand the principles, methodology, indications and hazards of the following procedures and perform them with supervision.
    1. Transurethral resection of bladder tumors
    2. Transurethral resection of uretercele
    3. Transurethral resection of urethral valves
    4. Transurethral prostatectomy
    5. Ureteroscopy and endoscopic management of stone and stricture disease
    6. Percutaneous nephrostolithotomy
    7. Orchiopexy for testicular maldescent
    8. Open renal surgery including nephrostomy, pyelostomy, nephrolithotomy, pyelolithotomy
    9. Partial nephrectomy
    10. Radical nephrectomy including thoracoabdominal and laparoscopic approach
    11. Nephrourecterectomy
    12. Pyeloplasty
    13. Ureterolithtomy
    14. Ureteroplasty
    15. Ureterolysis
    16. Uretero-ureterostomy
    17. Uretero-neocystostomy
    18. Uretero-sigmoidostomy
    19. Ileal and sigmoid conduit
    20. Cutaneous ureterostomy
    21. Diverticulectomy of bladder
    22. Partial cystectomy
    23. Closure of vesicovaginal fistula
    24. Urethrolysis
    25. Prostatectomy - simple open, radical open or laparoscopically
    26. Urethrectomy
    27. Excision urethral diverticulum
    28. Anterior and posterior urethroplasty
    29. Urethrovesical suspension or sling procedure
    30. Amputation of penis
    31. Shunt for priapism
    32. Vaso-vasostomy
    33. Plastic correction of hypospadias and epispadias
    34. Adrenalectomy
    35. Insertion of penile prosthesis
    36. Correction of penile curvature

Fourth Year - Chief Resident

The Chief Resident will be responsible for the entire service.  He/she will assign operative cases to their more junior residents.  He/she should insure that their personal experience is adequate in all types of cases.  He/she should preferentially assign more complex cases to themselves.  The Chief Resident will have teaching and administrative responsibilities including the overseeing of morning rounds. 

Surgical Skills

  1. General Objective:  The resident should understand the principles, methodology, indications and hazards of the following procedures and perform them with supervision.
    1. Ileal ureter
    2. Total cystectomy
    3. Radical cystectomy
    4. Pelvic exenteration
    5. Inguinal, pelvic and retroperitoneal lymphadenectomy
    6. Augmentation cystoplasty
    7. Epididymo-vasostomy
    8. Seminal vesiculectomy
    9. Insertion of artificial sphincter
    10. Laparoscopic nephrectomy
    11. Laparoscopic adrenalectomy
    12. Laparoscopic radical prostatectomy

Teaching and Administrative Skills

  1. General Objective:  The resident should accept personal responsibility for continued personal growth. 
    1. The resident should accept responsibility for participation in activities that further good patient care and are necessary for administration of patient care facilities.
    2. The resident should assume responsibility for teaching patients, colleagues, medical students and allied health personnel.