Urology resident objectives.doc
Upcoming SlideShare
Loading in...5
×
 

Urology resident objectives.doc

on

  • 999 views

 

Statistics

Views

Total Views
999
Views on SlideShare
999
Embed Views
0

Actions

Likes
0
Downloads
14
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft Word

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Urology resident objectives.doc Urology resident objectives.doc Document Transcript

    • Abbreviated Core Urology Objectives PGY 3-5 and PGY 1-2 on Urology Rotation PGY 1 and 2 core objectives found at http://meds.www.queens-urology.ca Further rotation specific objectives for core residents can be found in the Urology Syllabus PGY 1-2 Urology rotation Medical Expert/Knowledge-based and procedural-based competencies • evaluation and principles of management of a patient with hematuria (microscopic and gross) • evaluation of a patient with acute renal, bladder or urethral injury and principles of management • diagnosis and treatment of a patient with urinary infection including: acute cystitis and pyelonephritis, recurrent cystitis, persistent urinary tract infection, prostatitis (acute and chronic) and epididymo-orchitis • diagnosis and management of a patient with a common urological malignancy including the treatment options for the various stages of carcinoma prostate, bladder, testis and kidney with an understanding of the multidisciplinary approaches to these disease processes including the palliative care of a patient with advanced stage metastatic carcinoma • diagnosis and management of a patient with urinary obstruction (prostatic, bladder neck or ureteric) • diagnosis and management options for a patient with urolithiasis (including acute renal colic and chronic renal calculi) • evaluation and diagnosis of the common paediatric urological problems including hydrocele, cryptorchidism, ureteropelvic junction obstruction and vesicoureteric reflux • evaluation and diagnosis of various forms of urinary incontinence • diagnosis and management of various scrotal masses including hydrocele, epididymal cysts, orchitis, testis tumor, varicocele, torsion testis or appendages • principles and practice of renal transplantation - including organ harvesting including multi-organ harvesting, organ preservation, implantation and immunosuppression • psychological and emotional aspects of urological diseases including the emotional implications of a diagnosis of malignant disease, anaesthetic hazards in the elderly and in the management of acute confusional states in the elderly, medical/legal and ethical issues arising in urological patients with respect to transplantation, infertility and impotence evaluation, and the awareness of the concept of body image in surgical patients. Principles of Preoperative Assessment of the Surgical Patient • routine preoperative assessment of surgical patient with particular reference to patients with renal disease • assessment of patients with various co-morbidities (cardiac, pulmonary, renal and metabolic) • examination and management of a patient in shock (septic due to urinary infection vs. hypovolemic, neurogenic, cardiogenic shock) Emergency Urological Care: • management of the patient with an acute ureteric colic • management of the patient with acute urinary infection including a patient with urosepsis • management of a child with an acute scrotum • principles of management of a patient with urological trauma • suprapubic catheterization Technical Skills: • catheterization including urinary catheter care. • urethral manipulation and dilatation using filiforms and followers • cystoscopy • installation of intravesical therapeutic agents • wound closure 1
    • • vasectomy (if resident is so interested) • introduction to therapeutic technologies including electrosurgery, Extracoporeal Shock Wave Lithotripsy, lasers in urology (carbon dioxide, Nd/YAG, Holmium-YAG). DIAGNOSTIC SKILLS: • Urinalysis, including routine urinalysis, urine culture techniques, urinary collections for metabolic studies and urine cytologic studies • Renal function tests • Adrenal function tests • Tumor markers – e.g. alpha-feto protein, b-HCG, PSA, etc. • Radiological Studies Including intravenous excretory urography voiding cystourethrography • Ultrasonography – including doppler studies • Radioisotope Studies • CT scanning and MRI Scanning of the urinary tract Communicator The resident will be able to: Establish therapeutic relationships with patients and families and primary care givers. Obtain and synthesize relevant history from patients, families and communities. Listen effectively. Record accurately and succinctly data collected from patients, laboratory tests and radiological studies Discuss appropriate information with patients and families and the health care team. Be sensitive to patients fears, anxieties and needs for privacy Collaborator The resident will be able to: Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. Manager The resident will be able to: Utilize personal resources effectively to balance patient care, learning needs and outside activities. Understand health care resources are finite Work effectively and efficiently in a health care organization. Health Advocate The resident will be able to: Identify the important determinants of health affecting patients with urological disease. Recognize those issues where advocacy may be appropriate. Scholar The resident will be able to: Develop a personal continuing education strategy to ensure life-long professional growth. Critically appraise sources of medical information. Facilitate learning of patients, housestaff/students and other health professionals. To use information technology to optimize patient care, life-long learning and other activities 1. Demonstrate continuing evaluation of their own capabilities and limitations. 2
    • 2. Develop techniques for continuous improvement, information acquisition and information handling and participate in the quality improvement and quality assurance programs of the institutions in which they practice. 3. Maintain an inquisitive attitude, and understand the time commitment required for ongoing self-study for the maintenance of competence. 4. Demonstrate the use of data bases for literature searches and reviews. 5. Formulate a research plan to answer clinical problems. 6. Understand the ethics of animal and human experimentation. 7. Describe basic statistical methods used in clinical trials. 8. Residents will be able to critically evaluate reports of clinical trials and research protocols. All residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis. Professional The resident will be able to: Deliver highest quality care with integrity, honesty and compassion. Exhibit appropriate personal and interpersonal professional behaviours. Practice medicine ethically consistent with the obligations of a physician. PGY 3 Urology ROTATION SPECIFIC OBJECTIVES FIRST 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the junior resident should be able to demonstrate by the completion of the first 4 month rotation. Congenital and Developmental Abnormalities Cystic Diseases of the Kidney Horseshoe Kidney and Other Renal Anomalies Scrotal and External Genital Anomalies Obstructive Disease of the Lower Urinary Tract Bladder Outflow Obstruction Benign Prostatic Hypertrophy Lower Urinary Tract Symptoms (“LUTS”) Urinary Calculus Disease Renal and Ureteral Calculi Urinary and Genital Infections, and Sexually Transmitted Disease Bacterial (complicated and uncomplicated) and non-bacterial cystitis and urethritis Pyelonephritis and other renal infections Trauma (including the management and evaluation of a patient with multisystem trauma involving the GU Tract and the role of the urologist in multidisciplinary approach to multisystem trauma) Renal Trauma Ureteral Trauma 3
    • Urological Oncology For tumors (benign and malignant) of the genito-urinary tract, the junior resident should be able to describe the etiology, prevention, nutritional and environmental aspects of urologic malignant disease, including the natural history, histology and pathology. Renal cell carcinoma - etiology (including von Hippel Lindau syndrome) Transitional Cell Carcinoma of the bladder Adenocarcinoma of the prostate: Voiding Disorders including Relevant Neurourology Urinary incontinence (including stress urinary incontinence, urgency incontinence, total incontinence) Enuresis DIAGNOSTIC SKILLS The junior resident will understand the indications for the following investigative techniques of specific importance to the practice of urology, and the physiologic basis for each study. Urinalysis a. routine urinalysis b. urine culture techniques c. urinary collections for metabolic studies d. urine cytologic studies Biochemical Serum Studies a. Renal function tests b. Adrenal function tests c. Tumor markers – e.g. alpha-feto protein, b-HCG, PSA, etc. Imaging Studies The junior residents will demonstrate knowledge of the application of each of the following techniques to particular clinical situations, including the indications, interpretation, potential complications and management of complications for each technique, and the use of appropriate contrast agents when indicated: Intravenous excretory urography Voiding cystourethrography Ultrasonography - The principles and application of ultrasound techniques for imaging:  kidney  bladder Radioisotope Studies - The indications, application to clinical urology, principles, pharmacokinetics and application of radiopharmaceuticals used in:  renal imaging (including function studies) CT scanning and MRI Scanning of the urinary tract Diagnostic Histopathology The resident will be able to describe and recognize the gross and microscopic characteristics of the following: malignant lesions of the kidney - renal cell carcinoma, Wilm's tumor benign lesions of the kidney - oncocytoma, angiomyolipoma urothelial neoplasms of the renal pelvis, ureter, bladder and urethra Surgical Skills Endoscopic Procedures: Cystoscopy and urethroscopy, ureteric catheterization including ureteric stent insertion and removal, retrograde pyelography Urethral dilatation and visual internal urethrotomy Transurethral biopsy of bladder and urethra 4
    • Open Surgery Circumcision Suprapubic catheterization Urethral meatotomy, meatoplasty Scrotal surgery - hydrocele, epididymal cyst, epididymectomy, simple orchidectomy Laparotomy Communicator General Requirements: Establish therapeutic relationships with patients and families and primary care givers. Obtain and synthesise relevant history from patients, families and communities. Listen effectively. Discuss appropriate information with patients and families and the health care team. To achieve these objectives, the junior residents must develop the ability to: 1. Record accurately and succinctly data collected from patients, laboratory tests and radiological studies and to communicate conclusions based on these data to referring physicians and other involved health care personnel; 2. Be sensitive to patients fears, anxieties and needs for privacy; 3. Be able to explain clearly and concisely: a. management plans to other health care personnel in a way that ensures their effective participation; b. steps necessary for problem management when acting as a consultant for other physicians, particularly in the situation of consults in the emergency room or on the telephone with primary care givers. c. Ensure adequate information has been given to the patient prior to undergoing an invasive procedure Collaborator General Requirements: Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. To achieve these objectives, the junior resident must develop the ability to: 1. Interact effectively with: a. personnel in community service agencies, b. other health care personnel, for example, attending in discharge planning C. PATIENTS FROM ALL VARYING LIFESTYLES, SOCIOECONOMIC BACKGROUNDS AND VALUE SYSTEMS ALWAYS RESPECTING THE CONFIDENTIALITY OF THE PATIENT-PHYSICIAN RELATIONSHIP. (IE. CLINICS IN MOOSE FACTORY) 2. Accept responsibility for participation in activities that foster good patient care, including contributions to the administration of patient care facilities (such as in the OR or in the clinic). 3. Participate in professional organizations – such as the CUA, AUA and SLUG. Manager General Requirements: Utilize personal resources effectively to balance patient care, learning needs and outside activities. Allocate finite health care resources wisely. Work effectively and efficiently in a health care organization. Utilize information technology to optimize patient care and life-long learning and other activities. To achieve these objectives, the junior resident must develop the ability to: 5
    • 1. Access appropriate urological diagnostic and therapeutic technology in a timely and efficient manner to benefit all patients, especially in hospital given constraints of long admissions. (Discharge planning rounds) 2. Maintain a sytematic program of self directed learning suitable for life long learning. (preparing for didactic rounds) Health Advocate General Requirements: Identify the important determinants of health affecting patients with urological disease. Contribute effectively to improved health of patients and communities. Recognise and respond to those issues where advocacy is appropriate. To achieve these objectives, the junior resident must develop the ability to: 1. Recognize the importance and existance of community based patient support groups such as the Prostate Cancer Support Group. 2. Understand the role and function of the Canadian Urological Association and related urological societies in support of urologists and the urological care in Canada and internationally. Scholar General Requirements: Develop, implement, and monitor a personal continuing education strategy to ensure life-long professional growth. Critically appraise sources of medical information. Facilitate learning of patients, medical students and other health professionals. Contribute to the development of new knowledge. To use information technology to optimize patient care, life-long learning and other activities To achieve these objectives, the junior resident must develop the ability to: 1. Demonstrate continuing evaluation of their own capabilities and limitations. 2. Develop techniques for continuous improvement, information acquisition and information handling and participate in the quality improvement and quality assurance programs of the institutions. 3. Maintain an inquisitive attitude, and understand the time commitment required for ongoing self-study for the maintenance of competence. 4. Demonstrate the use of data bases for literature searches and reviews. 5. Formulate a research plan to answer clinical problems. 6. Understand the ethics of animal and human experimentation. 7. Describe basic statistical methods used in clinical trials. 8. Residents will be able to critically evaluate reports of clinical trials and research protocols. All residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis. Professional General Requirements: Deliver highest quality care with integrity, honesty and compassion. Exhibit appropriate personal and interpersonal professional behaviours. Practice medicine ethically consistent with the obligations of a physician. To achieve these objectives, the junior resident must develop the ability to: 1. Demonstrate personal responsibility to patients by availability, confidentiality and respect for each patient's physical and emotional comfort. 2. Demonstrate adherence to the best available practice, including referral to other qualified practitioners when appropriate. 6
    • 3. Demonstrate meticulous accuracy in reporting clinical and scientific information. 4. Demonstrate knowledge of the ethical problems of human organ procurement for the purposes of transplantation. 5. Demonstrate a working knowledge of provincial and federal laws and regulations related to the practice of medicine in general and urology in particular. 6. Demonstrate an understanding and appreciation for patients' legal rights in matters related to informed consent, delegated consent and informed decision making. 7. Understand medical protective procedures and the role of the Canadian Medical Protective Association in areas of patient-physician dispute. 8. Be aware of their own feelings and biases and recognise any personal reactions which may be detrimental to physician-patient relationships because of these feelings or biases and explore and willingly accept possible ways of changing detrimental or prejudicial feelings. 9. Identify a colleague or faculty member with whom they may discuss personal and professional goals, conflicts and stresses. PGY 3 Urology ROTATION SPECIFIC OBJECTIVES SECOND 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the junior resident should be able to demonstrate by the completion of the second 4 month rotation. Cognitive Skills Congenital and Developmental Abnormalities Bladder and Urethra Vesicoureteral reflux Epispadias and Extrophy Hypospadias and chordee Other anomalies Obstructive Disease of the Upper Urinary Tract Obstructive Uropathy, Hydronephrosis and Obstructive Renal Failure Ureteropelvic Junction Obstruction Obstructive Disease of the Lower Urinary Tract Bladder Outflow Obstruction Benign Prostatic Hypertrophy Lower Urinary Tract Symptoms (“LUTS”) Urinary Calculus Disease Bladder Calculi Trauma Renal Trauma Ureteral Trauma Vesical Trauma Urethral Trauma External Genital Trauma 7
    • Urological Oncology Cancer of the kidney: Renal adenocarcinoma - etiology (including von Hippel Lindau syndrome) Transitional Cell Carcinoma of Renal Pelvis and Ureter Angiomyolipoma Cancer of the prostate: Adenocarcinoma PIN Cancer of the testis: Germ cell (including seminoma and non-seminoma ) Non-germ cell tumors Voiding Disorders including Relevant Neurourology Urinary incontinence (including stress urinary incontinence, urgency incontinence, total incontinence) Voiding dysfunction due to neurological disease Systemic Diseases and Other Processes Affecting the Urinary Tract Miscellaneous External Genital problems (including hydrocele, varicocele, spermatocele, cysts) Torsion of testis, cord and appendages Dermatological lesions of the male external genitalia (including benign, pre-malignant and malignant lesions) Interstitial Cystitis Male Sexual Dysfunction Imaging Studies intravenous excretory urography retrograde urethrography, cystography and pyelography antegrade pyelography loop-o-graphy voiding cystourethrography Ultrasonography - The principles and application of ultrasound techniques for imaging: kidney bladder prostate (including transrectal ultrasonography) scrotal contents Doppler studies of renal, gonadal and penile vessels Radioisotope Studies - scans for adrenal localization CT scanning and MRI Scanning of the urinary tract Urodynamic Studies cystometrogram uroflowmetry voiding pressure studies 8
    • Diagnostic Histopathology testis tumors - including germ cell tumors, (seminoma and non-seminoma), functional tumors of the testis (Leydig tumors), Sertoli tumors inflammatory lesions of the kidney - xanthogranulomatous pyelonephritis, tuberculosis, chronic pyelonephritis inflammatory lesions of the lower urinary tract - interstitial cystitis, cystitis cystica, cystitis glandularis, cystitis follicularis, prostatitis Therapeutic Technologies Electrosurgery Extracoporeal Shock Wave Lithotripsy Lasers in urology - carbon dioxide, Nd/YAG, Holmium-YAG, etc. SURGICAL SKILLS Endoscopic Procedures: Cystoscopy and urethroscopy, ureteric catheterization including ureteric stent insertion and removal, retrograde pyelography Urethral dilatation and visual internal urethrotomy Transurethral biopsy of bladder and urethra Transurethral resection of prostate Transurethral resection of bladder tumors Ureteroscopy and lithotripsy of ureteric calculi Open Procedures Circumcision Suprapubic catheterization Fulguration of venereal warts, biopsy of penile lesions Scrotal surgery - hydrocele, epididymal cyst, epididymectomy, simple orchidectomy Inguinal surgery - varicocele, herniotomy, orchidopexy 1. Demonstrate personal responsibility to patients by availability, confidentiality and respect for each patient's physical and emotional comfort. 2. Demonstrate adherence to the best available practice, including referral to other qualified practitioners when appropriate. 3. Demonstrate meticulous accuracy in reporting clinical and scientific information. 4. Demonstrate knowledge of the ethical problems of human organ procurement for the purposes of transplantation. 5. Demonstrate a working knowledge of provincial and federal laws and regulations related to the practice of medicine in general and urology in particular. 6. Demonstrate an understanding and appreciation for patients' legal rights in matters related to informed consent, delegated consent and informed decision making. 7. Understand medical protective procedures and the role of the Canadian Medical Protective Association in areas of patient-physician dispute. 8. Be aware of their own feelings and biases and recognize any personal reactions which may be detrimental to physician-patient relationships because of these feelings or biases and explore and willingly accept possible ways of changing detrimental or prejudicial feelings. 9. Identify a colleague or faculty member with whom they may discuss personal and professional goals, conflicts and stresses. PGY 3 Urology ROTATION SPECIFIC OBJECTIVES 9
    • THIRD 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the junior resident should be able to demonstrate by the completion of the third 4 month rotation. Cognitive Skills Congenital and Developmental Abnormalities c External Genital Anomalies Intersex Undescended Testis Scrotal and External Genital Anomalies Obstructive Disease of the Lower Urinary Tract Bladder Outflow Obstruction Posterior Urethral Valves Functional Obstruction secondary to Neurological Disorders Urinary Calculus Disease Renal and Ureteral Calculi Bladder Calculi Urinary and Genital Infections, and Sexually Transmitted Disease Prostatitis including Prostatodynia Sexually transmitted diseases Genito-urinary tuberculosis Fungal/yeast urinary tract infections Other granulomatous infections (including xanthogranulomatous disease) Other Genital Infections (including Fournier’s gangrene) Renovascular Hypertension Surgically Correctable Hypertension Renal Transplantation Recipient selection Relevant transplantation immunology Immunosuppresion (including principles of management of rejection) Andrology Male Sexual Function and Dysfunction Fertility and Male factor Infertility Urological Oncology Cancer of the kidney: Renal adenocarcinoma - etiology (including von Hippel Lindau syndrome) Wilm's Tumor Transitional Cell Carcinoma of Renal Pelvis and Ureter Angiomyolipoma Other Tumors 10
    • Cancer of the bladder: Transitional Cell Carcinoma Squamous Cell Carcinoma Other Tumors Cancer of the prostate: Adenocarcinoma Other tumors Cancer of the testis: Germ cell (including seminoma and non-seminoma ) Non-germ cell tumors Cancer of the adrenal: Pheochromocytoma Neuroblastoma Adrenal adenoma and adenocarcinoma "Incidentaloma" Other tumors Voiding Disorders including Relevant Neurourology Urinary incontinence (including stress urinary incontinence, urgency incontinence, total incontinence) Functional Voiding Disorders Adrenal Diseases Adrenal cysts, hyperplasia Adrenal hyperfunction and hypofunction and associated syndromes Systemic Diseases and Other Processes Affecting the Urinary Tract Urological manifestations of systemic diseases (including e.g. diabetes mellitus, sepsis, AIDS, immunocompromised or immunoincompetent patients) The urinary tract in pregnancy (including normal physiologic and anatomic changes and management of urinary tract problems in the pregnant patient) Miscellaneous External Genital problems (including hydrocele, varicocele, spermatocele, cysts) Torsion of testis, cord and appendages Dermatological lesions of the male external genitalia (including benign, pre-malignant and malignant lesions) Interstitial Cystitis Imaging Studies Radiological Studies - intravenous excretory urography angiography of the kidneys and pelvic vessels venography (including vena cavography) loop-o-graphy voiding cystourethrography Ultrasonography - Radioisotope Studies - The indications, application to clinical urology, principles, pharmacokinetics and application of radiopharmaceuticals used in: renal imaging (including function studies) 11
    • voiding cystograms bone scans for staging of malignant disease for adrenal localization CT scanning and MRI Scanning of the urinary tract Urodynamic Studies cystometrogram uroflowmetry voiding pressure studies pelvic floor electromyography videourodynamic studies Therapeutic Technologies The junior resident will be able to describe the basic physics and technological application of the following therapeutic modalities. He/she will be able to describe the indications, contraindications, peri-operative and post-operative complications specific for each modality: Electrosurgery Extracoporeal Shock Wave Lithotripsy Lasers in urology - carbon dioxide, Nd/YAG, Holmium-YAG, etc. Transurethral prostatic hyperthermia/thermotherapy and other alternative modalities used in the management of patients with benign prostatic hyperplasia SURGICAL SKILLS Endoscopic Procedures: Transurethral resection of prostate Transurethral resection of bladder tumors Transurethral resection/ incision of ureterocele Ureteroscopy and lithotripsy of ureteric calculi Percutaneous renal surgery including nephrolithotomy with ultrasound / electrohydraulic / laser lithotripsy Open Surgical Procedures: Circumcision Suprapubic catheterization Cavernosal shunting procedures for priapism Testis biopsy Vasectomy Inguinal surgery - varicocele, herniotomy, orchidopexy Radical orchidectomy Repair of testis torsion Orchidopexy for undescended testis Insertion testis prosthesis Vesical neck suspension and procedures for stress urinary incontinence Pelvic lymphadenectomy PGY 4 Urology ROTATION SPECIFIC OBJECTIVES FIRST 4 MONTHS 12
    • Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the senior resident should be able to demonstrate by the completion of the first 4 month rotation. Cognitive Skills Congenital and Developmental Abnormalities Kidney and Ureter Cystic Diseases of the Kidney Horseshoe Kidney and Other Renal Anomalies Duplication, Retrocaval ureter and Other Anomalies Obstructive Disease of the Upper Urinary Tract Obstructive Uropathy, Hydronephrosis and Obstructive Renal Failure Ureteropelvic Junction Obstruction Urinary Fistulae Obstructive Disease of the Lower Urinary Tract Bladder Outflow Obstruction Posterior Urethral Valves Functional Obstruction secondary to Neurological Disorders Urinary and Genital Infections, and Sexually Transmitted Disease Pyelonephritis and other renal infections Genito-urinary tuberculosis Urological Oncology Cancer of the kidney: Renal adenocarcinoma - etiology (including von Hippel Lindau syndrome) Angiomyolipoma Cancer of the bladder: Transitional Cell Carcinoma Cancer of the prostate: Adenocarcinoma Voiding Disorders including Relevant Neurourology Urinary incontinence (including stress urinary incontinence, urgency incontinence, total incontinence) Voiding dysfunction due to neurological disease Miscellaneous External Genital problems (including hydrocele, varicocele, spermatocele, cysts) Torsion of testis, cord and appendages Dermatological lesions of the male external genitalia (including benign, pre-malignant and malignant lesions) Interstitial Cystitis DIAGNOSTIC SKILLS Imaging Studies 13
    • Radiological Studies - residents will demonstrate knowledge of the application of each of the following techniques to particular clinical situations, including the indications, interpretation, potential complications and management of complications for each technique, and the use of appropriate contrast agents when indicated: intravenous excretory urography retrograde urethrography, cystography and pyelography Ultrasonography - The principles and application of ultrasound techniques for imaging: kidney bladder Radioisotope Studies - The indications, application to clinical urology, principles, pharmacokinetics and application of radiopharmaceuticals used in: renal imaging (including function studies) CT scanning and MRI Scanning of the urinary tract Surgical Skills Endoscopic Procedures: Cystoscopy and urethroscopy, ureteric catheterization including ureteric stent insertion and removal, retrograde pyelography Urethral dilatation and visual internal urethrotomy Transurethral biopsy of bladder and urethra Open Surgical Procedures: Circumcision Suprapubic catheterization Vasovasostomy Inguinal surgery - varicocele, herniotomy, orchidopexy Repair of testis torsion Orchidopexy for undescended testis Pelvic lymphadenectomy Simple retropubic prostatectomy Communicator General Requirements: Establish therapeutic relationships with patients and families and primary care givers. Obtain and synthesise relevant history from patients, families and communities. Listen effectively. Discuss appropriate information with patients and families and the health care team. To achieve these objectives, the senior residents must develop the ability to: 2. Record accurately and succinctly data collected from patients, laboratory tests and radiological studies and to communicate conclusions based on these data to referring physicians and other involved health care personnel; 2. Be sensitive to patients fears, anxieties and needs for privacy; 3. Be able to explain clearly and concisely: a. diagnosis and management plans that are understandable to patients, that motivates and facilitates patients' willing participation; 14
    • c. management plans to other health care personnel in a way that ensures their effective participation; d. steps necessary for problem management when acting as a consultant for other physicians, particularly in the situation of an intra-operative consult or ward consult. Collaborator General Requirements: Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. To achieve these objectives, the ssenior resident must develop the ability to: 1. Interact effectively with: a. personnel in community service agencies (ie Homecare), b. other health care personnel, for example, attending in discharge planning 2. Accept responsibility for participation in activities that foster good patient care, including contributions to the administration of patient care facilities. 3. Participate in professional organizations – such as the CUA, AUA and SLUG. Manager General Requirements: Utilize personal resources effectively to balance patient care, learning needs and outside activities. Allocate finite health care resources wisely. Work effectively and efficiently in a health care organization. Utilize information technology to optimize patient care and life-long learning and other activities. To achieve these objectives, the junior resident must develop the ability to: 1. Access appropriate urological diagnostic and therapeutic technology in a timely and efficient manner to benefit all of their patients, for example, arranging appropriate investigations and follow-up when on call. 2. Maintain a sytematic program of self directed learning suitable for life long learning. Health Advocate General Requirements: Identify the important determinants of health affecting patients with urological disease. Contribute effectively to improved health of patients and communities. Recognise and respond to those issues where advocacy is appropriate. To achieve these objectives, the senior resident must develop the ability to: 1. Participate with community based patient support groups such as the prostate cancer support group. 2. Understand the role and function of the Canadian Urological Association and related urological societies in support of urologists and the urological care in Canada and internationally. Scholar General Requirements: Develop, implement, and monitor a personal continuing education strategy to ensure life-long professional growth. Critically appraise sources of medical information. Facilitate learning of patients, housestaff/students and other health professionals. Contribute to the development of new knowledge. To use information technology to optimize patient care, life-long learning and other activities 15
    • To achieve these objectives, the senior resident must develop the ability to: 1. Demonstrate continuing evaluation of their own capabilities and limitations. 2. Develop techniques for continuous improvement, information acquisition and information handling and participate in the quality improvement and quality assurance programs of the institutions in which they practice. 3. Maintain an inquisitive attitude, and understand the time commitment required for ongoing self-study for the maintenance of competence. 4. Demonstrate the use of data bases for literature searches and reviews. 5. Formulate a research plan to answer clinical problems. 6. Understand the ethics of animal and human experimentation. 7. Describe basic statistical methods used in clinical trials. 8. Residents will be able to critically evaluate reports of clinical trials and research protocols. All residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis. Professional General Requirements: Deliver highest quality care with integrity, honesty and compassion. Exhibit appropriate personal and interpersonal professional behaviours. Practice medicine ethically consistent with the obligations of a physician. To achieve these objectives, the senior resident must develop the ability to: 1. Demonstrate personal responsibility to patients by availability, confidentiality and respect for each patient's physical and emotional comfort. 2. Demonstrate adherence to the best available practice, including referral to other qualified practitioners when appropriate. 3. Demonstrate meticulous accuracy in reporting clinical and scientific information. 4. Demonstrate knowledge of the ethical problems of human organ procurement for the purposes of transplantation. 5. Demonstrate a working knowledge of provincial and federal laws and regulations related to the practice of medicine in general and urology in particular. 6. Demonstrate an understanding and appreciation for patients' legal rights in matters related to informed consent, delegated consent and informed decision making. 7. Understand medical protective procedures and the role of the Canadian Medical Protective Association in areas of patient-physician dispute. 8. Be aware of their own feelings and biases and recognise any personal reactions which may be detrimental to physician-patient relationships because of these feelings or biases and explore and willingly accept possible ways of changing detrimental or prejudicial feelings. 9. Identify a colleague or faculty member with whom they may discuss personal and professional goals, conflicts and stresses. PGY 4 Urology ROTATION SPECIFIC OBJECTIVES Second 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the senior resident should be able to demonstrate by the completion of the second 4 month rotation. 16
    • Cognitive Skills Trauma Ureteral Trauma Vesical Trauma Urethral Trauma External Genital Trauma Renovascular Hypertension Surgically Correctable Hypertension Renal Transplantation Recipient selection Relevant transplantation immunology Andrology Male Sexual Function and Dysfunction Fertility and Male factor Infertility Urological Oncology Cancer of the kidney: Renal adenocarcinoma - etiology (including von Hippel Lindau syndrome) Wilm's Tumor Transitional Cell Carcinoma of Renal Pelvis and Ureter Angiomyolipoma Cancer of the bladder: Transitional Cell Carcinoma Squamous Cell Carcinoma Other Tumors Cancer of the prostate: Adenocarcinoma Other tumors Cancer of the testis: Germ cell (including seminoma and non-seminoma ) Non-germ cell tumors Cancer of the adrenal: Pheochromocytoma "Incidentaloma" Voiding Disorders including Relevant Neurourology Urinary incontinence (including stress urinary incontinence, urgency incontinence, total incontinence) Voiding dysfunction due to neurological disease Enuresis Functional Voiding Disorders Adrenal Diseases 17
    • Adrenal cysts, hyperplasia Adrenal hyperfunction and hypofunction and associated syndromes DIAGNOSTIC SKILLS Imaging Studies intravenous excretory urography voiding cystourethrography Ultrasonography - The principles and application of ultrasound techniques for imaging: kidney bladder prostate (including transrectal ultrasonography) scrotal contents Doppler studies of renal, gonadal and penile vessels Radioisotope Studies - The indications, application to clinical urology, principles, pharmacokinetics and application of radiopharmaceuticals used in: renal imaging (including function studies) voiding cystograms testicular scans bone scans for staging of malignant disease scans for localization of inflammatory lesions scans for adrenal localization CT scanning and MRI Scanning of the urinary tract Urodynamic Studies cystometrogram uroflowmetry voiding pressure studies pelvic floor electromyography videourodynamic studies Histopathology testis tumors - including germ cell tumors, (seminoma and non-seminoma), functional tumors of the testis (Leydig tumors), Sertoli tumors inflammatory lesions of the kidney - xanthogranulomatous pyelonephritis, tuberculosis, chronic pyelonephritis inflammatory lesions of the lower urinary tract - interstitial cystitis, cystitis cystica, cystitis glandularis, cystitis follicularis, prostatitis SURGICAL SKILLS Endoscopic Procedures: Transurethral biopsy of bladder and urethra Transurethral resection of prostate Transurethral resection of bladder tumors Manipulation and extraction of calculi including litholopaxy, basket extraction 18
    • Ureteroscopy and lithotripsy of ureteric calculi Open Surgical Procedures: Circumcision Suprapubic catheterization Fulguration of venereal warts, biopsy of penile lesions Scrotal surgery - hydrocele, epididymal cyst, epididymectomy, simple orchidectomy Inguinal surgery - varicocele, herniotomy, orchidopexy Radical orchidectomy Repair of testis torsion Pelvic lymphadenectomy Nephrectomy PGY4 Urology Pediatric Urology Rotation at CHEO The overall goal of this mandatory two month rotation in Pediatric Urology is a concentrated experience of pediatric urologic problems in ambulatory clinics and in the operating room. Objectives Medical Expert/Knowledge-based and procedural-based competencies The resident will demonstrate an understanding and a thorough knowledge of the following problems as they relate to the practice of urology Congenital and Developmental Abnormalities A. Kidney and Ureter a. Cystic Diseases of the Kidney b. Horseshoe Kidney and Other Renal Anomalies c. Duplication, Retrocaval ureter and Other Anomalies B. Bladder and Urethra a. Vesicoureteral reflux b. Epispadias and Extrophy c. Hypospadias and chordee C. External Genital Anomalies a. Intersex b. Undescended Testis c. Scrotal and External Genital Anomalies Obstructive Disease of the Upper Urinary Tract A. Obstructive Uropathy, Hydronephrosis and Obstructive Renal Failure B. Ureteropelvic Junction Obstruction Obstructive Disease of the Lower Urinary Tract A. Posterior urethral valves B. Functional Obstruction secondary to Neurological Disorders Pediatric Oncology A. Wilm’s Tumor B. Neuroblastoma C. Mesoblastic Nephroma Imaging Studies A. Pediatric ultrasound of abdomen and pelvis B. VCUG 19
    • C. Radioisotope scans Open Surgical Skills The resident will have an understanding of the following open surgical procedures although not necessarily be able to perform independently. Circumcision Orchidopexy Repair of testicular torsion Hypospadius repair Uretero-neocystostomy Open pyeloplasty Partial nephrectomy Augmentation cystoplasty Communicator Establish therapeutic relationships with patients and parents (as well as primary care givers). Obtain and synthesize relevant history from patients, families and communities. Listen effectively. Discuss appropriate information with patients and families and the health care team. Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to urology. Collaborator Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. Interact effectively with patients from all varying lifestyles, socioeconomic backgrounds and value systems. Manager Utilize personal resources effectively to balance patient care, learning needs and outside activities. Work effectively and efficiently in a health care organization. Utilize information technology to optimize patient care and life-long learning and other activities. Health Advocate Identify the important determinants of health affecting patients with urological disease. Recognize and respond to those issues where advocacy is appropriate. Scholar Develop, implement, and monitor a personal continuing education strategy to ensure life-long professional growth. Critically appraise sources of medical information and demonstrate the use of data bases for literature searches and reviews. To use information technology to optimize patient care, life-long learning and other activities Professional Deliver highest quality care with integrity, honesty and compassion. Exhibit appropriate personal and interpersonal professional behaviours with children and their parents. PGY4 Urology ROTATION SPECIFIC OBJECTIVES 20
    • THIRD 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the senior resident should be able to demonstrate by the completion of the third 4 month rotation. Cognitive Skills Congenital and Developmental Abnormalities External Genital Anomalies Intersex Undescended Testis Scrotal and External Genital Anomalies Urinary and Genital Infections, and Sexually Transmitted Disease Bacterial (complicated and uncomplicated) and non-bacterial cystitis and urethritis Pyelonephritis and other renal infections Prostatitis including Prostatodynia Sexually transmitted diseases Other Genital Infections (including Fournier’s gangrene) Renovascular Hypertension Surgically Correctable Hypertension Renal Transplantation Immunosuppresion (including principles of management of rejection) Management of Surgical Complications of Renal Transplantation Urological Oncology Cancer of the testis: Germ cell (including seminoma and non-seminoma ) Non-germ cell tumors Cancer of the adrenal: Pheochromocytoma Neuroblastoma Adrenal adenoma and adenocarcinoma "Incidentaloma" Other tumors Adrenal Diseases Adrenal cysts, hyperplasia Adrenal hyperfunction and hypofunction and associated syndromes Systemic Diseases and Other Processes Affecting the Urinary Tract Urological manifestations of systemic diseases (including e.g. diabetes mellitus, sepsis, AIDS, immunocompromised or immunoincompetent patients) The urinary tract in pregnancy (including normal physiologic and anatomic changes and management of urinary tract problems in the pregnant patient) 21
    • DIAGNOSTIC SKILLS Ultrasonography - The principles and application of ultrasound techniques for imaging: prostate (including transrectal ultrasonography) scrotal contents Doppler studies of renal, gonadal and penile vessels Urodynamic Studies videourodynamic studies Therapeutic Technologies  Lasers in urology - carbon dioxide, Nd/YAG, Holmium-YAG, etc.  Transurethral prostatic hyperthermia/thermotherapy and other alternative modalities used in the management of patients with benign prostatic hyperplasia Laparoscopic Procedures SURGICAL SKILLS Endoscopic Procedures: Transurethral biopsy of bladder and urethra Transurethral resection of prostate Transurethral resection of bladder tumors Transurethral resection/ incision of ureterocele Manipulation and extraction of calculi including litholopaxy, basket extraction Ureteroscopy and lithotripsy of ureteric calculi Percutaneous renal surgery including nephrolithotomy with ultrasound / electrohydraulic / laser lithotripsy Open Surgical Procedures: Circumcision Suprapubic catheterization Meatal Repair for glanular hypospadias Scrotal surgery - hydrocele, epididymal cyst, epididymectomy, simple orchidectomy Inguinal surgery - varicocele, herniotomy, orchidopexy Radical orchidectomy Repair of testis torsion Orchidopexy for undescended testis Insertion testis prosthesis Vesical neck suspension and procedures for stress urinary incontinence Uretero-neocystostomy Augmentation cystoplasty Radical cystectomy and anterior pelvic exenteration Procedures for renal, ureteral and bladder trauma repair Pelvic lymphadenectomy Simple retropubic prostatectomy Radical prostatectomy Pyeloplasty for ureteropelvic junction obstruction Nephrectomy Nephroureterectomy Correction of proximal hypospadias and epispadias PGY 5 Urology 22
    • ROTATION SPECIFIC OBJECTIVES FIRST 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the chief resident should be able to demonstrate by the completion of the first 4 month rotation. Cognitive Skills Congenital and Developmental Abnormalities Hypospadias and chordee INTERSEX, AMBIGUOS GENETALIA IN THE NEWBORN Obstructive Disease of the Lower Urinary Tract Posterior Urethral Valves Urinary and Genital Infections, and Sexually Transmitted Disease Other Genital Infections (including Fournier’s gangrene) Renovascular Hypertension Surgically Correctable Hypertension Renal Transplantation Organ donation Recipient selection Urological Oncology Renal Cell Carcinoma - etiology (including von Hippel Lindau syndrome) Angiomyolipoma Squamous Cell Carcinoma bladder Pheochromocytoma Neuroblastoma Adrenal Diseases Adrenal cysts, hyperplasia Adrenal hyperfunction and hypofunction and associated syndromes Diagnostic Studies Angiography of the kidneys and pelvic vessels Loop-o-graphy CT scanning and MRI Scanning of the urinary tract Coordination of video-urodynamics SURGICAL SKILLS Endoscopic Procedures: Percutaneous renal surgery with ultrasound / electrohydraulic/laser lithotripsy Open Surgical Procedures: Vasovasostomy Vesical neck suspension and procedures for stress urinary incontinence Procedures for renal, ureteral and bladder trauma repair Simple retropubic prostatectomy Nephrectomy Nephroureterectomy 23
    • Communicator General Requirements: Establish therapeutic relationships with patients and families and primary care givers. Obtain and synthesise relevant history from patients, families and communities. Listen effectively. Discuss appropriate information with patients and families and the health care team. To achieve these objectives, the chief residents must develop the ability to: 3. Record accurately and succinctly data collected from patients, laboratory tests and radiological studies and to communicate conclusions based on these data to referring physicians and other involved health care personnel; 2. Be sensitive to patients fears, anxieties and needs for privacy; 3. Be able to explain clearly and concisely: a. diagnosis and management plans that are understandable to patients, that motivates and facilitates patients' willing participation; e. management plans to other health care personnel in a way that ensures their effective participation; f. steps necessary for problem management when acting as a consultant for other physicians, particularly in the situation of an intra-operative consult. Collaborator General Requirements: Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. To achieve these objectives, the chief resident must develop the ability to: 2. Interact effectively with: a. personnel in community service agencies, b. other health care personnel, for example, attending in discharge planning 2. Accept responsibility for participation in activities that foster good patient care, including contributions to the administration of patient care facilities. 3. Participate in professional organizations – such as the CUA, AUA and SLUG. Manager General Requirements: Utilize personal resources effectively to balance patient care, learning needs and outside activities. Allocate finite health care resources wisely. Work effectively and efficiently in a health care organization. Utilize information technology to optimize patient care and life-long learning and other activities. To achieve these objectives, the chief resident must develop the ability to: 3. Access appropriate urological diagnostic and therapeutic technology in a timely and efficient manner to benefit all of their patients, for example, running of the chief residents clinic. 4. Organize a priority list for patients waiting surgery. 5. Organize the resident schedule 6. Maintain a sytematic program of self directed learning suitable for life long learning. Health Advocate 24
    • General Requirements: Identify the important determinants of health affecting patients with urological disease. Contribute effectively to improved health of patients and communities. Recognise and respond to those issues where advocacy is appropriate. To achieve these objectives, the chief resident must develop the ability to: 3. Participate with community based patient support groups such as the prostate cancer support group. 4. Understand the role and function of the Canadian Urological Association and related urological societies in support of urologists and the urological care in Canada and internationally. Scholar General Requirements: Develop, implement, and monitor a personal continuing education strategy to ensure life-long professional growth. Critically appraise sources of medical information. Facilitate learning of patients, housestaff/students and other health professionals. Contribute to the development of new knowledge. To use information technology to optimize patient care, life-long learning and other activities To achieve these objectives, the chief resident must develop the ability to: 9. Demonstrate continuing evaluation of their own capabilities and limitations. 10. Develop techniques for continuous improvement, information acquisition and information handling and participate in the quality improvement and quality assurance programs of the institutions in which they practice. 11. Maintain an inquisitive attitude, and understand the time commitment required for ongoing self-study for the maintenance of competence. 12. Demonstrate the use of data bases for literature searches and reviews. 13. Formulate a research plan to answer clinical problems. 14. Understand the ethics of animal and human experimentation. 15. Describe basic statistical methods used in clinical trials. 16. Residents will be able to critically evaluate reports of clinical trials and research protocols. All residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis. Professional General Requirements: Deliver highest quality care with integrity, honesty and compassion. Exhibit appropriate personal and interpersonal professional behaviours. Practice medicine ethically consistent with the obligations of a physician. To achieve these objectives, the chief resident must develop the ability to: 10. Demonstrate personal responsibility to patients by availability, confidentiality and respect for each patient's physical and emotional comfort. 11. Demonstrate adherence to the best available practice, including referral to other qualified practitioners when appropriate. 12. Demonstrate meticulous accuracy in reporting clinical and scientific information. 13. Demonstrate knowledge of the ethical problems of human organ procurement for the purposes of transplantation. 14. Demonstrate a working knowledge of provincial and federal laws and regulations related to the practice of medicine in general and urology in particular. 15. Demonstrate an understanding and appreciation for patients' legal rights in matters related to informed 25
    • consent, delegated consent and informed decision making. 16. Understand medical protective procedures and the role of the Canadian Medical Protective Association in areas of patient-physician dispute. 17. Be aware of their own feelings and biases and recognise any personal reactions which may be detrimental to physician-patient relationships because of these feelings or biases and explore and willingly accept possible ways of changing detrimental or prejudicial feelings. 18. Identify a colleague or faculty member with whom they may discuss personal and professional goals, conflicts and stresses. PGY5 Urology ROTATION SPECIFIC OBJECTIVES SECOND 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the chief resident should be able to demonstrate by the completion of the second 4 month rotation. Cognitive Skills Trauma Renal Trauma Ureteric Trauma Testicular Trauma Renal Transplantation Management of complications after renal transplant Urological Oncology Penile Cancer Urethral Cancer Metastatic Cancers to Genito-urinary Tract Systemic Diseases and Other Processes Affecting the Urinary Tract Urological manifestations of systemic diseases (including e.g. diabetes mellitus, sepsis, AIDS, immunocompromised or immunoincompetent patients) The urinary tract in pregnancy (including normal physiologic and anatomic changes and management of urinary tract problems in the pregnant patient) Diagnostic Studies Ultrasound of scrotal contents Doppler studies of renal, gonadal and penile vessels Radioisotope Studies Understanding of the radio-pharmaceuticals in renal imaging (including function studies) scans for adrenal localization SURGICAL SKILLS Endoscopic Procedures: Use of Lasers in urology - carbon dioxide, Nd/YAG, Holmium-YAG, etc Percutaneous renal surgery with ultrasound / electrohydraulic/laser lithotripsy Lapaoscopic skills, diagnostic ie intrabdominal testicle Open Surgical Procedures: 26
    • Cavernosal shunting procedures for priapism Testis biopsy Procedures for renal, ureteral and bladder trauma repair Radical retropubic prostatectomy Nephroureterectomy Cystectomy with urinary diversion RPLND Open urethroplasty PGY 5 Urology ROTATION SPECIFIC OBJECTIVES THIRD 4 MONTHS Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the CHIEF resident should be able to demonstrate by the completion of the third 4 month rotation. Trauma Vesical Trauma Urethral Trauma External Genital Trauma Renal Transplantation Relevant transplantation immunology Immunosuppresion (including principles of management of rejection) Urological Oncology Wilm's Tumor Transitional Cell Carcinoma of Renal Pelvis and Ureter Adenocarcinoma of the prostate Germ cell (including seminoma and non-seminoma ) Non-germ cell tumors of the testes Diagnostic Studies angiography of the kidneys and pelvic vessels venography (including vena cavography) Coordination and interpretation of video-urodynamics antegrade pyelography Surgical Skills Open Surgical Procedures:  Cavernosal shunting procedures for priapism  Insertion testis prosthesis  Procedures for correction penile curvature and Peyronie's Disease  Insertion of penile prosthesis  Penectomy  Urethrectomy  Insertion artificial sphincter  Augmentation cystoplasty 27
    •  Repair of urinary fistulae - involving bladder, urethra, ureter, kidney  Urinary diversion procedures - continent, orthotopic and conduits  Radical cystectomy and anterior pelvic exenteration  Radical prostatectomy  Pyeloplasty for ureteropelvic junction obstruction  Partial nephrectomy  Retroperitoneal node dissection for carcinoma testis  Inguinal lymphadenectomy for carcinoma penis  Renal transplantation  Cadaveric and live donor renal harvesting for transplantation  Transplant nephrectomy  Vena cava resection and retrieval of atrial thrombus for carcinoma kidney PGY 5 Enrichment rotation On April 1, the official duties of the chief urology resident would be transferred to the senior urology resident. The senior resident would then carry out these duties for the remainder of the academic year: · administrative duties (scheduling, etc.) · primary operative assistance to Queen’s urological attending staff · ward consultations This provides the chief resident with the opportunity to pursue: · clinical and surgical enrichment activities · elective clinical rotations · focused study for the Royal College examinations in urology · conclusion research projects CLINICAL AND SURGICAL ENRICHMENT ACTIVITIES The chief resident would be free to pursue clinical and surgical learning opportunities to fill perceived gaps in his/her knowledge or experience base. These activities could be varied on a daily basis, at the discretion of the chief resident and the relevant clinical staff. Examples might include: · attending selected urological clinics, both general and specialized · attending selected non-urological clinics, with the permission of the appropriate attending staff (e.g. gynecology, nephrology, videourodynamics) · assisting with selected urological operations (e.g. uncommon operations, cystoscopy under local anaesthesia, vasectomy) · assisting with selected non-urological operations, with the permission of the appropriate attending staff (e.g. gynecology, general surgery, vascular surgery) · assisting with selected interventional radiology procedures, with the permission of the interventional radiologist (e.g. percutaneous nephrostomy insertion) · performing and interpreting urodynamic studies 28
    • · providing teaching to junior housestaff and medical students ELECTIVE CLINICAL ROTATIONS The chief resident would be free to arrange brief clinical rotations, both in Kingston and at other centres. Examples might include: • pediatric urology • renal transplantation • urogynecology • oncology • community urology • nephrology • infertility STUDY TIME An appropriate portion of the enrichment phase would be spent in directed studying for the Royal College examinations in urology. This might include simulated oral examinations from urology attending staff, reading, and practicing for the multiple choice and short answer components of the examination. RESEARCH PROJECTS If desired, the chief resident could work on pre-existing research projects or initiate new ones. Community Elective in Urology Medical Expert/Knowledge-based and procedural-based competencies The following is a listing of disease entities, diagnostic and surgical skills that are commonly included in the specialty of urology. This list is not meant to be inclusive but an example of the knowledge and skills that the resident should be able to demonstrate by the completion of the Community Elective in Urology rotation. Cognitive Skills The elective should focus on learning skills and acquiring knowledge which are more readily attainable outside of residency training at an academic centre such as Queen's. The resident should learn the skill of operating without another specialist physician assistant. Normally at a teaching centre there is an attending Urologist. Particular examples where differences in a community setting exist include: -Ureteroscopy -TURP -Inguinal/scrotal procedures -radical prostatectomy -laparcospic procedures including nephrectomy The resident should familiarize him/herself with what can realistically & safely be accomplished in terms of office procedures eg: -Vasectomies -Neonatal circumcisions -Cystoscopy -TRUS biopsy 29
    • Communicator General Requirements: Establish therapeutic relationships with patients and families and primary care givers. Obtain and synthesise relevant history from patients, families and communities. Listen effectively. Discuss appropriate information with patients and families and the health care team. To achieve these objectives, the residents must develop the ability to: 4. Record accurately and succinctly data collected from patients, laboratory tests and radiological studies and to communicate conclusions based on these data to referring physicians and other involved health care personnel; 2. Be sensitive to patients fears, anxieties and needs for privacy; 3. Be able to explain clearly and concisely: a. diagnosis and management plans that are understandable to patients, that motivates and facilitates patients' willing participation; g. management plans to other health care personnel in a way that ensures their effective participation; h. steps necessary for problem management when acting as a consultant for other physicians, particularly in the situation of an intra-operative consult. Collaborator General Requirements: Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. To achieve these objectives, the resident must develop the ability to: 1. Interact effectively with: other health care personnel, Patients from all varying lifestyles, socioeconomic backgrounds and value systems 2. Accept responsibility for participation in activities that foster good patient care, including contributions to the administration of patient care facilities. Manager General Requirements: Utilise personal resources effectively to balance patient care, learning needs and outside activities. Allocate finite health care resources wisely. Work effectively and efficiently in a health care organisation. Utilise information technology to optimise patient care and life-long learning and other activities. To achieve these objectives, the resident must review and understand: 1. Billing procedures via modem, within the provincial health plan 2. Billing codes and their acceptable/ethical interpretation 3. Billing procedures for un-insured services 4. Office computer hardware and software needs 5. Office staffing needs (transcription, reception, nursing etc) 6. Assessing one's present and future needs when looking for office physical space, and the potential cost of running an office 7. The pros & cons of leasing vs. buying office space 8. Accounting/bookkeeping needs 9. Financing of office equipment for minor procedures 30
    • 10. Cash flow management for personal and professional expenses 11. Obtaining professional financial advice for one's personal and professional life 12. The pros and cons of incorporation for Physicians 13. Maintain a systematic program of self directed learning suitable for life long learning. Health Advocate General Requirements: Identify the important determinants of health affecting patients with urological disease. Contribute effectively to improved health of patients and communities. Recognise and respond to those issues where advocacy is appropriate. Scholar General Requirements: Critically appraise sources of medical information. Contribute to the development of new knowledge. To use information technology to optimise patient care, life-long learning and other activities To achieve these objectives, the resident must develop the ability to: 1. Develop techniques for continuous improvement, information acquisition and information handling and participate in the quality improvement and quality assurance programs of the institutions in which they practice. 2. Maintain an inquisitive attitude, and understand the time commitment required for ongoing self- study for the maintenance of competence. 3. Demonstrate the use of databases for literature searches and reviews. Professional General Requirements: Deliver highest quality care with integrity, honesty and compassion. Exhibit appropriate personal and interpersonal professional behaviours. Practice medicine ethically consistent with the obligations of a physician. To achieve these objectives, the resident must develop the ability to: 1. Demonstrate personal responsibility to patients by availability, confidentiality and respect for each patient's physical and emotional comfort. 2. Demonstrate adherence to the best available practice, including referral to other qualified practitioners when appropriate. 3. Demonstrate meticulous accuracy in reporting clinical and scientific information. 4. Demonstrate an understanding and appreciation for patients' legal rights in matters related to informed consent, delegated consent and informed decision making. 5. Demonstrate knowledge of legal requirements of staff privileges 6. Demonstrate knowledge of legal responsibility of provincial licensing authorities in the practice of medicine Research Objectives Resident Training Program, Urology Queen’s University Research Objectives 1. To permit residents the opportunity and guidance in preparing a research proposal 31
    • 2. To permit residents the opportunity to develop skills in study design and data analysis 3. To permit residents the opportunity to develop the communication skills required to verbally present research results 4. To permit residents to develop the skills necessary in writing a paper for publication 5. To help familiarize the resident with the practice of clinical or basic science research in the context of clinical urologic practice 6. To facilitate the residents research potential as it relates to post-graduate studies and possible career choices 7. To develop skills of critical appraisal of the literature and aspects of evidence based medicine Principles of Research Training 1. Residents differ in their motivation and background in order to develop research skills during residency. 2. Relevant research skills will need to be assessed individually. Some further research training for residents may need to be permitted to facilitate completion of projects. (Queen’s or KGH resources can be explored). 3. Specific acquisition of research skills include attendance in the Queen’s Research Methodology Course entitled “Introduction to Research” held in the PGY1 year. As needed, the Grand Rounds schedule can include specific teaching of research skills such as Statistics and Epidemiology. 4. Resident swill be encouraged to attend basic science course such as those offered by the AUA and the University of Toronto. 5. Residents will be encouraged to participate in resident research conferences including SLUG and Upstate New York resident research day as well as national and international Urologic meetings. 6. Understanding of research design and data analysis is an ongoing process and can be acquired outside of a didactic course or ongoing research project, such as through discussion with experts during appropriate learning moments (in clinic/journal club). 7. All residents will be actively encouraged to complete at least one research project during the three years of urology training. This may involve retrospective or prospective clinical research, quality assurance research, medical education research or, in particular circumstances, basic science research. 8. Residents will be encouraged to choose a project early in residency (PGY1-2) in order to allow sufficient time for completion of projects. 9. Ongoing research in the department of urology is abundant and residents will have great opportunity to be involved in several projects; however, if there is a desire to investigate a research endeavor outside of the department it will also be encouraged. 10. Most projects will be completed outside of a specific block of research time as dictated by the specific requirements of training. As circumstances permit, specific blocks of time will be arranged to help facilitate completion of ongoing projects. 11. Progress of resident research as a whole will be evaluated at regular intervals including bi-monthly research rounds and quarterly resident evaluations. The Urology ITER does include consideration of research skills. 12. All residents will be encouraged to present their research to the Urology staff and colleagues in order to help acquire verbal communication skills prior to presenting data for regional, national, or international audiences. Last revision August 2009 32