Curriculum

Quick guide to Urology Residency curriculum

Educational goals
Didactic sessions - lectures/conferences
Sessions - practical/hands on training
Descriptions for URO-1 through URO-5

Educational goals

• The program will provide a supportive learning environment in which the resident receives a strong foundation in both basic science and clinical science relating to the specialty and practice of Urology.
• The program will provide the tools and know how, as well as the skills for the practice of lifelong learning.
• The program will provide the breadth of knowledge required to provide the highest quality care for patients in both the outpatient and inpatient setting.
• The program will teach technical surgical skills as well as create an environment for the development of surgical judgment which encompasses the whole surgical specialty of Urology. The resident will perform surgical procedures of increasing complexity and become increasingly responsible as he or she passes through the residency.
• The program will teach statistics, research study design, and encourage critical analysis of published studies.
• The program will provide opportunity for resident involvement in scholarly activity and research projects.
• The program will teach and encourage good medical record keeping skills.
• The program will foster and encourage good moral and ethical behavior.
• The program will teach and stress proper inter-personal and communication skills allowing the resident to effectively interact with patients, patient families, allied health professionals and other members of the healthcare team.
• The program will teach organizational skills, stress professionalism and provide the experience necessary for the resident to become an independent practitioner.

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Didactic sessions – lectures/conferences

Instruction in the core domains:

• calculous disease
• female pelvic medicine
• infertility and sexual dysfunction
• pediatric urology
• reconstruction
• urologic oncology
• voiding dysfunction

Instruction will be provided at regularly scheduled didactic sessions per the lecture schedule (see below), conferences and online modules. These will take the form of formal prepared lectures by faculty or guest faculty and more senior residents. The resident teaching conference will include Campbell’s chapter review and AUA updates. The curriculum will be designed such that it is repeated in whole every 2 years. These sessions will also help fulfill the Medical Knowledge requirement. Didactic conferences must be attended by residents and faculty members, and the list of conferences will include the date, conference topic, presenter name and the names of faculty members and residents present for each conference. In addition, a series of practical teaching modules and labs will help fulfill the procedural competency component of the Patient care and procedural skills requirement.

Daily didactic sessions include formal hospital rounds.
Weekly and bi-weekly didactic sessions are in the table below.

^{*see Pediatrics conference schedule under URO-3 description}

Meeting descriptions

GU Tumor Board

Faculty members will be responsible for leading Tumor Board discussion. Cases can be submitted to the conference coordinator by faculty, residents and fellows of all disciplines. Tumor Board focuses on complex cases, where diagnosis and course of treatment for cancer patients are not clearly defined. Cases will be gathered by the Urology faculty as well as faculty from Radiation Oncology and GU Medical Oncology and presented with faculty from pathology and radiology in attendance. All residents are encouraged to ask pertinent questions at these Tumor Boards. Chief residents (URO-5) are expected to take an active part in the discussions at tumor boards. Faculty will lead discussions and focus on enhancing resident education in the evaluation and treatment of cancer patients. Pathology and radiology teaching will be emphasized.

Grand Rounds

The program director and faculty members will be responsible for facilitating Grand Rounds. Grand Rounds will be based off of an educational curriculum as well as a 90 topic lecture created by the Program Director. The Program Director will set the schedule for the Grand Rounds. Grand Rounds will be presented by a diverse group of faculty members. In addition, faculty from other AHN disciplines and guest lecturers will present during Ground Rounds. Chief residents (URO-5) will be afforded the opportunity to present during Grand Rounds under advisement and mentorship of an assigned faculty member.

Case Conference

Each week, faculty’s scheduler will update the master surgical schedule with the head Physician Assistant (APP). Cases will be then chosen from the various urology specialties to avoid repetition. The faculty is responsible for leading this conference, as well as providing feedback to the presenting resident on that service. Cases are broken down into evaluation, differential diagnosis, treatment options, and risks/complications. Faculty will provide feedback on both the case presentation and mastery of the fundamentals of the planned management. 

Journal Club

Faculty members will be responsible for encouraging and providing feedback to residents during Journal Club. Faculty members will select topics and articles for review, as well as assign residents to present at Journal Club (on a rotating basis). After the presentation, a discussion will ensue focusing on the principles of evidence based medicine, scientific rigor, appropriate statistical methods, relevant clinical utility and topics for future study. This conference will emphasize education in the critical appraisal of medical evidence. 

Morbidity and Mortality Conference

Faculty members will be responsible for facilitating and providing feedback to residents during the Morbidity and Mortality Conference. Cases presented during this conference will focus on adverse clinical events. They will be collected by the senior APP at each site and reviewed with the site director and then added to the monthly list. The presentation will include analysis of the course, causes, and consequences of events which occurred during the care of the patient and proposals for actions to avoid recurrence of similar events. A resident or a faculty member will be assigned to present at the Morbidity and Mortality Conference. When a resident presents, he/she will work one-on-one with the assigned faculty member in preparation and discussion of the case. When appropriate, the case may serve as a subject for root cause analysis by the resident and faculty member. The outcome will then be presented to the Patient Safety Committee.

Resident Teaching Conference

Once the program has chief residents, the chief residents will be responsible for leading this conference in conjunction with assistance from faculty members. Urology faculty will provide a list of Campbell's chapters and AUA updates and assign a topic to the chief resident. This will be posted on the master conference schedule. The chief resident will be tasked to summarize the material in an informal bulleted power-point presentation to all Urology residents. Prior to the program having chief residents, faculty members will be responsible for summarizing the conference content and overseeing this conference. 

Radiology Body Imaging Conference

Residents will be exposed to a wide range of pathology across all imaging modalities, with emphasis on the importance of protocol design in optimizing exams. Residents and attendings will discuss the latest evidence-based guidelines for the management of imaging findings. 

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Sessions – practical / hands on training

AHN Urology Online Handbook

Online resource made available to URO-1 residents to aid in the management of common hospital and emergency room urology issues. There are practical tips for issues including retention, hematuria, triage of the stone patient and common post op issues in the urology patient. It will also contain guidelines on who to call, when and how.

Urology Bootcamp

URO-1 residents will attend this full-day workshop focusing on difficult Foley placement, different Foley, use of urethral dilators, use of filiforms and followers, CBI, percutaneous tubes, flexible cystoscopy and transrectal US and biopsy. This will take place at the STAR center at West Penn utilizing labs and advanced manikins.

Surgical Skills Lab

URO-2 residents will also take part in the FLS (fundamentals in laparoscopic surgery) online modules and practical lab training at the STAR Center. In addition they will be mentored in the Pig Lab at Allegheny General Hospital learning basic procedures such as nephrectomy as well the handing of bowel or vascular injuries. 

Robotic Training

Beginning in the URO-2 year and extending into the 3rd year, the residents will be given dedicated time on the robot trainers alongside a faculty member. They will also complete the online modules and simulations required before assuming a primary surgeon role in the operating room. Finally, robots with dual consoles will be prioritized for all Urology cases involving the residents.

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Description of each year of training – URO-1 through URO-5

URO-1

At the start of the URO-1 year, the residents will be familiarized with and expected to review the online AHN Urology Basics handbook. The handbook is full of tips for managing common urology issues arising in the hospital and ER. They will also attend a full day urology lab where hands on practical skills are emphasized.

The URO-1 year is spent exclusively at AGH. During intern year, residents will be taught basic clinical and surgical principles with an emphasis on the preoperative evaluation and postoperative care of surgical patients. The residents will spend 1 month of night float covering the surgical subspecialties including urology with a senior general surgery resident as back up and a faculty member always available by phone. Interns will spend an additional 6 months on department of surgery rotations including: trauma, colorectal, transplantation, vascular, surgical ICU, and  general surgery. Lastly, they will spend 5 months on the urology service. When on the urology service, interns will attend all urology didactic sessions and conferences. The URO-1 will rotate with the AGH consult service and training will focus on the evaluation of common urologic disorders with an emphasis on radiologic evaluation and physical examination.  It is during this rotation that the residents will be first introduced to basic endoscopic and scrotal procedures. 

URO-2

At the beginning of the second year of training, the residents will attend our Urology Bootcamp at the STAR center – West Penn Hospital. The URO-2 residents will spend 4 months each on the Wexford HWP Ambulatory service, Allegheny General Hospital Gold service, and the Allegheny General Hospital Consult service. The Wexford HWP Ambulatory service includes 3 days of clinic and 2 days of operating time. There will a small inpatient service and a mix of inpatient and ambulatory procedures. In the clinics, the URO-2 resident will take a history and examine every patient assigned to them by the attending. After completing the history and physical, the resident will discuss the case with the supervising faculty who will ensure that an adequate examination, documentation and counseling had occurred. In these clinics the resident will be exposed to urologic subspecialties for the first time. The URO-2 resident will perform outpatient and inpatient surgical procedures commensurate with their level of training and skills, assisted by a staff urologist. Under supervision by the Pine Chief and or the advanced practice professional (APP), the URO-2 will be responsible for the daily care of urology inpatients, including daily progress notes. The URO-2 will be responsible for assuming some on-call duties from home with a supervising attending available by phone.

The AGH Gold service includes the AGH Urology clinic, the AGH out-patient surgery service and all non-oncologic general urology cases. In the clinic, the URO-2 will see and present patients to the Gold Chief and under supervision, perform surgical procedures on those patients. The URO-2 will also participate in the AGH out-patient cases as directed by the chief and under attending supervision. The resident will share on-call duties with the other junior residents.  The AGH Consult service is responsible for all inpatient and emergency room consults and is staffed by a resident, APP and the attending of the day. It is during this year that residents will learn to perform a comprehensive and focus based urologic history and examination. They will be expected to order appropriate radiographic and laboratory tests, and create a differential diagnosis and treatment plan. The resident will consult and communicate with other AGH subspecialty service personnel. The residents will learn the basics of catheter placement, urethral dilation, cystoscopy, stent placement and stone procedures.

The URO-2 is expected to be an active participant in all academic conferences.  Cases for presentation at case conference will be assigned by the attending involved in the case. They will be an active participant in the Resident’s teaching conference. Lastly, the URO-2 residents will attend the virtual AUA Basic Science Conference in June.

URO-3

The 3rd year resident will spend 4 months each on the pediatric rotation at Nationwide Children’s Hospital in Columbus Ohio, the Allegheny General Hospital Gold service and the Oncology service. The residents on the pediatric rotation will be housed in Columbus and will be able to return to Pittsburgh 3 weekends out of 4. No vacation will be taken during this rotation. This service will emphasize the evaluation and management of common congenital and pediatric urologic conditions. As they progress through this rotation they will be given greater responsibility in the clinic and participate in cases of increasing complexity with the attending in the operating room. The residents are responsible for attending all of the urologic conferences at Nationwide Hospital and for presenting 1 lecture per month on the rotation and for presenting cases at the M and M conference. 

Nationwide Urology Conference Schedule

Weekly: Indications Conference Mondays 7-8AM
Monthly: (Wednesdays)
7:30-8:30AM NURAG, Radiology Conference, Surgery Grand Rounds, Journal Club
8:30-9:30AM Urodynamics Conference, Research Conference, Pathology, Campbell’s Chapter, Didactics/Chalkboard

On the Allegheny General Hospital gold rotation the URO-3 resident will be expected to provide teaching to the medical students, URO-1 and URO-2 residents on the service.

During this rotation residents will begin to independently evaluate patients with common urologic