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.

Urology Didactic Schedule

^{*See pediatrics conference schedule under URO-3 description}

Meeting Descriptions

GU Tumor Board

Virtual conference scheduled on the first and third Wednesday of each month, 5:00PM - 6:30PM.
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-4 and URO-5) are expected to take an active part in the discussions at tumor boards. Trainees on the oncology rotation will present and take part in the tumor board discussions. 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 Ground Rounds. Chief residents (URO-4 and URO-5) will be afforded the opportunity to present during Grand Rounds under advisement and mentorship of an assigned faculty member.

Case Conference

Scheduled on the first Tuesday of each month, always at 6:30AM before grand rounds. 
On a rotating basis, PGY2 and higher residents will present their cases scheduled to take place in the upcoming 4 weeks. Resident will provide a brief history and review imaging in Epic discussing differential diagnosis, treatment options and patient counselling. The goal is to cover several cases quickly and include cases from all the urologic disciplines. Interesting cases with a medical treatment outcome are also included. Faculty attendance and input is mandatory. PowerPoint presentation is not necessary

Journal Club

Scheduled on the fourth Thursday of each month at 6:30AM - 7:30AM.
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 & Mortality Conference and Quality Improvement/Patient Safety Conference  (QIPS)

Scheduled on the fourth Tuesday of each month after Grand Rounds.  
The chief resident is responsible for compiling the list of cases to be presented. Cases from all services, HWP, WPH and AGH, will be entered into the Epic log and presented by the resident involved. If a resident is not involved, the attending will present the case. Attendings involved in the cases will be notified the Friday prior and are expected to participate. If consultants such as pathology, radiology, radiation oncology, medical oncology, etc. presence is required, the chief resident is responsible for arranging this. The chief resident will compose a summary of all cases presented, including attending’s name and patient MRN. The summary will be given to the coordinator at the conclusion of M&M. A brief PowerPoint presentation, consisting of a few sentences on each patient, is required. An article pertaining to each patient is applicable but not required. 

Quality Improvement and Patient Safety (QIPS) is scheduled with the Morbidity and Mortality Conference on Tuesday mornings. Residents receive training on reporting safety/adverse events via the RL6 system and they will report on events at QI/PS meeting.  Residents will be assigned a QI/PS project and will work one-on-one with an assigned faculty mentor to prepare and present his/her case. The case will serve as a subject for root cause analysis by the resident and faculty member patient safety and quality assurance. The outcome will be presented at a M+M & QI/PS meeting

Resident Teaching Conference

Scheduled on the first, second and third Thursdays, at 6:30a to 7:30a. The 4th Thursday is Journal Club. 
Resident’s Teaching Conference is optional if there is a fifth Thursday. The chief resident will lead the conference. Content will include AUA updates, AUA guidelines, Campbell’s chapters and SASP study questions. The purpose of this conference is to broaden knowledge and to prepare for the in-service exam given in November. Senior residents will lead the conference when chief resident is not available. 

Imaging Conference

Scheduled on the second Tuesday of each month after Grand  Rounds.
The conference is organized by the associate program director and the chief resident. The conference features cases with both distinctive and routine imaging findings. It primarily is driven by the participation of the residents with contributions from the urology faculty. Common topics include management of renal trauma, complex stone disease, and malignancy. It is an excellent opportunity for residents to heighten their skills both in interpretation of radiographic findings, as well as hone their clinical acumen in the management of these findings. 

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Sessions – Practical and 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 half-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 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.

Pig Lab

All residents are invited to our Saturday Pig Lab featuring pig organs and the Xi
and SP Robots.  Residents will practice tissue handling, dissection and suturing.

Simulation Lab

Two or three times per year, Tuesday didactics will include endourologic workshop with guest lectures and mechanical/virtual trainers. 

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Description of Each Year of Training – URO-1 through URO-5

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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. In July, interns will attend our Urology Bootcamp, at the STAR Center/West Penn Hospital, 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 5 months on department of surgery rotations including: TICU/SICU, colon and rectal service, transplantation, plastic and reconstructive surgery, and acute care surgery. Lastly, trainees will spend 6 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

In their URO-2 year, the trainee spends a total of 12 months in adult urology, alternating in three-month blocks, at Allegheny General Hospital (AGH) or Wexford Health and Wellness Pavilion (HWP)/Wexford Hospital (WXH). The
experience is ambulatory and consult service, along with an operative intensive
service. This is a pivotal year in which the resident is immersed in the practice of urology forming the knowledge and technical skill foundation for subsequent years.  Through progressive education in clinical urology, the resident is expected to master the basics of history taking, examination, and become proficient in basic procedural and operative skills, as well as become exposed to and read about disease processes from each of the domains of urology. 

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 chief resident. They will be an active participant in the Resident’s Teaching Conference.

URO-3

The 3rd year resident will spend 4 months on the pediatric rotation at Nationwide Children’s Hospital in Columbus Ohio, 4 months on the oncology service,  2 months on research and 2 months on either AGH or WXH service. 

The resident on the pediatric rotation will be housed in Columbus, Ohio. 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 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. Residents will also be assigned a pediatric research project.
 

Nationwide Children's Hospital
Wednesday Morning Conference Schedule

On the URO3 research rotation, the resident will have protected time to complete his/her research projects in collaboration with their mentor. Numerous resources and opportunities (including the NCDB database, our affiliation with the AHN

Moonshot program, several local biotech start-ups, ongoing studies on prostate
cancer epidemiology and numerous cancer projects with Dr. Stefan Mao (in
medical oncology) are available. URO-3 residents will be expected to present at
least 1 abstract at a national meeting. The resident will have begun
formulating a project with their mentor during the URO-2 year and onwards,
culminating with the 2-month research rotation.

The Oncology service is based at both Allegheny General and West Penn Hospitals. On the Oncology service, residents will spend time in the cancer specific clinics learning the comprehensive evaluation of urologic malignancies, preoperative evaluation, post-hospital care, and the roll of other medical specialties. They will then accompany the GU oncologists to the operating room. This service will emphasize robotic and open abdominal/flank cases. Operative responsibilities will increase as the resident gains experience and demonstrates technical proficiency and sound surgical judgement. The residents will take primary home call for patients on the oncology inpatient service with a supervising attending.

On the AGH and WXH rotations, 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 problems and formulate a treatment plan. As the responsibilities begin to increase, they will be given more independence in the clinic and participate in urologic procedures of increasing complexity including TUR cases, BPH procedures and endoscopic and percutaneous stone procedures. In addition, they will be assigned by the chief resident to scrub on uncovered AGH specialty service cases.

URO-4

The 4th year resident will spend 4 months as chief at West Penn Hospital, 4 months on the specialty rotation, and 2 months on the West Penn Hospital rotation, and 2 months on research. At the West Penn facility, the 4th year resident will have responsibility for managing emergency room and inpatient consults and working with the APPs. They will cover all complex and robotic cases.

At West Penn, the URO-4 will begin to assume increasing responsibility for medical student and junior resident teaching. They will assist the chief with management of the inpatient service. This service will emphasize major robotic and open cases. 

On the specialty rotation, the URO-4 resident will participate in the men’s health/reconstructive clinic (Dr. Jaffee), reconstructive clinic (Dr. Sury) urogynecology clinic (Dr. Rooker), and infertility clinic (Dr. Chaudry). On this rotation the resident will be exposed to a high volume of urologic subspecialty patients and accompany the clinic faculty to the operating room. The resident will be exposed to and acquire skills in interpreting urodynamics, female pelvic cases, male urethral and penile surgery, and microsurgery.

URO-5

The chief year will be split into 2 rotations: The Allegheny General Hospital administrative chief rotation and the West Penn Hospital chief rotation. At WPH, the chief resident will perform cases of higher complexity as primary surgeon with the faculty. The chief will also be responsible for assigning resident cases based on each resident’s individual progress. The chief will oversee the inpatient service and will assign rounding responsibilities to the junior residents in conjunction with the APPs.

The administrative chief will run the Allegheny General Hospital service and West Penn Hospital service. The administrative chief will be responsible for the resident call schedule, case conference, assigning residents to specific cases and organizing the resident teaching conference. URO-5 residents will be sponsored for the AUA Review course in June of their graduating year. Finally, two “mock” part 2 examinations will be administered to each URO-5 by the faculty and guest faculty to prepare them for part 2 of the ABU certifying examination.