Instruction in the core domains:
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
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.
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.
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.
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.
Uroradiology / Pathology Conference
Urology faculty members, in conjunction with the radiology and pathology faculty, will be responsible for facilitating the Pathology and Radiology Conference (Urological Imaging Review). Contemporary cases for this conference will be submitted the week prior by the attending faculty urologists. In addition, historical cases of interest will be chosen by the Radiologists and Pathologists based on educational value. This conference will focus on non-cancer urology diseases. The list of cases will be published prior to each conference.
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.
URO-1 residents will attend this full-day workshop focusing on difficult foley placement, different foleys, 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.
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.
At the start of the URO-1 year, the residents will be familiarized with and expected to review the online AHN Urology Basics handbook – 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 this 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. They will spend an additional 7 months on department of surgery rotations including: trauma, colorectal surgery, Surgical ICU, plastic surgery, general surgery, vascular surgery and transplantation. One month will be spent on the anesthesia service. Lastly they will spend 3 months on the urology service. The URO-1 will attend all Urology didactic sessions and conferences. They 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.
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.
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
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 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 Black and AGH specialty service cases. 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.
The 4th year resident will spend 4 months as chief at the Wexford Hospital, 4 months on the Allegheny General Hospital specialty rotation, 2 months on the Allegheny General Hospital Black rotation and 2 months on research. At the Wexford facility, the 4th year resident will have responsibility for managing emergency room and inpatient consults and supervising the APPs and junior residents. They will assist the attending on more complex procedures and assign cases to the junior resident. On this rotation the resident will be assigned to all robotic cases.
On the AGH black service, 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 AGH specialty rotation, the URO-4 resident will participate in the men’s health/reconstructive clinic (Dr. Bagga), 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.
On the 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 Chemimage, on going studies on prostate cancer epidemiology and numerous cancer projects with Dr. Stefan Mao in medical oncology) are available. URO-4 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 chief year will be split into 2 rotations: administrative chief and chief of the Allegheny General Hospital Black service. On the AGH Black service, 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. When appropriate, they will also scrub on the higher complexity cases at West Penn Hospital. The administrative chief will run the Allegheny General Hospital Clinic and the AGH Gold service. This chief will be responsible for the resident call schedule, 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.