Rotation Goals

EDUCATIONAL GOALS AND OBJECTIVES BY LOCATION AND SERVICE ROTATION

The urology training program assigns residents using a preceptor format primarily based on subspecialty orientation. In addition, the two off-site rotations (VA Hospital and St. Joseph’s Hospital) have specific teaching value. At the beginning of each rotation the section head or designee will discuss the aims and expectations for each training level. End of rotation evaluation with one-on-one feedback focusing on areas of weakness and strengths with future recommendations will be provided to each resident.

Urologic Oncology

Medical Knowledge and Patient care

  • Effectively and efficiently perform a history and physical examination directed at the diagnosis and surveillance of patients with urologic malignancies. 
  • Understand the impact of medical comorbidities and extent of disease on treatment decisions and the use of multidisciplinary therapies. 
  • Completely manage postoperative care after large urologic oncologic procedures, such as partial nephrectomy, radical nephrectomy with or without IVC thrombectomy, radical cystectomy with various types of urinary diversions, radical prostatectomy, and retroperitoneal lymph node dissection for testis cancer [junior residents (PGY-1 and PGY-2)].
  • Apply established care pathways in the post-operative management of major urologic oncology procedures and understand when adherence to the pathway is not in the best interest of the patient. 
  • Demonstrate surgical competency for senior residents in oncologic procedures, such as partial nephrectomy, radical nephrectomy, radical cystectomy, radical prostatectomy, and retroperitoneal lymph node dissection. (See Section VI)
  • Recognize post-operative complications and initiate prompt and proper intervention. 
  • Timely and concise documentation of operative procedures, clinic notes, and inpatient medical records

Systems-Based Practice

  • Identify barriers to access to health care in patients with Urologic malignancies
  • Use the medical record appropriately
  • Describe the roles of various health care providers in managing patients with Urologic cancers

Practice-Based Learning and Improvement

  • Demonstrate self-directed and lifelong learning skills
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available
  • Become proficient in the EMR for patient care

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity
  • Communicate effectively with patients, families, and professional colleagues
  • Be able to educate and advise patients with sensitivity, compassion, and concern
  • Give accurate, clear, and concise oral presentations

Professionalism

  • Adhere to local and institutional code of conduct, demeanor, behavior and attire
  • Demonstrate respect to patient, families and other healthcare providers
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies
  • Demonstrate an awareness of one’s limitations
  • Describe the principles of informed consent
  • Ensure that dictations and entries into the medical record are performed in a timely manner

By the end of the Urologic Oncology rotations, the resident will be able to:

a)    Demonstrate the ability to diagnose and counsel patients regarding treatment options for common Urologic malignancies.

b)    Confidently manage the perioperative care of patients with Urologic cancers undergoing surgical intervention incorporating existing care pathways and identify/manage post-operative complications promptly and appropriately. 

c)    Perform the common procedures in Urologic Oncology by the completion of the last rotations

d)    Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge                      

Endourology and Stone Disease

Medical Knowledge and Patient care

  • Effectively and efficiently perform a history and physical examination in the patient with urinary calculi, upper urinary tract obstruction, upper urinary tract masses and tumors (including solid and cystic parenchymal masses, and renal pelvic lesions) and other patients with conditions suitable for endourologic management.
  • Interpret radiographic studies and integrate the findings with the remainder of the patient evaluation in the patient with urinary calculi, upper urinary tract obstruction, upper urinary tract masses and tumors (including solid and cystic parenchymal masses, and renal pelvic lesions) and other patients with conditions suitable for endourologic management.
  • Interpret metabolic stone assessments, and formulate evidence-based metabolic treatment plans for metabolic prevention.
  • Develop appropriate differential diagnosis and management plans for flank pain, hematuria, urinary calculi, upper urinary tract obstruction, upper urinary tract masses and tumors (including solid and cystic parenchymal masses, and renal pelvic lesions) and other patients with conditions suitable for endourologic management.
  • Identify relevant comorbidities that may impact the medical and surgical management patients with flank pain, hematuria, urinary calculi, upper urinary tract obstruction, upper urinary tract masses and tumors (including solid and cystic parenchymal masses, and renal pelvic lesions) and other patients with conditions suitable for endourologic management.
  • Demonstrate proficiency appropriate to the level of training in cystoscopic procedures, ureteroscopy, percutaneous surgery and shock-wave lithotripsy.
  • Demonstrate proficiency appropriate to the level of training in laparoscopic procedures.
  • Identify potential postoperative complications and management thereof. Formulate appropriate postoperative management of patients of endourology patients in the outpatient setting.
  • Document concise clinic notes in an appropriate format.
  • Maintain medical records in a legible and legally appropriate professional manner.

Systems-Based Practice

  • Identify drug-seeking behavior, self-destructive behavior and other patient situations that interfere with delivering optimal medical care.
  • Use the medical record appropriately.
  • Coordinate testing and management across the spectrum of relevant departments and services for complicated patients.

Practice-Based Learning and Improvement

  • Demonstrate self-directed and lifelong learning skills.
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge.
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available.
  • Become proficient in the EMR for patient care.

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity.
  • Communicate effectively with patients, families, and professional colleagues.
  • Educate and advise patients with sensitivity, compassion, and concern.
  • Give accurate, clear, and concise oral presentations.

Professionalism

  • Adhere to local and institutional code of conduct, demeanor, behavior and attire.
  • Demonstrate respect to patient, families and other healthcare providers.
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies.
  • Demonstrate an awareness of one’s limitations.
  • Describe the principles of informed consent.
  • Ensure that dictations and entries into the medical record are performed in a timely manner.

By the end of the Endo/Stone rotations, the resident will be able to:

a)    Assess the need for metabolic and/or surgical treatment of patients with urinary stones, and formulate expedient evaluation and management plans for their care.

b)    Formulate reasonable evaluation and management plans for patients with flank pain, hematuria, and other upper urinary tract diseases, including upper tract tumors.

c)    Perform cystoscopic procedures, ureteroscopy, percutaneous surgery and shock-wave lithotripsy.

d)    Complete timely log of surgical cases.

e)    Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge                      

Consult Rotation / General Urology

Medical Knowledge and Patient care

  • Consult resident will receive all new consults and staff with on call faculty
  • Commit to a lifelong process of evidence based learning and adapting clinical care based on new knowledge
  • Effectively and efficiently perform a history and physical examination that is appropriate
  • Identify factors which are important conditions affecting the urologic conditions patient such as: family history, age, comorbidity, metabolic disorders
  • Develop appropriate differential diagnosis and management plans for evaluation common urologic conditions including hematuria, elevated PSA, prostate cancer screening, urinary tract infections, lower urinary tract symptoms, chronic pelvic pain/prostatitis/IC, erectile dysfunction, active surveillance for prostate cancer
  • Document concise clinic notes in an appropriate format
  • Maintain medical records in a legible and legally appropriate professional manner

Systems-Based Practice

  • Identify barriers to access to urologic care and surgery
  • Use the medical record appropriately
  • Report cases for M&M, case peer review, as indicated

Practice-Based Learning and Improvement

  • Demonstrate self-directed and lifelong learning skills
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available
  • Become proficient in the EMR for patient care

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity
  • Communicate effectively with patients, families, nurses, medical assistants, physician assistants, clerical staff
  • Be able to educate and advise patients with sensitivity, compassion, and concern
  • Give accurate, clear, and concise oral presentations
  • Appreciate and be able to discuss sensitive issues with patients, including erectile dysfunction and incontinence

Professionalism

  • Learn the lesson that physicians should take care of patients, the way they would like to be cared for themselves
  • Adhere to local and institutional code of conduct, demeanor, behavior and attire
  • Demonstrate respect to patient, families and other healthcare providers and staff
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies
  • Demonstrate an awareness of one’s limitations
  • Describe the principles of informed consent
  • Ensure that dictations and entries into the medical record are performed in a timely manner

By the end of the General Urology rotation, the resident will be able to:

a)      Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge

b)      Develop the differential diagnoses list, and an evaluation/management plan for common general urologic problems

c)      Perform endoscopic and outpatient procedures including prostate biopsies, flexible cystoscopy, vasectomy

d)      Perform transurethral prostatectomy including TURP, VLAP. TUBE and PVP for management of BPH.

Neurourology and Pelvic Reconstructive Surgery

Medical Knowledge and Patient care

  • Effectively and efficiently perform a history and physical examination, including female pelvic examination
  • Develop appropriate differential diagnosis and management plans for female and male urinary incontinence, neurogenic bladder dysfunction, complicated urinary tract infections, and male stricture disease
  • Identify relevant comorbidities that may impact the medical and surgical management of these patients, including physical disabilities, decubitus ulcers, malnutrition, pelvic prolapse, advanced malignancy, radiation effects, and bowel dysfunction
  • Document concise clinic notes in an appropriate format
  • Maintain medical records in a legible and legally appropriate professional manner

Systems-Based Practice

  • Identify barriers to access to health care in patients with disabilities
  • Use the medical record appropriately
  • Describe the roles of various health care providers in managing patients with neurogenic bladder dysfunction

Practice-Based Learning and Improvement

  • Demonstrate self-directed and lifelong learning skills
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available
  • Become proficient in the EMR for patient care

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity
  • Communicate effectively with patients, families, and professional colleagues
  • Be able to educate and advise patients with sensitivity, compassion, and concern
  • Give accurate, clear, and concise oral presentations

Professionalism

  • Adhere to local and institutional code of conduct, demeanor, behavior and attire
  • Demonstrate respect to patient, families and other healthcare providers
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies
  • Demonstrate an awareness of one’s limitations
  • Describe the principles of informed consent
  • Ensure that dictations and entries into the medical record are performed in a timely manner

By the end of the NPR rotations, the resident will be able to:

a)    Demonstrate the ability to identify common urodynamic findings

b)    Complete timely log of surgical cases and urodynamic procedures.

c)    Perform sacral neuromodulation procedures, botulinum toxin injections, male urethroplasties, artificial urinary sphincter implantations, pubovaginal slings, and urinary diversion surgeries

d)    Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge                       

Pediatric Urology

Medical Knowledge and Patient Care

  • Obtain a history eliciting not only the child’s complaints (as age allows) but also the concerns and observations of the parents as well as the antenatal and birth history.
  • Perform a physical examination, with particular attention to the child’s abdominal, genitourinary and neurologic systems, including abnormal genitourinary development.
  • Develop a differential diagnosis and management plan for common pediatric medical and surgical diagnoses including enuresis, cryptorchidism, vesicoureteral reflux, recurrent urinary tract infections, voiding dysfunction, neurogenic bladder, hypospadias, hydronephrosis and upper and lower urinary tract obstruction.
  • Produce concise but thorough clinical notes (inpatient and outpatient) in a format appropriate to the context (inpatient progress, outpatient evaluation and recommendations, etc).
  • Communicate and present a patient’s clinical course in a logical and concise manner that demonstrates mastery of prioritization and comprehension of clinically-relevant events.
  • Assist in both minor and advanced surgical cases, especially those considered typical of Pediatric Urologic practice (orchiopexy, circumcision and penile corrective surgeries, ureteral reimplantation and pyeloplasty) in a manner that demonstrates increasing independence over time.

Systems-Based Practice

  • Use the medical record appropriately and efficiently, including transitions to new EMR systems.
  • Identify barriers to access to health care in patients with disabilities as well as patients whose parents have significant difficulties with access.  Also, demonstrate comprehension of barriers to interventions unique to the surgical care of children.
  • Report complications for Morbidity and Mortality conference, as indicated.
  • Use the specialized resources of a tertiary referral center in the patient’s best interest including recruitment of appropriate ancillary services and subspecialists.

Practice-Based Learning and Improvement

  • Demonstrate self-directed learning, particularly with respect to preparation for surgical cases and advancing one’s knowledge base of conditions specific to Pediatric Urology such as posterior urethral valves or cryptorchidism.
  • Demonstrate the ability to access, analyze and integrate sources available to apply scientific knowledge to patient care.
  • Demonstrate proficiency with computer applications such as databases, spreadsheets (consult database), electronic presentations and order-writing software.
  • Demonstrate improvements in surgical technique and understanding of key steps in the operation with repeated performance of procedures.

Interpersonal Skills and Communication

  • Listen actively, without interrupting, and demonstrate cultural, ethnic, gender, racial and religious sensitivity.
  • Communicate effectively and age-appropriately with patients, parents, families, nurses, medical assistants, clerical staff and our colleagues from various other departments as a team.
  • Be able to reassure patients and educate and advise their parents with sensitivity, compassion and concern.
  • Give accurate, clear, and concise oral presentations.
  • Appreciate and respect the heightened anxiety that often accompanies the care of children.

Professionalism

  • Adhere to local and institutional codes of conduct, demeanor, behavior and attire.
  • Demonstrate respect to patients, families and all healthcare providers.
  • Use extreme discretion in both private and public communications in accordance with HIPAA policies. This includes oral communication in public spaces, electronic communication regarding patient care, seeking consultations from colleagues and the passing along of protected health information to other residents.
  • Demonstrate awareness of both physical limitations (current surgical skills) and medical knowledge base and seek assistance from supervisors without hesitation.
  • Understand and apply the principles of informed consent.
  • Ensure dictations and progress notes regarding patient care are entered into the medical record in a timely manner.

By the end of the Pediatric rotation, the resident will be able to:

a) Evaluate patients presenting to C. S. Mott Children’s Hospital, demonstrate mastery of the Pediatric Urologic history, physical, differential, and arrive at a diagnosis

b) Demonstrate comprehension and competency in the surgical treatment of common Pediatric Urologic conditions such as vesicoureteral reflux, cryptorchidism, phimosis, paraphimosis, hypospadias and ureteropelvic junction obstruction

c) Complete timely log of surgical cases and balance case variety appropriately

d) Manage preoperative and postoperative Pediatric surgical patients including management of fluids, diet, constipation, weight-based medication dosing, and parent education

e) Recruit the assistance of Child Life and Pediatric Nursing in the preoperative/preprocedure and postoperative/postprocedure care of Pediatric patients 

Male (ED/Infertility)

Medical Knowledge and Patient care

  • Effectively and efficiently perform a history and physical examination in the patients with infertility, including detailed assessment of risks factors for male infertility and identification of physical findings that give clues to etiology of male infertility.
  • Perform a cursory female infertility history to be able to ascribe male vs. female etiology to a couple with infertility problem.  Obviously, a urology resident cannot function at the same level as a gynecology resident or fellow, but a basic understanding of female fertility and infertility problems is essential in treating the couple.
  • Recognize the reasons for ordering a hormonal assessment and being able to interpret such a laboratory panel, as it relates to the male infertility problem.
  • Interpret ultrasound studies and integrate the findings with the remainder of the patient evaluation in the patient with male infertility.  Recognize the role of prostate ultrasound, testicular ultrasound, and seminal vesicle aspiration in the evaluation of male infertility.
  • Demonstrate proficiency appropriate for level of training in microsurgical varicocelectomy, vasovasostomy and vasoepididymostomy.
  • Effectively and efficiently perform a history and physical examination in the patients with male sexual dysfunction.
  • Critically examine the need (or lack of need) for specific diagnostic testing in male sexual dysfunction, including nocturnal penile tumescence monitoring, duplex ultrasound, and penile arteriography.
  • Identify relevant comorbidities that may impact the medical and surgical management of patients with sexual dysfunction, including a very firm understanding of the relationship between sexual dysfunction and cardiovascular disease.  Understand the Princeton Guidelines for cardiovascular risk associated with sexual activity.
  • Prescribe office-based treatments for male erectile dysfunction, including PDE5 inhibitors, urethral suppository therapy and penile injections.
  • Demonstrate proficiency appropriate to the level of training in sexual dysfunction procedures, including surgical implantation of penile prostheses, and correction of penile deformities.
  • Identify potential postoperative complications and management thereof, including penile prosthesis infection/salvage operations.
  • Demonstrate knowledge of the various methods of testosterone replacement therapy in men with hypogonadism.
  • Develop appropriate differential diagnosis and management plans for male infertility, male sexual dysfunction and male hypogonadism.
  • Document concise clinic notes in an appropriate format.
  • Maintain medical records in a legible and legally appropriate professional manner.

Systems-Based Practice

  • Identify drug-seeking behavior, self-destructive behavior and other patient situations that interfere with delivering optimal medical care.
  • Identify psychogenic etiologies leading to complaints of sexual dysfunction or male genital pain that lead to inefficiencies in delivering care.
  • Use the medical record appropriately.
  • Coordinate testing and management across the spectrum of relevant departments and services for complicated patients.

Practice-Based Learning and Improvement

  • Attend several sessions in the microsurgical training lab to develop a cadre of basic skills to then be applied in the operating room in microsurgical cases.  This laboratory experience is essential in making the surgeon ready for the rigors of microsurgery in the field.
  • Demonstrate self-directed and lifelong learning skills.
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge.
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available.
  • Become proficient in the EMR for patient care.

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity.  This is especially important in men with sexual dysfunction and infertility situations, as these diagnoses invoke significant emotional reactions in couples with these problems.
  • Communicate effectively with patients, families, and professional colleagues.
  • Be able to educate and advise patients with sensitivity, compassion, and concern.
  • Give accurate, clear, and concise oral presentations.

Professionalism

  • Adhere to local and institutional code of conduct, demeanor, behavior and attire.
  • Demonstrate respect to patient, families and other healthcare providers.
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies.
  • Demonstrate an awareness of one’s limitations.
  • Describe the principles of informed consent.
  • Ensure that dictations and entries into the medical record are performed in a timely manner.

By the end of the Sexual and Reproductive Medicine rotations, the resident will be able to:

a)    Assess couples with the complaint of infertility, including ascribing a male/female or combined etiology to the problem.

b)    Discern the cause of male sexual dysfunction, including organic and psychogenic causes, and formulate a plan that efficiently reaches a patient-goal oriented approach to a solution.

c)    Screen for hypogonadism with history and blood testing and determine who is a candidate for hormone replacement therapy and which types of therapy are available.

d)    Perform andrology procedures, including microsurgical varicocele repair, vasovasostomy, and implantation of an inflatable penile prosthesis.

e)    Complete timely log of surgical cases.

f)     Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge.                     

VA Medical Center - Ann Arbor

Medical Knowledge and Patient care

  • Effectively and efficiently perform a history and physical examination directed at the diagnosis and surveillance of patients with the complete range of urologic disease. 
  • Understand the impact of medical comorbidities and extent of disease on treatment decisions and the use of multidisciplinary therapies within the VA Health System. 
  • Identify factors which are important conditions affecting the perioperative patient such as: extremes of age, immunosuppression, metabolic disorders, substance abuse, psychiatric conditions
  • Develop appropriate differential diagnosis and management plans
  • Write concise clinic notes in an appropriate format and timely manner
  • Effectively communicate with primary care and consulting physicians at our institution and other VA facilities to promote the comprehensive medical care of our Veterans
  • Competently perform minor and advanced surgical cases appropriate to training level typically encountered at a high-complexity VA hospital
  • Completely manage postoperative care after the complete range of urologic procedures
  • Apply established care pathways in the post-operative management of urologic procedures when appropriate 
  • Recognize post-operative complications and initiate prompt and proper intervention. 

Systems-Based Practice

  • Identify barriers to access to health care in our nations Veterans
  • Use the VA medical record appropriately
  • Describe the roles of the various health care providers at the Ann Arbor VA and mobilize their skills appropriately in managing our patients’ urologic and medical conditions
  • Understand the strengths and weaknesses to providing health care in a large, integrated government health system

Practice-Based Learning and Improvement

  • Demonstrate self-directed and lifelong learning skills
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available
  • Become proficient in the use of the CPRS EMR for patient care

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity
  • Communicate effectively with patients, families, and professional colleagues
  • Be able to educate and advise patients with sensitivity, compassion, and concern
  • Give accurate, clear, and concise oral presentations
  • Appreciate and be able to discuss sensitive issues with patients, including death and dying, substance abuse, health maintenance

Professionalism

  • Adhere to local and institutional code of conduct, demeanor, behavior and attire
  • Demonstrate respect to patient, families and other healthcare providers
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies
  • Demonstrate an awareness of one’s limitations
  • Describe the principles of informed consent
  • Ensure that dictations and entries into the medical record are performed in a timely manner

By the end of the VA rotation, the resident will be able to:

a)    Organize and staff the VA outpatient clinics with faculty supervision on site for each clinic.

b)    Perform the broad spectrum of urologic surgical procedures ranging from oncology, endourology, robotic, laparoscopic and general urology.

c)    Gain experience with a more autonomous role in the management of the entire spectrum of urologic patients in the VA setting.

d)    Develop administrative skills in patient care management in a more independent fashion.

e)    Demonstrate the ability to diagnose and counsel patients regarding treatment options for common Urologic diseases.

f)     Confidently manage the perioperative care of Veterans with Urologic disease undergoing surgical intervention and identify/manage post-operative complications promptly and appropriately.

g)    Develop the ability to manage the entire spectrum of urologic conditions in an outpatient setting effectively employing the resources of a large, integrated health system.

St. Joseph’s Mercy Hospital

Medical Knowledge and Patient care

  • Effectively and efficiently perform a history and physical examination that is appropriate for evaluation of a surgical patient
  • Identify factors important in perioperative surgical patient such as: concomitant diseases involving organ systems (cardiac, endocrine, hepatic, infectious, pulmonary, renal, and psychiatric)
  • Identify factors which are important conditions affecting the perioperative patient such as: extremes of age, immunosuppression, metabolic disorders, pregnancy, substance abuse
  • Develop appropriate differential diagnosis and management plans
  • Write concise clinic notes in an appropriate format
  • Maintain medical records in a legible and legally appropriate professional manner
  • Perform minor and advanced surgical cases typically seen at a large community hospital.

Systems-Based Practice

  • Identify barriers to access to health care
  • Use the medical record appropriately
  • Identify differences in private practice versus academic health care environment
  • Identify strengths and weaknesses of healthcare delivery in a private practice setting
  • Describe the roles of various health care providers in a private practice setting

Practice-Based Learning and Improvement

  • Demonstrate self-directed and lifelong learning skills
  • Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge
  • Be proficient with computer applications such as word-processing, spreadsheets, databases, and electronic presentations if available
  • Become proficient in the EMR for patient care if available

Interpersonal Skills and Communication

  • Listen actively with cultural, ethnic, gender, racial and religious sensitivity
  • Communicate effectively with patients, families, and professional colleagues
  • Be able to educate and advise patients with sensitivity, compassion, and concern
  • Give accurate, clear, and concise oral presentations
  • Appreciate and be able to discuss sensitive issues with patients, including death and dying, substance abuse, health maintenance

Professionalism

  • Adhere to local and institutional code of conduct, demeanor, behavior and attire
  • Demonstrate respect to patient, families and other healthcare providers
  • Use discretion in private and public communications which include electronic communication devices in accordance to HIPAA policies
  • Demonstrate an awareness of one’s limitations
  • Describe the principles of informed consent
  • Ensure that dictations and entries into the medical record are performed in a timely manner

By the end of the St. Joseph hospital rotation, the resident will be able to:

a)    Will complete timely log of surgical cases and urodynamic procedures.

b)    Demonstrate the ability to access, analyze, and use sources available to ascertain scientific knowledge

c)    Perform endoscopic, robotic, laparoscopic and open cases.

d)    Perform robotically assisted prostatectomy, partial nephrectomy and pyeloplasty

e)    Perform transurethral prostatectomy, including TURP, VLAP. TUBE and PVP for management of BPH.

f)     Continue to work effectively with support personnel. 

Surgical Skills Development

A)Post-Graduate Orientation Assessment

Incoming residents are required to complete the PGOA.  This assessment is comprised of several stations/modules and assess important clinical care issues such as informed consent, interpretation of radiologic imaging, critical value interpretation, evidence based medicine, sterile technique etc. 

B) OPEN

C) ENDOSCOPIC

D) LAPAROSCOPIC

E) ROBOTIC

1. GOALS OF TRAINING:  This course should teach the resident or faculty member how to do the following:

a. Set up of the Davinci Robot
b. Use the Robot from the console
c. Troubleshoot the Robot during the case
d. Be a first assistant

2.    METHODS

a. Participate in the set-up, sterile draping, and activation of the robot for three Davinci cases. This will be accomplished by having the resident and or faculty member assist the nursing staff in the set-up prior to the Davinci case.

b. Review the written material and CD ROM regarding the Davinci Robot provided by Intuitive Inc.

c. Be a second assistant for two Davinci cases observing the first assistant and learning the laparoscopic techniques necessary from the first assistant. As a second assistant the resident/faculty member will learn docking of the robot arms, insertion of instruments, and manipulation of the robot arms.

d. Have progressive time at the console with a Davinci-accredited faculty member developing graded responsibility and performing various parts of the operation.

e. Learn how to disassemble the Robot

3.    COMPETENCY EVALUATION:

a. Under the supervision of the Davinci trained nurses the resident or faculty member will set-up the robot and perform lens application.

b. The resident or faculty member will attach the robot to the Davinci arms, insert the working arms and assist in a Davinci case as a first assistant with a previously trained physician observing as second assistant.

c. The resident or faculty member will disassemble the robot and store it after the Davinci case.

Supervisory faculty: Drs. Ghani, Palapattu, Hollenbeck, Montgomery, Hafez, Morgan, Miller and Weizer