Urology Residents Responsibilities & Objectives

In compliance with the ACGME minimum program requirements, the Urology Residency Program at the Medical College of Georgia at Augusta University requires its residents to obtain competencies in the 6 areas listed below to the level expected of a new practitioner:

1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
3. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific
   evidence, and improvements in patient care Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
4. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
5. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

While these competencies have always been a part of residency training, their delineation as requirements has mandated specific competency-directed activities and careful documentation. Toward this end, the following knowledge, skill, and attitude requirements, as well as additional urologic surgery technical ability and institutional requirements, have been defined.

Responsibilities and Objectives for All Residents on All Rotations

1. All residents will maintain a full-time position as surgical resident in the Section of Urology. All residents will be responsible for the year-specific job description described hereafter.
   Goals and Objectives/Competency: Institutional Requirement
   Documentation: Graduate Medical Education Office Resident Rolls
2. Upon receiving and reviewing this handbook, all residents should sign the last page, certifying receipt of the handbook, tear out the page, and turn it in to the Program Coordinator, Kim Maddox.
   Goals and Objectives/Competency: Institutional Requirement
   Documentation: Receipt of signed certification page by Program Coordinator
3. All residents will engage in the care of patients on the urology in-patient service and the outpatient clinic as well as in the operating room. Residents act as a team under the guidance of the attending surgeon to manage all patient care issues, from the preoperative, perioperative, and postoperative time intervals.
   Goals and Objectives/Competency: Patient Care, Professionalism, Interpersonal and Communication Skills
   Documentation: Global Resident Competency Rating Form, Observed Patient Encounter Rating Form, 360 Degree Rating Form by Peers, Nursing Staff, and Anesthesia Evaluations.
4. All residents will prepare for, attend, and participate actively in all teaching conferences (Campbell's review, journal club, faculty didactic lectures, AUA update series review), morbidity and mortality conference, urodynamics conference, radiology conferences, Rinker-Witherington symposium, and any additional lectures and course instruction deemed mandatory by the faculty. Residents on medical leave, annual leave, or called to see a patient for a matter than cannot be delegated to the physician assistant wait until the conclusion of the conference will be excused.
   Goals and Objectives/Competency: Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal
   and Communication Skills
   Documentation: Record of Attendance, Global Resident Competency Rating Form, In-Service Examination Scores, Presentation score cards
5. All residents will prepare for and take the annual in-service examination sponsored by the American Board of Urology.
   Goals and Objectives/Competency: Medical Knowledge
   Documentation: In-Service Examination Scores
6. Residents are responsible for all histories and physicals as well as obtaining preoperative consent under the supervision of the attending urologist. Attending notes are added to comply with the laws of Medicare/Medicaid/Tricare. The residents are to write daily notes and orders, operative notes and orders. A discharge note and complete orders are to be on the chart on the day of discharge prior to beginning daily duties, such as clinic or operations. Discharge summaries and consultations are to be sent to referring physicians. Rounds with faculty responsible for individual in house patients will occur on a daily basis with the exception of weekends. Residents are to contact the appropriate faculty member regarding any patient management questions.
   Goals and Objectives/Competency: Patient Care, Professionalism
   Documentation: Global Resident Competency Rating Form, Observed Patient Encounter Rating Form
7. For surgical cases in which the resident is the only resident and/or is the primary surgeon, residents are expected to:
   a. Have familiarized themselves with the patient and their history, discuss any questions with attending
   b. Done the appropriate reading prior to any operation
   c. Have all necessary radiographic studies in the O.R. and hanging on the light box (or displayed on the monitor in the
   case of digital images) prior to the start of the cased.
   d. Dictate operative reports within 24 hours. If not dictated in 48 hrs, residents will lose O.R. privileges.
   e. Write post-operative admission orders or outpatient orders including prescriptions
   f. Promptly enter cases into their own personal and the ACGME Resident Case Log System.
   To access the online:

   Resident Case Log System

   If you do not have an ID and password, contact the Program Coordinator, Kim Maddox
   (email: kimaddox@augusta.edu or office (706) 721-2519).
   You can download a copy of the instruction manual for the Resident Case Log System at:

   Resident Case Log System Instruction Manual

   A list of CPT codes to help expedite entries can be downloaded from:

   CPT Codes Instruction Manual

   For problems with the system, call the ACGME Help Desk at contact the ACGME Help Desk 312-755-7464 or email oplog@acgme.org. 

   Goals and Objectives/Competency: Patient Care, Technical Skills, Institutional Requirements, Delinquent Dictation
   Reports from Medical Records
   Documentation: Global Resident Competency Rating Form, Resident Case Logs
8. All residents are to adhere to the 80 hour work week policy described in the “Policy on Duty Hours” portion of this Handbook. Residents will complete online One45 Duty Hours accessed at:

   ONE45

   and log on using the ID and password generated for you by the residency coordinator. More detailed instructions for the completion of the on-line Duty Hours are available in the “Policy on Duty Hours” section of this Handbook. Additional assistance can be obtained by contacting: Diana Duva at 706-721-2423 or by email dduva@augusta.edu. If the duty hour limit is reached, the resident should notify the chief resident and/or supervising faculty member, sign-out his or her pager, and leave the facility.
   Goals and Objectives/Competency: ACGME/Institutional Regulations, Patient Care
   Documentation: Duty Hour Logs, Institutional Duty Hour Log Audit Reports
9. All residents are responsible for monitoring their level of fatigue. If a resident feels as if his or her level of fatigue is compromising their ability to provide patient care, the resident should notify the chief resident and/or supervising faculty member, sign-out his or her pager, and go to an appropriate call bedroom (or home if near the end of shift and the resident is not too compromised to drive) and sleep. The resident may return to duty after a nap if he or she feels sufficiently rested and the shift is not completed or the 80 hour work week limits have not been reached. If a resident is judged to be too fatigued to adequately provide patient care by the chief resident and/or supervising faculty, even if the resident does not agree, the same protocol applies.
   Goals and Objectives/Competency: Patient Safety
   Documentation: Global Resident Competency Rating Form, 360 Degree Rating Form by peers
10. All residents will read assigned chapters in Campbell's Urology Ninth Edition and other reading assignments as part of their personal home study routine. At Reading Assignment Review Conferences, all residents will be asked questions at random, such as from the Campbell's Urology Study Guide, about the assigned chapters and any incorrect or unclear answers reviewed by supervising faculty assigned by area of expertise.
    Goals and Objectives/Competency: Medical Knowledge, Interpersonal and Communication Skills, Practice-Based
    Learning
    Documentation: Attendance Record, Minutes of Meeting
11. All residents will read articles in Journal of Urology or other articles in journals (e.g., Urology, BJU, Prostate, Endourology, Andrology, NEJM, JAMA) assigned by the faculty as part of their personal home study routine. At monthly Journal Club, all residents will be asked at random to summarize articles and/or will be asked to categorize the methodology of the study (e.g., case series, controlled, blinded, etc.), appropriateness of the statistical analysis, and alternative study designs that might better answer the hypothesis presented by the authors. Questions from any CME questions published with the assigned articles may also be asked. Any incorrect or unclear answers reviewed by supervising faculty assigned by area of expertise. A subscription to Journal of Urology (as part of resident membership in the AUA) is required.
    Goals and Objectives/Competency: Medical Knowledge, Interpersonal and Communication Skills, Practice-Based
    Learning
    Documentation: Attendance Record, Global Resident Competency Rating Form
12. All residents should demonstrate understanding of socioeconomic issues impacting upon the practice of urologic surgery including but not limited to the awareness lack or limits of individual patient Medicare, Medicaid, Peach Care, HMO or other insurance coverage; frugal use of expensive tests and medications; and familiarity with social services available to assist patients in need.
    Goals and Objectives/Competency: Systems-Based Practice, Professionalism
    Documentation: Attendance (either live or on-line) and adequate score on posttest for GME Core Competency
    Lectures related to Socioeconomic Issues,
    Attendance at urology section didactic lectures by practice CEO/coding office/hospital legal counsel,
    Clinical Examination Evaluation, Faculty Evaluations
13. All residents are expected to demonstrate sensitivity to patient diversity issues including but not limited to race, gender, cultural/religious beliefs, sexual orientation, career choice, socioeconomic status, and educational/intelligence level.
    Goals and Objectives/Competency: Professionalism
    Documentation: Attendance (either live or on-line) and adequate score on posttest for GME Core Competency
    Lectures related to Ethics, Attendance at urology section didactic lectures by hospital legal counsel, Clinical
    Examination Evaluation, Evaluations from Faculty, Nursing Staff, Administrative Staff, Peers
14. All residents are expected to develop and demonstrate values consistent with the highest ethical practice of medicine.
    Goals and Objectives/Competency: Professionalism
    Documentation: Attendance (either live or on-line) and adequate score on posttest for GME Core Competency
    Lectures related to Ethics, Attendance at urology section didactic lectures by hospital legal counsel, Clinical
    Examination Evaluation, Evaluations from Faculty, Nursing Staff, Administrative Staff, Peers, Patients
15. During clinic, inpatient rounds, surgical procedures, and conferences, residents are expected to take part in the teaching of students, interns, and more junior residents including but not limited to discussions of normal genitourinary anatomy, physiology and embryogenesis; elements of urologic history taking; elements and technique of urologic physical examination; common urologic signs and symptoms, their implications, and components of appropriate evaluation; patient disease processes and congenital anomalies; rationale, indications, and risks of urologic surgical procedures and medical interventions; and technique of urethral catheter insertion as well as more general topics such as format and content of preoperative history and physical examinations and postoperative progress notes, sterile technique, sharps safety, universal precautions, and perioperative patient care.
    Goals and Objectives/Competency: Medical Knowledge, Interpersonal and Communication Skills, Professionalism
    Documentation: 360 Degree Rating Form by peers and students
16. Residents are expected to participate in academic contributions to the Section of Urology by seeking opportunities for involvement in research such as questioning existing data through literature reviews, formulating research questions, and discussing potential research projects with faculty members. Summarizing the history and course of an interesting patient in the form of a case report is also acceptable. Residents are required to understand and comply with the institutional Human Assurance Committee Policies. For projects approved by the involved faculty member, residents can access data from existing databases maintained by that faculty member or establish and collect a novel data set from patient chart reviews. After data analysis and interpretation residents are expected to present their findings via manuscript admission. Submission of associated abstracts to scientific meetings is also encouraged. While the current residency rotations do not allow for dedicated research time with which to perform basic science research, the clinical
    portion of such projects, such as serum collection for proteomic analysis, can be performed in collaboration with one of the basic science faculty. For more in-depth research exposure, residents are encouraged to apply for funding for a fellowship position in the Section through the American Foundation for Urologic Disease.
    Goals and Objectives/Competency: Medical Knowledge, Practice-Based Learning
    Documentation: Submitted/Accepted Manuscripts and Abstracts
17. All residents will complete Faculty Evaluations and Program Evaluation annually as well as Self and Peer Evaluation twice yearly. In order to complete the Faculty, Program and Peer evaluations, residents should go to:

    ONE45

    Follow the detailed instructions for the completion of the on-line Faculty and Program Evaluations are available in the “Policy on Resident, Faculty, and Program Evaluation” section of this Handbook. For the Peer Evaluations, residents should complete the 360 Degree Rating Form for each of their fellow residents.
    Goals and Objectives/Competency: Institutional Requirement, Practice-Based Learning and Improvement,
    Professionalism
    Documentation: Completed Evaluation Forms
18. All residents have access to a VESSL lab and are encouraged in their free time to utilize this to practice their surgical skills. You may enter the lab via key pad. The code to enter is 9375 *. If you need any assistance you may contact the coordinator for the VESSL, at ext. 4202.
    Goals and Objectives/Competency: Medical Knowledge, Surgical Skill
    Documentation: Faculty Evaluations
19. All residents are expected to participate in the teaching of rotating medical students and interns including assisting students in the completion of their topic checklist.
    Topics to be discussed with students and interns include but are not limited to:
    1. Urologic physical exam
    2. Performing and interpreting clinic urinalysis
    3. Components of hematuria evaluation (CT or IVP, cysto, cytology, not ultrasound with normal renal function)
    4. Voiding symptoms associated with
    a. Obstruction (BPH)
    b. UTI
    c. Stress incontinence
    d. Urge incontinence
    e. Mixed incontinence
    5. Presenting symptoms of epididymitis vs testicular torsion
    6. Prostate cancer
    a. Screening (age appropriateness)
    b. Natural history
    c. Treatment options
    d. Basic hormone therapy concepts
    7. What patient to treat and not to treat with asymptomatic bacteruria (catheterized, intestinal diversion, pregnancy, immunocompromised)
    8. Precautions with GU implants (prophylactic antibiotics, catheterization)
    9. Foley catheter management
    a. Placement (prep, closed system, French size and coude indications)
    b. Alternatives (SP tube, CIC)
    c. Colonization
    d. Removal approaches (antibiotics, fill and pull)
    Student teaching is to be performed in a gracious and positive fashion. Students will be given the opportunity to evaluate residents on their teaching skill.
    Goals and Objectives/Competency: Medical Knowledge, Interpersonal and Communication Skills, Practice-Based
    Learning
    Documentation: Student Checklists, Evaluation Forms
20. All residents are expected to follow the goals and objectives on the following pages regarding the knowledge, skills, progressive responsibility for patient management, and other attributes of residents for each major rotation and each year of training (see details on following pages). Along with these goals and objectives, the responsibility given to residents in patient care will also depend upon each resident's knowledge, problem-solving ability, manual skills, experience, and the severity and complexity of each patient's status as determined by the supervising faculty member.