COMPETENCY-BASED GOALS AND OBJECTIVES FOR UROLOGY RESIDENT EDUCATION. Pre-Urology Residency Training (PGY 1) in [1 + 4 Format Program]

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1 COMPETENCY-BASED GOALS AND OBJECTIVES FOR UROLOGY RESIDENT EDUCATION Pre-Urology Residency Training (PGY 1) in [1 + 4 Format Program] Adapted with modifications from: 1. Objectives For Urology Residency Education 5 th Ed. 2001, SUU 2. Prerequisites For Graduate Surgical Education 1998, ACS 3. ACGME s Outcomes Project Rotations: 12 Months General (or Subspecialty) Surgery (Including 3 Months on General Surgery; 3 Months on General Surgical Subspecialty Rotations [Transplantation, Trauma / SICU, and Plastic / Reconstructive Surgery] + 6 months on Urological Surgical Rotations) I. Attitudinal Learning Objectives (Clinical Competency-Based) - Common to All Rotations: Clinical Competency Acquisition Demonstrate an awareness of the following six (6) general medical competencies (and associated skills) to be acquired during residency training in order to function and succeed as a physician. A. Provide Patient Care that is compassionate, appropriate, and effective for treatment and prevention of disease. 1. Learn to communicate effectively and demonstrate caring and respectful behaviors to patients and families. 2. Be able to gather essential/pertinent and accurate information during history taking. 3. Begin to make informed diagnostic and therapeutic decisions based on patient information and preferences. 4. Learn to develop and carry out logical patient management plans. 5. Acquire the ability to provide compassionate counseling and advice to patients and their family members. 6. Demonstrate the ability to gather and apply appropriate information and technology to support management recommendations. 7. Begin to perform competently medical and surgical procedures appropriate to your level of training. 8. Learn when to provide preventive health care advice and guidance for health maintenance. 9. Learn to work as a team member with other health care providers in providing patientfocused care. B. Continue to acquire Medical Knowledge (demonstrate knowledge about established and evolving sciences and their application to patient care). 1. Demonstrate an investigatory and analytic thinking approach to clinical situations. 2. Learn to apply basic and clinically supportive sciences appropriate to your urologic level of training. C. Refine your Interpersonal and Communication Skills (to accomplish effective information exchange and teaming). 1. Learn how to create and sustain a therapeutic and ethically sound relationship with patients. 2. Learn how to use effective listening skills and elicit and provide information using effective communication skills. 3. Learn how to work effectively with others as a member of a health care team. D. Exhibit Professionalism (commitment to professional responsibilities, ethical principles, and sensitivity to diverse patient population). 1. Demonstrate respect, compassion, and integrity and unselfish responsiveness to needs of patients and society. 2. Demonstrate accountability to patients, society, and the medical profession. 3. Demonstrate a commitment to excellence and ongoing professional development.

2 4. Demonstrate a commitment to ethical principles pertaining to provision or withholding of care. 5. Maintain the confidentiality of patient information and provide fully-informed consent. 6. Understand and provide sound, ethical business practices. 7. Demonstrate sensitivity and responsiveness to patients culture, age, gender, and disabilities. E. Demonstrate an understanding of Practice Based Learning and Improvement (investigate and evaluate practice patterns and improve patient care). 1. Use systematic methodology for practice analysis and perform practice-based improvement. 2. Demonstrate ability to locate, appraise, and assimilate evidence from scientific studies related to patient health problems. 3. Be able to obtain and use information on your own patient population and relate it to larger patient populations. 4. Demonstrate the ability to analyze study designs and statistical methods in the evaluation of clinical studies and treatments. 5. Use information technology to obtain and manage current and continuing self-education. 6. Participate in or facilitate the learning of students and other health care professionals. F. Acquire an understanding of Systems Based Practice (demonstrate an awareness of and responsiveness to the larger context and system of health care). 1. Demonstrate the ability to effectively call on system resources to provide care that is of optimal value. 2. Understand the interrelationships between your practice and the larger system of health care. 3. Learn how the different types of medical practice and delivery systems differ from one another. 4. Understand the methods of controlling health care costs and allocating resources. 5. Begin to practice cost-effective health care and resource allocation without compromising quality of care. 6. Understand how to be an advocate for quality patient care and how to assist patients in dealing with medical system complexities. 7. Learn how to partner with case managers, social workers, and other providers to assess, coordinate, and improve care. II. Additional Educational Objectives: A. General: Develop and demonstrate daily practice attitudes, which enhance the provision of optimal patient care, support acceptable standards of medical ethics, and provide maximal personal professional satisfaction. B. Specific: 1. Demonstrate that patients and their families have a right to obtain complete and unbiased information and recommendations for management. 2. Be aware of patients Advanced Directives and conform, if possible, to their wishes. 3. Preserve the patients autonomy and confidentiality. 4. Accept responsibility and demonstrate reliability and dependability. 5. Become well-organized and efficient, and develop clinical skills to estimate the time needed to accomplish necessary tasks. 6. Be familiar with and actively participate in the principles of utilization review, quality management, and peer review. 7. Demonstrate empathy, understanding, compassion, integrity, and honesty in dealing with patients, family members, colleagues, and other medical and paramedical personnel. 8. Demonstrate willingness and ability to function as a member of an interdisciplinary team and exhibit mutual respect and cooperation among medical and paramedical personnel. 9. Demonstrate willingness to obtain consultation whenever appropriate. 10. Demonstrate a desire for self-improvement and the willingness to obtain continuing education.

3 11. Know the resources available (departmental or institutional) when ethical or professional behavior problems arise. 12. Be aware of one s limitations and accept criticism. 13. Begin mentoring and role-model patterns. 14. Develop teaching skills and facilitate medical student and fellow resident learning. III. Demonstrate an understanding of the pre- and postoperative care of patients by discussing: A. Acid-base balance, fluid and electrolyte therapy, and surgical nutrition in surgical patients. B. Principles of endocrine and metabolic responses to injury and disease. C. Hemostasis, surgical bleeding and its control, and transfusion indications and risks, including HIV / AIDS and Hepatitis. D. Surgical anesthesia and the management of pain. E. The influence of other diseases or pharmacologic agents upon surgical care. F. Psychological and emotional problems, which might impact presentation or response to treatment. IV. Demonstrate proper techniques for tissue handling, applications of electrocautery, wound closure, and wound care. V. Demonstrate proper techniques of administration and understanding of risks and benefits of local anesthesia. VI. Demonstrate competence in obtaining a detailed urologic history, including chief complaint, history of present illness, review of systems, past medical history (medical and surgical), family history, and social history. VII. Demonstrate competence in performing an accurate and complete physical examination. A. Describe and be able to identify abnormalities which might be found upon visual inspection. B. Demonstrate the ability to palpate and percuss, to identify and outline renal or abdominal masses and tenderness. C. Demonstrate the ability to transilluminate abdominal or scrotal masses. D. Demonstrate an understanding of possible applications of auscultation to identify abdominal or flank bruits and their possible causes. E. Demonstrate ability to perform accurate breast examination and recognize abnormal masses or discharge. F. Demonstrate the ability to identify an enlarged bladder upon inspection and be able to list possible causes. G. Demonstrate the ability to inspect/examine a phallus to identify the followings types of problems: 1. Phimosis and paraphimosis 2. Balanoposthitis and balanitis 3. Penile cancer 4. Meatal stenosis and megameatus 5. Hypospadias or epispadias 6. Priapism 7. Condylomata 8. Herpetic or syphilitic lesions 9. Urethral discharge 10. Peyronie s Plaque 11. Presence of a penile prosthesis H. Describe and identify (in pictures or with actual patients) the following scrotal abnormalities: 1. Cancer of scrotal wall or contents 2. Varicocele 3. Sebaceous cysts 4. Scrotal edema 5. Elephantiasis 6. Inguinal hernia 7. Absent or cryptorchid testis

4 8. Orchitis / epididymitis 9. Torsion of spermatic cord 10. Atrophy of testis 11. Paratesticular mass and abnormalities thereof, such as torsion of appendix testis and adenomatoid tumor of epididymis. 12. Presence of inflatable prosthesis pumps / reservoirs. 13. Presence or absence of vas deferens (and implications of its absence on renal embryology) 14. Sperm granuloma at previous vasectomy sites 15. Hydrocele or spermatocele and be able to distinguish between the two in diagnosis and treatment recommendations. I. Describe and identify (in pictures or with actual patients) the following vaginal / introital abnormalities: 1. Meatal stenosis 2. Urethral Prolapse or urethral discharge 3. Vulvar abnormalities such as bartholinitis, condylomata, cancer, or herpetic/syphilitic venereal lesions. 4. Pelvic organ prolapse such as urethrocele, cystocele, rectocele, enterocele, or procidentia. 5. Normal and abnormal cervix 6. Normal and abnormal uterus 7. Normal and abnormal adnexal structures J. Through rectal inspection and palpation (of a patient or mannequin / model) identify the following: 1. Normal and abnormal perineal sensation 2. Normal and abnormal anal sphincter tone 3. Anal-sacral reflexes and implications of their presence or absence 4. Hemorrhoids 5. Rectal fissures / fistulae / perirectal abscesses 6. Rectal polyps or cancer K. Through digital rectal examination of the prostate in a patient (or manikin/model) characterize the following: 1. Size, consistency, mobility, and presence / absence of nodularity or induration of prostate parenchyma. 2. Demonstrate technique and ability to perform and obtain expressed prostatic secretions. 3. Demonstrate the ability to palpate an enlarged seminal vesicle and discuss its possible significance. L. Demonstrate the ability to recognize visually and to palpate enlarged nodes in regions related to GU disease and discuss their importance relative to differential diagnosis. VIII. Demonstrate the ability to develop a complete differential diagnosis. IX. Obtain written informed consent for any recommended diagnostic invasive diagnostic tests or procedures. X. Document a logical and legible treatment plan including the indications and alternatives for management in the medical record. XI. Dictate a detailed operative note. XII. Dictate or document a complete discharge summary with defined patient instructions and follow up care. XIII. Develop patient assessment and perioperative skills to include the following: A. Order and interpret basic laboratory tests and screening X-Rays, and evaluate the patients cardiac, pulmonary, renal, and neurologic status. B. Review, prioritize, and order medications being taken or currently needed by the patient. C. Use and understand the nursing notes and patient data in the medical records. D. Prescribe activity levels, management of medications, pain management, arrange follow-up appointments, and obtain urgent contact information.

5 E. Recognize abnormalities in basic radiologic and laboratory tests and learn normal values and ranges for commonly used tests. F. Choose optimal imaging tests to evaluate patients. G. Interpret basic EKG findings and recognize ischemia and arrhythmia patterns. H. Be able to obtain control of airway and provide Ambu ventilation. I. Be able to perform orotracheal intubation, nasotracheal intubation, nasogastric intubation, and thoracostomy tube placement. J. Be familiar with intraoperative monitoring and be able to interpret the anesthesia record. K. Understand and utilize basic principles of mechanical ventilation and arterial blood gas analysis and alterations. L. Be familiar with insertion of arterial, venous, and central venous lines and catheters and their potential value in patient monitoring. M. Know the mediators of temperature elevation or fever, and list the differential diagnosis, evaluation, and management of the febrile patient and provide supportive treatment. N. Initiate definitive treatment of infections with appropriate antibiotics, monitor levels, and recognize drug-related complications and their management. O. Know the common flora of various organ systems and the manifestations of infection of these organ systems. P. Know and apply the principles of prevention of nosocomial infections, sterile technique, and universal precautions. Q. Know and apply the principles of incision and drainage (I & D) of abscesses. R. Discuss the proper use of prophylactic antibiotics. S. Describe the classification of wounds (Clean, Clean-contaminated, Contaminated, and Dirty / Infected) T. Be able to recognize, initiate appropriate supportive treatment and discuss possible causes and mediators of septic syndrome and its pathophysiology. U. Understand the development of bacterial resistance and the basic characteristics of epidemics. V. Be knowledgeable in AIDS diagnosis and prevention of HIV infection. 1. Know the common opportunistic infections of AIDS and other immunocompromised patients, their clinical manifestations, diagnosis, and management. 2. Understand the epidemiology and treatment of sexually transmitted diseases and other communicable diseases. XIV. Demonstrate competence in performing the following outpatient clinic diagnostic skills: A. Routine urinalysis (dipstick and microscopic). B. Residual urine measurement by urethral catheterization or Bladder Scan techniques. C. Collection and preparation of specimens for culture (e.g., urine, urethral discharge, and wound drainage). D. Gastrointestinal endoscopy rigid and / or flexible (with supervision). E. Fluoroscopy and radiation safety XV. Demonstrate knowledge and competence in performing the following surgical skills: A. Perform as first assistant learn various techniques to obtain hemostasis of small vessels and techniques to provide exposure of the operative field for the surgeon. B. Be familiar with common surgical instruments and suture materials and their proper use. C. Perform basic maneuvers such as suture of skin, soft tissues, and fascia; tie knots (one handed and two handed); learn proper use and risks of electrocautery. D. Under supervision: demonstrate competence in the following procedures: 1. Excise benign lesions of skin and subcutaneous tissues. 2. Perform simple open and needle biopsies of superficial masses. 3. Incise and drain abscesses. 4. Repair simple lacerations. 5. Perform clamp and surgical circumcisions. 6. Repair umbilical and inguinal hernias.

6 7. Obtain and apply split thickness skin grafts and manage donor sites. 8. Pass urethral and nasogastric catheters. 9. Insert, maintain, and remove peripheral and central venous catheters, arterial lines, feeding tubes, Foley catheters, and chest tubes. 10. Manage tubes or drains placed intraoperatively or percutaneously. 11. Perform and interpret paracentesis, thoracentesis, and diagnostic peritoneal lavage. 12. Perform appendectomies, breast biopsies, and lumpectomies. 13. Debride and lavage infected / necrotic tissues. 14. Perform endotracheal intubation. E. Understand and practice proper wound management principles: 1. Differentiate between, and initiate proper treatment for, wound infection, hematoma, seroma, urinoma, and lymphocele. 2. Perform wound irrigation and debridement. 3. Pack wounds and / or apply dressings. 4. Identify, differentiate and manage wound dehiscence and evisceration. 5. Obtain proper wound specimens for culture and staining. F. Assess, prioritize, and manage complications of surgery or unexpected deterioration in health status. G. Recognize and manage acute peritonitis and differentiate from non-surgical conditions such as PID, acute pancreatitis, and urolithiasis. H. Recognize and manage (or consult appropriate services) when managing patients with the following conditions: 1. Coagulopathy 2. Deep vein thrombosis, thrombophlebitis, or pulmonary embolism 3. Myocardial infarction or cardiogenic shock 4. Acute renal failure 5. Congestive heart failure, pulmonary edema, and bronchospasm 6. Anaphylactic reaction 7. Anemia 8. Aspiration 9. Bowel obstruction 10. Diabetes and its common complications 11. Hypertension 12. Pregnancy 13. Cerebral vascular events (strokes) 14. Hematuria and its various causes 15. Urinary retention 16. Urinary tract infection 17. Various malignancies (e.g., skin, viscera, connective or hematologic tissues) 18. Acute alcohol intoxication or chronic alcohol abuse or other drug intoxication or abuse XVI. Trainees are expected to complete The Fundamentals of Surgery Curriculum during the period of July May 15 th of their PGY-1 year. This is a highly interactive, case-based, online curriculum that addresses the essential content areas that all surgical residents need to master in the early years of training. Developed by the American College of Surgeons Division of Education and subscribed to by the Department of Urology, LSUHSC-S, the curriculum includes over 90 simulated case scenarios in which residents are asked to recognize and assess symptoms and signs, order appropriate tests and procedures, evaluate data, and initiate appropriate actions. A. Approximately 20 hours of interactive patient scenarios are used to address essential content in the 11 areas of:

7 Preoperative Assessment On-Call Issues (such as postoperative hypotension and postoperative fever) Fluid and Electrolyte Management Nutritional Support Pain Management Respiratory Management Cardiac Conditions Unresponsive Patients and Agitated Patients Gastrointestinal Conditions (including lower GI bleeding, perianal disease, and bowel obstruction) Wound Management (including traumatic stab wounds, burns, and decubiti) Patient and Workplace Safety B. The Fundamentals of Surgery Curriculum virtual environment: builds learner confidence within the safety of a virtual environment; provides the same learning opportunities for all residents; emphasizes critical thinking skills; supplements current educational programs; is available 24/7 through any computer with Internet access; provides tools for program directors to track resident progress. I have reviewed with the PGY-1 trainee his / her progress toward accomplishment of the stated goals & objectives for the initial level of training and have provided individual feedback evaluation. Signed: Date: Program Director Note to Resident: At the end of each training year you will also be asked to self-evaluate your personal attainment of each educational goal and objective. You will indicate your perception of accomplishment of each stated goal and objective by marking in the margin alongside each the following coded response: + indicates satisfactory accomplishment of this particular goal or objective. indicates exposure to, but incomplete acquisition of, knowledge or experience.** - indicates perceived deficiency in knowledge or clinical experience in this area.** ** You are expected to carry these goals & objectives over to subsequent years. I have reviewed with the Program Director my understanding of educational goals and objectives expected during this year/level of training (prior to beginning this year), and have received individual feedback regarding my degree of accomplishment of the stated goals and objectives including acquisition of competency in the six designated competencies of medical knowledge, patient care, professionalism, performance-based learning and improvement, communication & interpersonal skills, and systems-based practice (at the completion of this year). Signed: Date: PGY-1 Resident