DIVISION OF UROLOGY ROTATION SPECIFIC OBJECTIVES FOR VHHSC VGH SITE Preamble Vancouver General Hospital provides a full tertiary care urologic service for the province of British Columbia. VGH provides a stimulating training environment in which four or more residents at all levels work together as a team. There is broad interaction with other medical and surgical services. As such, it offers excellent exposure to all aspects of general urology and a number of subspecialty fields including: Oncology: Including tertiary and quaternary care referrals Trauma: Designated provincial trauma centre Transplantation/MIS: Renal & renal/pancreas transplantation, laparoscopic renal surgery Stones/Endourology: ESWL, PNL, ureteroscopy with lithotripsy Men s Health: Andrology, erectile dysfunction: Outpatient assessment and investigation The objectives for Resident Training at VGH site are designed to prepare the resident for clinical practice, as outlined below according to the CanMEDs framework. Objectives according to the CanMEDS Framework
Medical Expert Surgical techniques Senior level residents To perform a variety of standard and tertiary open urologic operative procedures in a proficient and timely fashion. Initially, this is acquired by performing the procedure with the attending staff as first assistant. Ultimately, the senior resident should be able to competently perform the procedure while directing a more junior resident to assist. As well, the resident should become proficient at endoscopic surgery. Specifically to obtain technical surgical experience in transurethral surgery, especially in transurethral resection of the prostate, and ureteroscopy Surgical techniques Junior level residents To learn basic techniques including catheterization, clot irrigation, spermatic cord block To learn to use and care for urological instruments To learn operative techniques by assisting in cases To be able to comfortably perform simple urological procedures such as cystoscopy, retrograde pyelography, hydrocelectomy, etc., through time spent in the surgical daycare Patient care To manage the urologic care of all patients admitted to the urology service To clinically assess, diagnose and initiate treatment for all inpatients referred for Consultation to the urology service from other hospital services, including the critical care services To assess, diagnose and initiate treatment for all patients referred for consultation to the urology service from the emergency room All such clinical responsibilities are performed under the direction of the attending staff to be discussed at the time of consultation, and by review of imaging studies and followup in consultation with attending staff To understand the indications for surgery, participate in the selection of patients for surgery, and apply the principles of urologic surgery in deriving a surgical treatment plan Attendance at Ambulatory clinics Attendance at Ambulatory (daycare surgery)
Communicator Presentation at Monthly VHHSC morbidity and mortality rounds Teaching of Medical students Daily ward rounds on inpatients to effectively update patients and their families on their condition and care management plan Dictation of clinic and consultation notes on the hospital transcription system Communication with other services involved in the care of a common patient Collaborator Participation in a multidisciplinary team involving nursing staff and other allied healthcare professionals in order to coordinate efficient and safe admission and discharge of patients to the Urology unit Collaboration with office and clinic staff regarding the specific plans for follow up imaging, surgery and clinic visits Booking of emergent and semi-emergent surgeries Manager Recognize the need for cost containment regarding the judicious ordering of diagnostic tests and timely discharge wisely allocating finite healthcare resources Manage time and utilize information technology effectively To participate in office ambulatory clinics in order to gain understanding of the managerial and business aspects of running a clinical practice within a hospital setting Participation in monthly VHHSC morbidity and mortality rounds Prepare on-call lists in conjunction with other residents in the call group
Manager continued While at VGH, senior residents are expected to effectively manage a full service/tertiary care acute urology ward including: Supervision of patient care through daily rounds Pre and postoperative care Delegation of responsibilities to junior house-staff Co-ordinate medical care with other in-hospital services Liaison with nursing staff Liaison with ancillary staff i.e. physiotherapy, dietician, pharmacy, home care Supervising the urology consult service and deciding management for patients from the emergency ward, acute and chronic care services Functioning as a liaison between residents and staff urologists Organization of academic schedule including Grand Rounds, Resident Seminars, Journal Clubs etc. in conjunction with the Program Director and Chariman (For a full description of the responsibilities of the Chief Resident see the syllabus chapter on Chief Resident Responsibilities ) Health Advocate Education of patients and families on the modifiable risk factors for GU conditions such as urothelial malignancy (tobacco) and urolithiasis (dietary modifications) Recognition of when and how to advocate appropriately on behalf of patients, families and their communities Scholar Residents must develop and implement an effective personal education strategy Periodic participation and presentation at weekly Division of Urology Grand Rounds Preparation for and participation in all regular UBC Division of Urology academic Sessions (including seminars, rounds, Grand Rounds, and Journal Club) Pose questions that will provide the basis for clinical research Participation in clinical/basic research projects under the direction of attending staff Attendance at weekly multidisciplinary Uro-oncology rounds at the BC Cancer Agency
Scholar continued While at VGH, senior residents are expected to acquire the academic knowledge required for the fellowship examination and general urological practice. This should be accomplished through: Self-study. Resident seminars and rounds. Grand Rounds. One-on-one discussion with staff urologists. Practice examinations. Professional It is expected that Residents will demonstrate a commitment to ethical practice and high personal standards of behavior at all times with honesty and respect for diversity The resident must recognize her/his limits, make independent decisions when appropriate, but keep senior residents and attending surgeons informed The resident should seek and accept advice graciously The resident should be punctual, meet deadlines and commitments made Residents must be aware of the ethics of research concerning patients