Educational Goals of the Residency Program

PGY-1 (Uro 1)

12 months (Adult)

Expectations

The PGY-1 year is spent in the Department of Urology, with a six-month rotation in the Department of Surgery. The goal of the first year is for residents to obtain a firm foundation in the care of critically ill surgical patients and to become skillful in fundamental surgical techniques. While in urology, they will be expected to learn basic general urology both endoscopic an open urology. They also learn to manage urology patients in emergency setting and on the floor.

The six ACGME core competencies are introduced to residents and specified in the goals and objectives of the Mass General Surgery Residency Program.

PGY-2 (Uro 2)

Residents begin as a junior member on three different urology services ( Leadbetter, Kerr or O’Neil service ), in which they are exposed to inpatient and outpatient urology patients. Twelve months are spent as the junior resident on the adult service at Mass General. During this time residents are exposed to the use of lasers in urology as part of surgical management of BPH as well as stone disease. They learn prosthetics and other procedures in Men’s Health. Residents also begin skill set training in laparoscopy by using the training modules and attending the laboratory simulations. They will have primary responsibility for the day-to-day activities of inpatient care and are trained in the systems of health care to include patient placement and post-discharge home support.

Residents are exposed to all aspects of urologic surgery and expected to become proficient in both endoscopic and open penile and scrotal procedures.

Residents will acquire cognitive and clinical skills in the outpatient and inpatient care of urology patients and will be introduced to urologic data collection, i.e., history and physical examination and clinical decision-making. They should be familiar with urologic imaging modalities and will be introduced to urologic diagnostic techniques including the following:

• Cystoscopy
• Retrograde pyelography
• Stent placement
• Bladder biopsy
• Transurethral resection of bladder tumors
• Transrectal ultrasound
• Biopsy of the prostate

Residents will cultivate communication, attitudinal and professional skills with ethical standards and will be respectful of patients and their families, obtain informed consent and will demonstrate conduct consistent with a professional. Residents will become knowledgeable about systems-based practice, will be able to work well with the case manager to facilitate proper patient placement in the appropriate facility, as well as provide for patient needs in the home following discharge if that is the destination. Residents will be introduced to quality of care metrics and be capable of effectively accessing the literature to enhance the practice. Residents will begin scholarly activities, which will involve literature reviews of clinical or basic science problems. A scholarly paper is the ultimate goal of all abstracts or posters presented at the regional/national urological conferences. The resident's participation is mandatory in weekly chapter reviews and all conferences.

By the end of the 12-month rotation, residents are expected to have become proficient at the following:

Patient Care

• Demonstrate basic skill in use of laparoscopic instruments and knot tying through simulation
• Attain laser safety knowledge.
• Provide effective, routine inpatient care and management
• Obtain informed consent for most urologic procedures
• Perform simple procedures in the acute care setting
• Treat and follow patients in the acute care setting and access diagnostic and referral mechanisms
• Demonstrate proficiency in penile, scrotal procedures, diagnostic endoscopy and simple cystoscopic procedures
• Participate in open, laparoscopic and endourologic procedures

Systems-based Practice

• Determine appropriate patient placement follow-up and home health assistance

Medical Knowledge

• Demonstrate basic medical knowledge base in urology, assessed by in-service examinations
• The goal is to be above 50th percentile

Practice-based Learning and Improvement

• Participate in systematic analysis and use quality improvement methods to enhance quality of care, patient safety, cost-effective care and patient outcomes

Interpersonal and Communication Skills

• Communicate effectively with patients, families, physicians and other health care professionals

Professionalism

• Carry out professional responsibilities and adhere to ethical principles

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PGY-3 (Uro 3)

8 months adult clinical, 4 months children clinical

Residents will spend 4 months at Mass General Hospital in both inpatient and outpatient care of the adult urology patient and will be responsible for the inpatient unit on the O’Neil, Kerr or Leadbetter service. Residents serve as the operating surgeon for most open major urological oncological procedures. They are also responsible for oversight of first year residents when on call and participate in medical student education. Residents gain exposure to inpatient consultation and are mentored in this by faculty and senior residents. Residents access support facilities for the benefit of patients.

Next, residents rotate at Newton Wellesley Hospital for 4 months. During this time, resident assumes the role of senior resident and is responsible for managing urology service at that hospital. They will function as the main operating surgeon for all the urological surgery performed at that hospital. During this clinical rotation residents will obtain a progressive increase in cognitive and clinical skills in urologic patient care. Residents are directly supervised by the faculty practicing at NWH both in operating room and inpatient care.

At MGH, they will participate in the teaching of junior urology residents, interns and medical students. While at NWH, they will supervise and are assisted by advance practice providers. They will attain proficiency in cystoscopic, diagnostic and therapeutic techniques, be exposed to all aspects of urologic pathology, and will show competence in urologic imaging modalities.

In addition, residents will be introduced to advanced endoscopy, including ureteroscopic and laparoscopic diagnostic and therapeutic methods. Residents are expected to achieve the following:

• Continued improvement in decision-making
• Exposure to complex major operations
• Exposure to robotic procedures at NWH
• Conduct scholarly activity combined with outpatient urology
• Show continued progress in communication, attitudinal, professional and ethical standards
• Be capable of appropriately obtaining informed consent for most urologic procedures
• Evaluate methods of treatment through assessment of the literature
• Use information technology to optimize learning
• Set learning improvement goals with the help of the in-service examination
• Be able to work effectively in a system-based practice to place patients appropriately and provide for appropriate care and support services
• Be proficient in computer-based documentation of patient care for both in- and outpatients
• Understand quality of care measures and provision of quality care in a cost-effective manner
• Understand methods of assessing patient safety, quality of care and outcomes 

By the end of this rotation, residents are expected to have achieved the following:

Patient Care

• Function independently for inpatient and outpatient care, with attending oversight
• Demonstrate proficiency in all aspects of diagnostic and endoscopic urology
• Demonstrate proficiency in the various imaging modalities used in urology
• Obtain informed consent for all urologic procedures
• Demonstrate proficiency in computer-based documentation of patient care for both in- and outpatients

Medical Knowledge

• Demonstrate adequate knowledge base on the in-service examination by attaining a score above the 50th percentile

Practice-based Learning and Improvement

• Evaluate methods of treatment through assessment of the literature
• Use information technology to optimize learning and set learning-improvement goals with the help of the in-service examination
• Understand quality of care measures and provision of quality care in a cost-effective manner
• Understand methods of assessing patient safety, quality of care and outcomes

Professionalism

• Demonstrate continued progress in communication, attitudinal, professional and ethical standards

Systems-based Practice

• Utilize the healthcare systems and support to optimize both home care and inpatient care

Pediatric Rotation

Residents spend 4 months at Boston Children's Hospital gaining experience in the diagnosis and treatment of pediatric urologic patients, including inpatient care, emergency room consults and outpatient clinical activity. Trainees are exposed to most pediatric urologic procedures and will be able to perform simple pediatric urological procedures. Residents will be exposed to all domains of pediatric urology at a senior level and will achieve proficiency of non-complex pediatric urologic procedures. Conference attendance at BCH is an integral part of this rotation. By the end of the rotation, residents are expected to have achieved proficiency in the following:

Patient Care

• Care for inpatient pediatric urology patients
• Perform simple diagnostic and surgical therapeutic pediatric urology procedures

Medical Knowledge

• Demonstrate knowledge of all aspects of pediatric imaging
• Demonstrate knowledge in all aspect of pediatric urology, renal physiology and congenital abnormalities.

Professionalism

• Demonstrate a mastery of attitudinal and professional skills
• Adhere to the highest ethical standards
• Act with sensitivity to cultural differences and patient diversity

Interpersonal and Communication Skills

• Communicate effectively with parents and children of all ages across a broad range of socioeconomic and cultural backgrounds

Systems-based Practice

• Demonstrate awareness and responsiveness to systems of care in the pediatric in- and outpatient setting and the use of hospital support facilities

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PGY-4 (Uro 4)

Four months adult Female Pelvic Medicine and Male Reconstructive Surgery, Four months on inpatient adult urology service. Remaining time is spent on research. 

Senior Urology Resident Rotation with Female Pelvic Medicine and Reconstruction Surgery (FPMRS) Faculty

During the PGY-4 year, urology residents will advance their knowledge of female pelvic medicine with the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty from the Urology faculty and Urogynecology faculty in the Department of Obstetrics & Gynecology. The field of FPMRS is rapidly growing, and joint training opportunities between Urology and OB/GYN subspecialties are available. Residents benefit from more exposure to the female pelvic reconstruction, since many female patients present to urologists with lower urinary tract symptoms that require evaluation and prolapse repair. Nationwide, many FPMRS programs are jointly managed between Urology and Ob/Gyn subspecialties with great success. Participation of both sub-specialties significantly enhances the educational opportunities for trainees. This four-month rotation also includes exposure to male reconstruction including both upper and lower urinary tract reconstruction. 

Operating room–Urology residents will learn how to identify and diagnose female pelvic disorders with particular emphasis on how the disorders affect the lower urinary tract symptoms in the female patient population. Through the education and exposure gained in the clinic setting, urology residents will distinguish between surgically and medically correctable entities. In the operating room, urology residents will learn the surgical techniques that anatomically correct female pelvic disorders. Trainees also rotate to Spaulding spine and rehabilitation center and participate in the urodynamics laboratory.

• Explain procedures and obtain informed consent effectively for all procedures

Outpatient Clinics: Residents are expected to follow their preceptor in their respective clinics both at MGH and at Spaulding rehabilitation hospital. They learn outpatient evaluation and management of these patient as well learn to perform an interpret urodynamic studies.

The resident will be able to demonstrate the following:

• Independent decision-making for patient care with attending oversight
• Cognitive and clinical skills at an advanced level in urologic patient care
• A mastery of the communication skills, attitudinal and professional skills necessary to achieve the highest quality of patient care
• Demonstrate the highest ethical standards
• Be sensitive to cultural differences and patient diversity
• Be capable of obtaining informed consent for all procedures
• Possess excellent rapport with patients and their families
• Be able to manage patients in the outpatient, inpatient and post-discharge settings
• Demonstrate the ability to place and provide for support of patients following their hospital stay
• Be able to work with support services and social services in the outpatient setting to provide proper care
• Demonstrate proficiency in practice-based learning by using the literature to evaluate and improve outcomes 
• Display an ability to identify areas needing improvement in his or her learning and effective methods of addressing them

Scholarly activity and outpatient medicine continue, along with exposure to major operative procedures. Residents participate in the on-call schedule and learn inpatient consultation skills. Residents learn to independently manage inpatient urology consults under the direct supervision of faculty.

The remaining time is spent in scholarly activity and outpatient urology. Research time is tailored to the need and research goals of residents. It is divided in 4, 8 or 12 months block time. During this time an experienced investigator mentor research residents. The trainees meet with the Research Director at least monthly to determine progress and address any existing problems related to research. Residents continue to see patients in the outpatient clinic during this time . By the end of this rotation, residents are expected to be proficient in the following:

Patient Care

• Manage all inpatients
• Provide inpatient consultations for most urologic problems
• Demonstrate advanced skills in outpatient urology
• Operate on their clinic patient to provide continuity of care.

Interpersonal and Communication Skills

• Communicate effectively with patients, peers and families
• Explain procedures and obtain informed consent effectively for all procedures

Practice-based Learning and Improvement

• Use the literature to evaluate and improve outcomes
• Identify areas needing improvement in his or her learning and effective methods of addressing them

Professionalism

• Demonstrate a mastery of attitudinal and professional skills
• Adhere to the highest ethical standards
• Act with sensitivity to cultural differences and patient diversity

Medical Knowledge

• Demonstrate knowledge of fundamental statistical methods
• Demonstrate knowledge of how to design an experiment/clinical study
• Demonstrate knowledge of how to critically analyze data
• Produce a scholarly paper for peer review or presentation
• Demonstrate adequate knowledge base on the in-service examination by attaining a score above the 50th percentile

Systems-based Practice

• Demonstrate awareness and responsiveness to systems of care in the pediatric in- and outpatient setting and the use of hospital support facilities.

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PGY-5 (Uro 5)

Final 12 months are spent as Chief resident rotating on open and robotic/laparoscopic surgery.

Operating room: Chief resident function as the main operating surgeon in complex open and advance robotic and laparoscopic uro-oncology cases. Residents rotate with each oncologic faculty on a 4 months block developing advanced skills in open and laparoscopic surgery.

Outpatient clinics: Residents are responsible for managing their own patients in outpatient clinic.

Urology service is divided into three services for patient care and each chief resident are responsible for managing patients on their service.

Kerr Service:

• The first four months of this year are spent as Chief Resident on the Kerr Service, overseeing the care of patients and supervising the junior residents and serving as the administrative chief resident effectively organizing conferences and call schedules.  During this time trainees are the operating surgeons for most procedures, developing advanced skills in open and laparoscopic surgery.

O’Neil Service

• The next four months of this year are spent as Chief Resident on the O’Neil Service, where they supervise the junior residents.  During this time trainees are the operating surgeon for most endourologic and endoscopic procedures, developing advanced skills in open and laparoscopic surgery. Trainees also function as the administrative chief resident, coordinating conferences and the daily assignment of residents to operative cases. 

Leadbetter Service

During the last four months, residents serve as the chief resident of the Leadbetter Service. As the operating surgeon on open and advanced laparoscopic surgery, trainees provide senior consultation for inpatients on the Leadbetter Service. Trainees participate in the educational process of grand rounds and in the education of junior residents and medical students. Residents also review surgical cases booked from the resident clinic to ensure that the correct information has been gathered and the procedure is appropriate. 

Residents will demonstrate the following:

• A complete knowledge of didactic urology
• An understanding of different health care systems and how they apply to patient care
• Administrative and leadership skills
• Exceptional communication, attitudinal and professional standards as well as ethical standards
• Be able to manage patients effectively in the system of health care
• Demonstrate excellence of teaching
• Present his or her scholarly activity at national society meetings.
• Understand quality of care issues and administration of this care in a cost-effective manner
• Knowledge about patient safety issues and ability to conduct a safe practice
• Ability to assess and understand assessment methods of evaluating patient care activities, his or her learning and patient outcomes.

By the end of the Chief Resident year, residents are expected to be proficient in the following:

Patient Care

• Demonstrate proficiency in open and laparoscopic surgery
• Provide effective and timely consultation for all urologic diseases
• Provide inpatient and outpatient care and support
• Demonstrate proficiency in use of diagnostic and urologic imaging modalities

Medical Knowledge

• Demonstrate a comprehensive medical knowledge base in urology by achieving satisfactory score in both in-service exam and board certification exams.
• Demonstrate knowledge in post- and pre-operative management of patients

Practice-based Learning and Improvement

• Understand quality of care metrics and how to assess and enhance them
• Demonstrate knowledge of methods of assessing patient care and safety issues
• Demonstrate acceptable skills in educating patients, families, students, residents and other health professionals

Interpersonal and Communication Skills

• Demonstrate exceptional interpersonal and communications skills
• Serves as the administrative resident to coordinate the resident call schedule

Professionalism

• Demonstrate compassion, integrity and respect for others
• Continued demonstration of the highest ethical standards
• Expected to be a role model for the junior team members.

Systems-based Practice

• Manage patients in the health care system, calling on other resources as needed to provide optimal health care
• Demonstrate leadership and administration skills at the level of a beginning urologist
• Provide high quality of care in a cost-effective manner 

Assessment and Evaluation:

Residents are evaluated for proficiency in all core competencies by all faculty member and other healthcare providers twice a year.

 Proficiency in the six ACGME competencies will be assessed and evaluated by the following means:

• Patient Care: Throughout the residency there is a graded responsibility for patient care culminating in overall oversight for in- and outpatient care with attending supervision.  Compassionate, appropriate and effective care is assessed during quarterly faculty reviews (written reports), faculty meetings, mortality and morbidity conferences, 360º evaluation (to include nurses, secretaries, social workers) and family comments (patient satisfaction)
• Medical Knowledge: The full base of urologic knowledge and its applications to patient care is evaluated by in-service exams, conference performance, and global, competency-based evaluations by faculty
• Practice-based Learning and Improvement: Gained from quality of care activities, along with interactive and active assessment by the chief practice nurse of patient care. Residents will also have the opportunity to study outcomes for new procedures. Laparoscopic skills are initially gained in the Lap Skills Lab. These aspects are assessed by mortality and morbidity conference and 360º evaluations. Literature reviews help define areas for additional improvement
• Interpersonal and Communication Skills: Assessed by faculty-written evaluations and 360º evaluations
• Professionalism: Continually assessed by patient surveys, faculty global evaluations and 360º evaluations
• System-based Practice:Involves using the systems for patient scheduling, documentation and patient-related social placement services, among others. Reports are generated for the Chief of Service, and individual resident performance noted. Faculty global assessments and 360º evaluations are also conducted

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