Review Committee for Urology

New Application: Urology

Review Committee for Urology

ACGME

ProgramPersonnel and Resources

Program Director

Will the program director ensure that didactic conferences include: [PR II.A.4.s).(1)-(4)]

a)combined morbidity and mortality conferences for all participating sites...... ☐YES ☐NO

b)urological imaging conferences...... ☐YES ☐NO

c)urological pathology conferences...... ☐YES ☐NO

d)journal review...... ☐YES ☐NO

If “NO,” explain.

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Faculty

1.LocalSiteDirectorsforParticipatingSites[PRII.A.4.b)]

Provide thename of the local site director and the number of hours per week devoted to the program foreachsiteparticipatingintheprogram.Insertadditionaltables asrequiredifmorethanfoursitesparticipatewiththeprogram.

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ParticipatingSiteNumber / #1
NameofLocalSiteDirector / Name of local site director /
Approximate hours per week devoted to residency program / # /
Was the appointment of the local site director approved by the urology residency program director? / ☐YES ☐NO
Is the local site director responsible for the supervision of all educational and clinical activities at this site? / ☐YES ☐NO
Participating Site Number / #2
Name of Local Site Director / Name of local site director /
Approximate hours per week devoted to residency program / #. /
Was the appointment of the local site director approved by the urology residency program director? / ☐YES ☐NO
Is the local site director responsible for the supervision of all educational and clinical activities at this site? / ☐YES ☐NO
Participating Site Number / #3
Name of Local Site Director / Name of local site director /
Approximate hours per week devoted to residency program / #. /
Was the appointment of the local site director approved by the urology residency program director? / ☐YES ☐NO
Is the local site director responsible for the supervision of all educational and clinical activities at this site? / ☐YES ☐NO
Participating Site Number / #4
Name of Local Site Director / Name of local site director /
Approximate hours per week devoted to residency program / #. /
Was the appointment of the local site director approved by the urology residency program director? / ☐YES ☐NO
Is the local site director responsible for the supervision of all educational and clinical activities at this site? / ☐YES ☐NO

UrologyUpdated 04/2017

2.Faculty

a)Foreachofthefollowingareasofexpertise,indicatewhichmember(s)ofthefacultycompletedfellowshipeducationandbrieflydescribehowtheywill interactwiththeresidents:[PRII.B.2.a)]

Area of expertise / Name of faculty member(s) / Name of fellowship program completed / Brief description of interaction with residents
Voiding dysfunction / Name / Fellowship / Description /
Female urology / Name / Fellowship / Description /
Reconstruction / Name / Fellowship / Description /
Oncology / Name / Fellowship / Description /
Calculus disease / Name / Fellowship / Description /
Pediatrics / Name / Fellowship / Description /
Sexual dysfunction / Name / Fellowship / Description /
Infertility / Name / Fellowship / Description /

b)Doesatleastonememberofthefacultyhaveexpertiseintheeachofthefollowingtechniques:[PRII.B.2.b)]

(1)Endo-urology...... ☐YES☐NO

(2)Minimallyinvasiveintra-abdominalandpelvicsurgicaltechniques
(e.g.,laparoscopy,roboticsurgery)...... ☐YES☐NO

(3)Majorflankandpelvicsurgery...... ☐YES☐NO

(4)Urologicimaging...... ☐YES☐NO

(5)Microsurgery...... ☐YES☐NO

If“NO,”explain.

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c)Will residentshaveclinicalinteractionwithfacultymembers withexpertisein:[PRII.B.2.c)]

(1)Geriatrics...... ☐YES☐NO

(2)Infectiousdisease...... ☐YES☐NO

(3)Renovasculardisease...... ☐YES☐NO

(4)Renaltransplantation...... ☐YES☐NO

(5)Trauma...... ☐YES☐NO

(6)Interventionalradiology...... ☐YES☐NO

(7)Plasticsurgery...... ☐YES☐NO

(8)Medicaloncology...... ☐YES☐NO

If“NO,”explain.

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d)Is the faculty-to-resident ratio 1:2?[PR II.B.2.e)]

If “NO,” explain.

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Resources

Brieflydescribethespaceandequipmentavailableforresidenteducation,includingmeeting roomsandclassrooms;officespace;diagnostic,therapeuticandresearchfacilities;andoutpatientfacilities,clinics, and office space.[PRII.D.1.]

Limit response to 400 words.

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2.Indicatewithan‘X’ifequipmenttoperformthefollowingproceduresisavailableforeachparticipatingsite.[PRII.D.2.a)-c)]

UrologyUpdated 04/2017

TypeofEquipment / Site#1 / Site#2 / Site#3
Flexiblecystoscopy / ☐ / ☐ / ☐ /
Ureteroscopy / ☐ / ☐ / ☐ /
Percutaneous endoscopy / ☐ / ☐ / ☐ /
Percutaneous renal access / ☐ / ☐ / ☐ /
Shock wave lithotripsy / ☐ / ☐ / ☐ /
Ultrasonography and biopsy / ☐ / ☐ / ☐ /
Fluoroscopy / ☐ / ☐ / ☐ /
Laparoscopy / ☐ / ☐ / ☐ /
Laser therapy / ☐ / ☐ / ☐ /
Urodynamic evaluation equipment / ☐ / ☐ / ☐ /
Video imaging / ☐ / ☐ / ☐ /
Other: specify / ☐ / ☐ / ☐ /
Other: specify / ☐ / ☐ / ☐ /
Other: specify / ☐ / ☐ / ☐ /
Other: specify / ☐ / ☐ / ☐ /
Other: specify / ☐ / ☐ / ☐ /
Other: specify / ☐ / ☐ / ☐ /

UrologyUpdated 04/2017

Resident Appointments

Eligibility Criteria

1.Is the educational program for the general surgery period developed by the program director of the respective surgery residency program with the input and approval of the respective urology program director? [PR III.A.1.a)] ☐YES ☐NO

If “NO,” explain.

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2.Does your program require one year of prerequisite education in surgery, or two years?
[PR III.A.1.]...... ☐1 ☐2

3.Does the prerequisite education in surgery have a minimum of three months in general surgery, as well as a minimum of three months in the core surgical rotations of critical care, vascular surgery, or trauma? [PR III.A.1.a)] ☐YES ☐NO

OtherLearners

Providetheinformationrequestedbelowregardingresidentsand/orfellowsfromotherprogramsassignedtorotations in theprogram.Add rows as necessary.[PR III.D.]

UrologyUpdated 04/2017

TypeofProgram / NameofRotation / LengthofRotation / NumberofResidents/FellowsAssigned
Type of program / Name of rotation / Length / # /
Type of program / Name of rotation / Length / # /
Type of program / Name of rotation / Length / # /
Type of program / Name of rotation / Length / # /
Type of program / Name of rotation / Length / # /

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Educational Program

PatientCare

For each patient care experience at each level, describe resident responsibility under supervision for total patient care, including admission, initial evaluation, diagnosis, selection and implementation of therapy and management of complications. Include with this description resident responsibility for continuity of care with patients; night/weekend responsibility; and long-term care, and address how the program ensures that residents assume increasing responsibility.[PR IV.A.5.a).(2).(a)-(c)]

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2.Will residents receive instruction in each of the following core techniques: [PR IV.A.5.a).(2).(e)-(i)-(vi)]

a)endo-urology...... ☐YES ☐NO

b)major flank and pelvic surgery...... ☐YES ☐NO

c)microsurgery...... ☐YES ☐NO

d)minimally invasive intra-abdominal and pelvic surgical techniques, including laparoscopy and robotics ☐YES ☐NO

e)perineal and genital surgery...... ☐YES ☐NO

f)urologic imaging, including fluoroscopy, interventional radiology,
and ultrasound...... ☐YES ☐NO

If “NO,” explain.

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MedicalKnowledge

1.Are residentsprovidedwithdidacticinstructionin:[PRIV.A.3.a).(1)-(7)]

a)calculus disease...... ☐YES☐NO

b)femalepelvic medicine...... ☐YES☐NO

c)infertility and sexual dysfunction...... ☐YES☐NO

d)pediatric urology...... ☐YES☐NO

e)reconstruction...... ☐YES☐NO

f)urologic oncology...... ☐YES☐NO

g)voiding dysfunction...... ☐YES☐NO

If“NO,”explain.

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2.Will residentsreceiveinstructionineachofthefollowingareas:[PRIV.A.5.b).(1).(a)-(u)]

a)bioethics...... ☐YES☐NO

b)biostatistics...... ☐YES☐NO

c)calculus disease...... ☐YES☐NO

d)epidemiology...... ☐YES☐NO

e)evidence-based medicine...... ☐YES☐NO

f)female pelvic medicine...... ☐YES☐NO

g)infectious disease...... ☐YES☐NO

h)infertility and sexual dysfunction...... ☐YES☐NO

i)geriatrics...... ☐YES☐NO

j)medical oncology...... ☐YES☐NO

k)patient safety and quality improvement...... ☐YES☐NO

l)pediatric urology...... ☐YES ☐NO

m)plastic surgery...... ☐YES ☐NO

n)pre-operative, intra-operative, post-operative, and aspects of:

(1)endoscopic urology...... ☐YES ☐NO

(2)major open flank and pelvic surgery ...... ☐YES ☐NO

(3)microsurgery...... ☐YES ☐NO

(4)minimally-invasive intra-abdominal and pelvic surgical techniques, including laparoscopy and robotic surgery ☐YES ☐NO

(5)urologic imaging, including fluoroscopy, interventional radiology, and ultrasound
☐YES ☐NO

o)radiation safety...... ☐YES ☐NO

p)reconstruction...... ☐YES ☐NO

q)renal transplantation...... ☐YES ☐NO

r)renovascular disease...... ☐YES ☐NO

s)trauma...... ☐YES ☐NO

t)urologic oncology...... ☐YES ☐NO

u)voiding dysfunction...... ☐YES ☐NO

If“NO,”explain.

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3.Describetheresponsibilityoftheresidentsandmembers of the facultyinpreparingandpresentingconferences.[PRII.A.4.t,CPR IV.A.3.andPR IV.A.5.b).(1)]

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Practice-based Learning and Improvement

Briefly describe one learning activity in which residents demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. [PR IV.A.5.c)] (Limit response to 400 words)

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Briefly describe one planned learning activity in which residents engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; and identify and perform appropriate learning activities to achieve self-identified goals (life-long learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)

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Briefly describe one planned quality improvement activity or project that will allow the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that will guide this process. [PR IV.A.5.c).(4)] (Limit response to 400 words)

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Briefly describe how residents will receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is used to evaluate these skills have it available for review by the site visitor.) [PR IV.A.5.c).(5)] (Limit response to 400 words)

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Briefly describe one example of a learning activity in which residents engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients' health problems. [PR IV.A.5.c).(6)-(7)] (Limit response to 400 words)

The description should include:

Locating information
Using information technology
Appraising information
Assimilating evidence information (from scientific studies)
Applying information to patient care
Conducting a comprehensive literature search

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Briefly describe how residents will participate in the education of patients, families, students, residents, and other health professionals. [PR IV.A.5.c).(8)] (Limit response to 400 words)

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Interpersonal and Communication Skills

Briefly describe one learning activity in which residents demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. [PR IV.A.5.d)] (Limit response to 400 words)

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Briefly describe one learning activity in which residents develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health related agencies. [PR IV.A.5.d).(1)-(2)] (Limit response to 400 words)

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Briefly describe one learning activity in which residents develop their skills and habits to work effectively as members or leaders of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities. [PR IV.A.5.d).(3)] (Limit response to 400 words)

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Briefly describe how residents will be provided with opportunities to act in a consultative role to other physicians and health professionals. [PR IV.A.5.d).(4)] (Limit response to 400 words)

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Briefly describe how residents will be provided with opportunities to maintain comprehensive, timely, and legible medical records, if applicable. [PR IV.A.5.d).(5)] (Limit response to 400 words)

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Professionalism

Briefly describe the learning activity(ies), other than lecture, by which residents demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles, including: compassion, integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society, and the profession; and sensitivity and responsiveness to a diverse patient population, including diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. [PR IV.A.5.e).(1)-(5)] (Limit response to 400 words)

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Systems-based Practice

Briefly describe the learning activity(ies) through which residents demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. [PR IV.A.5.f)] (Limit response to 400 words)

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Briefly describe the learning activity(ies) through which residents achieve competence in the elements of systems-based practice: working effectively in various health care delivery settings and systems, coordinating patient care within the health care system; incorporating considerations of cost-containment and risk-benefit analysis in patient care; advocating for quality patient care and optimal patient care systems; and working in interprofessional teams to enhance patient safety and care quality. [PR IV.A.5.f).(1)-(5)] (Limit response to 400 words)

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3.Briefly describe an activity that fulfills the requirement for experiential learning in identifying system errors and implementing potential systems solutions. [PR IV.A.5.f).(6)] (Limit response to 400 words)

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Night Float

How many weeks of night float will residents be assigned in each year of the program? [PR VI.F.6.a)-b)]

URO-1 / # /
URO-2 / # /
URO-3 / # /
URO-4 / # /

Institutional Data

Provide the following data for all participating sites listed in the Accreditation Data System (ADS) for the most recent academic year.

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Site #1 / Site #2 / Site #3 / Site #4
General Urology / # / # / # / # /
Transurethral / # / # / # / # /
TRUS/prostate biopsy / # / # / # / # /
Scrotal/inguinal surgery / # / # / # / # /
Urodynamics (general urology) / # / # / # / # /
Ultrasound (general urology) / # / # / # / # /
Other (general urology) / # / # / # / # /
Endourology/Stone Disease / # / # / # / # /
Shock wave lithotripsy / # / # / # / # /
Ureteroscopy / # / # / # / # /
Percutaneous / # / # / # / # /
Percutaneous - kidney / # / # / # / # /
Other (endourology/stone disease) / # / # / # / # /
Other - kidney (endourology/stone disease) / # / # / # / # /
Reconstructive Surgery / # / # / # / # /
Male - penile/incontinence / # / # / # / # /
Male - urethra / # / # / # / # /
Female / # / # / # / # /
Other reconstructive surgery - fistula / # / # / # / # /
Other reconstructive surgery - kidney / # / # / # / # /
Other reconstructive surgery - trauma / # / # / # / # /
Other reconstructive surgery - ureter / # / # / # / # /
Intestinal diversion / # / # / # / # /
Other (reconstructive surgery) / # / # / # / # /
Oncology / # / # / # / # /
Pelvic - bladder / # / # / # / # /
Pelvic - prostate / # / # / # / # /
Pelvic - other / # / # / # / # /
Retroperitoneal - RPLND / # / # / # / # /
Retroperitoneal - kidney / # / # / # / # /
Retroperitoneal - adrenal / # / # / # / # /
Retroperitoneal - other / # / # / # / # /
Other (oncology) / # / # / # / # /
Pediatrics / # / # / # / # /
Minor - endoscopic / # / # / # / # /
Minor - hydrocele/hernia / # / # / # / # /
Minor - orchiopexy / # / # / # / # /
Minor - other / # / # / # / # /
Major - kidney / # / # / # / # /
Major - hypospadias / # / # / # / # /
Major - ureter / # / # / # / # /
Major - other / # / # / # / # /
Radiologic / # / # / # / # /
Fluoroscopy / # / # / # / # /
Ultrasound (radiologic) / # / # / # / # /
Urodynamics (radiologic) / # / # / # / # /
Other - radiologic / # / # / # / # /
Cystoscopy / # / # / # / # /
Cystoscopy / # / # / # / # /
Non-TRUS Biopsy Ultrasound Procedures / # / # / # / # /
Scrotal (ultrasound) / # / # / # / # /
Renal (ultrasound) / # / # / # / # /
Pelvic (ultrasound) / # / # / # / # /
Prostate (ultrasound) / # / # / # / # /
Penile (ultrasound) / # / # / # / # /

UrologyUpdated 04/2017