Ambulatory Urology Residency Rotation

Preceptors:  Drs. Mowad, Simmons

Schedule
Monday
Simmons/Mowad all-day clinic 
One Monday per month Drinis cysto clinic for RUGS, video-urodynamics

Tuesday
Simmons ambulatory endoscopic cases rm 4
   
Wednesday
Simmons all-day clinic
Urodynamics 2 half days per month (goal 8 studies/month)

Thursday
Minimally invasive BPH therapy and cystoscopy with Simmons/Rukstalis

Friday 
Simmons TRUS/Bx am & vasectomy, minor procedures pm
Alternate Fridays at ambulatory surgery center Woodbine.

Educational goals
Resident will refine history taking, physical exam, and procedural skills pertaining to the wide range of ambulatory urology topics.

Objectives
Patient Care
Will learn through supervised patient contact how to conduct a detailed infertility history and physical.
Will participate in infertility surgeries such as varicocele repair and testis biopsy.
Resident will perform TRUS, prostatic block and biopsy under direct supervision.
Resident will learn how to perform a history and physical appropriate for the detection of contributing factors to ED. 
Resident will learn to apply the current AUA guidelines for hematuria evaluation. 
Resident will refine cystoscopy skills in awake ambulatory patients.
Resident will review x-rays and formulate treatment plans with attending and counsel patients.
Resident will participate in stone procedures both in clinic and OR.
Resident will learn to conduct a thorough yet time efficient history of women with urinary incontinence, prolapse and pelvic pain. 
Through direct supervision, resident will learn a thorough pelvic exam, assessing for incontinence, prolapse, and pelvic floor muscle dysfunction.
The resident will learn the proper evaluation and treatment options for patients with frequent UTIs. 
The resident will focus on bladder, kidney, and testis cancers as it involves ambulatory management of these diseases as chronic conditions (ie. post-op surveillance) as well as the initial evaluation and diagnosis of the disease.  In depth study is accomplished on the oncology rotation.
The resident will learn the appropriate metabolic evaluation of stone formers.

Medical Knowledge
Through self-study, will review the natural history of the disease of BPH.
Learn when to obtain and how to interpret objective data, such as voiding diaries, PVR measurements, non-instrumented uroflow, multichannel urodynamics and validated research tools such as the IPSS questionnaires, etc.
Will learn to interpret and apply results of laboratory tests ordered for infertility cases.  
Will focus on the application and interpretation of screening techniques for prostate cancer in the ambulatory general urology population. 
The resident will learn the indications, effectiveness and risks of currently available treatment options.
Microscopy skills will be developed with direct supervision.  
Through self-study, he will learn the dosing, spectrum and side effects of common urologic antibiotics prescribed for UTIs.
Through self-study, will learn the normal pathways of spermatogenesis, sexual function and fertility.  Through self-study and didactic teaching will learn the incidence and causes of male infertility. 
Resident will learn through self-study and didactic lectures, the pathophysiology of stone formation. 

Practice Based Learning and Improvement
The resident will learn through self study and didactic and hands on teaching the comparative outcomes, complications, and financial implications of treatment including observation, behavior modification, medical therapy, minimally invasive and surgical therapy of BPH.  Patient will participate in formulating treatment plans, counseling patients and performing a wide range of BPH therapies.

Interpersonal and Communication Skills
The resident will demonstrate the interpersonal skills and communication skills that facilitate his/her role as consultant and team member.
The resident will interact in a professional manner with nursing and other support staff.
The resident will demonstrate care and concern for patients and their families by responding appropriately to patient and family emotions, establishing rapport, providing reassurance, being respectful and considerate, and does not rush the patient or the family of the patient.
The resident communicates effectively with patients and their families by allowing the patient to tell his/her own story, listening attentively, using non-technical language when explaining and counseling, involving the patient and/or family in decision-making (treatment options), and encouraging questions and checking for understanding.
The resident communicates effectively with other healthcare professionals by maintaining complete and legible medical records, writing clear and concise consultation reports and referral letters, making organized and concise presentations of patient information, giving clear and well-prepared presentations at conferences, providing clear understanding about who is responsible for continuing care.   
The resident works effectively with other members of the healthcare team by demonstrating courtesy to and consideration of consultants, therapists, and other team members, inviting others to share their knowledge and opinions, making requests not demands, negotiating and compromising when disagreements occur, handling conflict constructively, and handling emergency situations effectively.
Resident will learn to counsel patients about diseases and treatment plans and manage expectations about outcomes.

Professionalism
The resident accepts responsibility and follows through on tasks by willingly accepting responsibilities, being industrious and dependable, completing tasks carefully and thoroughly, responding to requests in a helpful and prompt manner.
The resident practices within the scope of his/her abilities by recognizing the limits of his/her abilities, asking for help when needed, referring patients when appropriate, exercising authority accorded by position and /or experience.
The resident responds to each patient’s unique characteristics and needs by being sensitive to issues related to each patient’s culture, age, gender & disabilities, and providing equitable care regardless of patient culture or socioeconomic status.
The resident demonstrates integrity and ethical behavior by taking responsibility for his/her actions, admitting mistakes, putting patient needs above his/her own interests, recognizing and addressing ethical dilemmas and conflicts of interest, and maintaining patient confidentiality.

Systems-Based Practice
 Will become familiar with algorithms for appropriate and cost effective laboratory evaluation of the infertile male. 
The resident provides cost-conscious medical care by considering costs and benefits of tests and treatments, adhering to established patient care pathways, not ordering unnecessary tests, and; using appropriate billing codes for outpatient visits and surgical procedures.
The resident will demonstrate facility with the EMR and an understanding of documentation guidelines and requirements.
The resident will develop an understanding of coding and billing functions of the Department and the intersection between these activities and medical documentation.
The resident will demonstrate acceptable attention to maintenance of medical records including thorough consultative notes, direct patient communications and operative notes (when appropriate).

Evaluations
The resident will expect to receive formative feedback on a prompt and ongoing basis from their assigned faculty preceptors.
The resident will receive summative feedback at the end the ambulatory rotation.
The resident will demonstrate the ability to solicit feedback from faculty and other support staff.
The resident will demonstrate an understanding of the established supervisory and grievance policy.
During discussion of cases being seen, attending will assess resident’s progress with independent reading and study.