Goals and Objectives for the Geriatric Elective
Goals
The changing demographics of the American population has resulted in an increased number of both medically well and unhealthy elderly individuals who suffer with urologic disorders. The practicing Urologist must develop a working fund of knowledge in both the specific medical and surgical issues pertinent to the treatment of urologic disorders in the elderly. This elective is designed to expose the urology resident to the outpatient and inpatient diagnostic evaluation and medical therapy of elderly patients in order to create an integrated approach to the management of these patients. Objectives
Patient Care
The resident will demonstrate the ability to thoroughly evaluate an elderly patient in the outpatient setting including all organ systems.
The resident will perform a thorough evaluation of a hospitalized elderly patient.
The resident will express an understanding of the impact of physical health on the patient’s ability to perform the activities of daily living.
The resident will estimate the risk of any urologic surgical procedure relative to the overall physical condition of an elderly patient. Medical Knowledge
The resident will describe the incidence of cardiac, pulmonary, neurologic and orthopedic illnesses in the elderly population and the impact of these disorders on the treatment of urologic illness.
The resident will understand the geriatric medical instruments for estimating an elderly patients cognitive function and ability to conduct the activities of daily living.
The resident will integrate the various methods to improve the delivery and outcome of medical care for the hospitalized elderly patient.
The resident will estimate the incidence of urologic disorders in the healthy and medically ill elderly. Interpersonal and Communication Skills
The resident will demonstrate the ability to communicate effectively with an elderly patient and his/her family about medical and surgical treatments and test resuts.
The resident will demonstrate effective communication skills for managing a cognitively intact and cognitively impaired elderly patient.
The resident will demonstrate the communication and interpersonal skills required to coordinate the care of an elderly individual with all providers that may be involved.
Professionalism:
The resident will treat the patient’s concerns and fears with compassion and respect.
The resident will manage any personal frustration that may be a result of attempting to treat the complex medical and surgical disorders of a cognitively impaired elderly patient.
The resident will acquire the skills to provide health care to an elderly individual who may want more personal control over medical decisions including refusing to accept apparently appropriate medical recommendations. Practice Based Learning and Improvement:
The resident will utilize pertinent medical literature in developing a treatment plan for urologic disorders in the elderly.
The resident will employ established instruments in the evaluation of the elderly patient.
The resident will understand the pertinent literature which distinguish the health care needs of the frail versus healthy elderly. Systems Based Practice
The resident will verbalize the complex interplay of all medical providers involved in the care of an elderly patient.
The resident will utilize the EMR to coordinate the pharmacologic treatment of a urologic illness in an elderly patient already receiving multiple medications.
The resident will understand the resource needs and costs of treatment in the frail versus healthy elderly. Goals and Objectives for the MIS/Robotics Elective
Goals
Technologic advances over the past decade have fundamentally altered the treatment options for patients with urologic disorders. This change has been most apparent in the field of laparoscopy and robotics. Although the Department of Urology at the Geisinger Health System actively provides the urology residents with exposure to these minimally invasive and robotic procedures a specific elective has been constructed to provide the interested individual resident with a more in-depth experience. This elective is designed to facilitate the development of an advanced understanding of the engineering principles involved in minimally invasive and robotic surgery as well as the opportunity to acquire advanced technical skills. Objectives
Patient Care
The resident will participate as first assistant, patient side assistant and/or surgeon on all MIS and robotic procedures performed during the elective by participating teaching faculty.
The resident will provide the preoperative evaluation, intraoperative surgical care and postoperative care to patients treated with MIS approaches.
The resident will determine optimal port configurations for all MIS/robotic procedures that are performed during the elective.
The resident will identify and treat all complications of the MIS procedures. Medical Knowledge
The resident will understand the specific indications for a laparoscopic or robotic surgical approach for urologic disorders.
The resident will contrast the risks and benefits of the MIS/robotic approaches relative to the other treatment options.
The resident will express the anatomic and medical aspects of a patient’s condition which may complicate a MS/robotic procedure. Interpersonal and Communication Skills
The resident will reflect the indications, risks and benefits of MIS/robotic procedures with patients.
The resident will obtain informed consent in an accurate , compassionate and respectful manner.
The resident will participate on the MIS surgical team in an effective manner to facilitate the completion of the procedures. Professionalism
The resident will interact with all involved health care providers in a professional manner.
The resident will put patient needs above own interests in the process of determining the optimal treatment approach. Practice Based Learning and Improvement
The resident will organize the pertinent literature regarding the outcomes of open , laparoscopic and robotic surgical procedures.
The resident will develop and maintain a QI data base so that surgical outcomes can be improved through analysis of current treatment technique and results. Systems Based Practice
The resident will utilize the EMR to thoroughly document information about the health care of an individual patient such that this information can be employed for quality improvement efforts.
The resident will contrast the costs of the open, laparoscopic and robotic approaches for the treatment of prostate cancer, renal disorders and pediatric urologic reconstruction procedures.
The resident will analyze the challenges of the incorporation of advanced technology into the surgical operating room environment. Goals and Objectives for the Radiology Elective
Goals
Radiologic imaging has always been of central importance in the diagnosis and evaluation of many urologic disorders. Recently , technological advancements in the imaging equipment , as well as therapeutic devices have increased the importance of an effective imaging based skill set for urologists. The elective is designed to provide the urology resident with an in-depth experience in ultrasound, CT and MRI imaging of patients. Additionally, urology residents will develop an understanding about current interventional approaches to percutaneous access to the urinary tract and tissue ablation. Objectives
Patient Care
The resident will express the indications for the use of US, CT and MRI based imaging in the evaluation of urologic disorders.
The resident will apply the anatomic and pathophysiology skills acquired in other educational rotations to the interpretation of US, CT and MRI films.
The resident will perform an adequate number of genitourinary US procedures to become credentialed as a non-radiologist provider of US.
The resident will participate in all GU interventional procedures performed during the elective.
The resident will observe, and when appropriate perform, intentional vascular access procedures. Medical Knowledge
The resident will describe the fundamental principles of US , CT and MRI imaging.
The resident will discuss the published literature regarding image guided tissue ablation. Interpersonal and Communication Skills
The resident will employ effective interpersonal and communication skills during interactions with radiologic personnel such as technicians and physicians
The resident will verbalize the risks and benefits of image guided access and ablation treatments to patients. Professionalism
The resident will function as part of the diagnostic and treatment team in a professional manner.
The resident will treat the concerns of health care providers and patients with compassion and respect. Practice Based Learning and Improvement
The resident will evaluate the pertinent literature regarding the optimal imaging protocol of specific urologic disorders.
The resident will maintain a database regarding all imaging studies performed during this elective.
The resident will maintain a quality improvement data base to determine the optimal approach to image guided ablation. Systems-Based Practice
The resident will verbalize an understanding of he complex interplay between interventional radiologists and urologists in the management of patients with image guided procedures.
The resident will acquire the skills to develop a cost-effective diagnostic and treatment protocol for patients with urologic disorders. Goals and Objectives of Nephrology Elective Rotation
Goals
The goal of the Nephrology rotation is to expose residents to the process of providing quality consultative care to hospital inpatients and outpatients with chronic kidney disease. Residents will learn how to evaluate medical problems and risks in patients on non-medical services using an evidence-based approach to evaluation and management. Objectives
Patient Care
Able to complete an accurate work-up of patients with hematuria and proteinuria
Able to implement a treatment plan for dialysis patients
Able to develop a treatment plan for patients with chronic kidney disease
Able to develop a treatment plan for patients with renal lithiasis Medical Knowledge
To understand the impact of urologic disease on chronic kidney disease (CKD)
To recognize the criteria for intitiation and need for dialysis
To understand the management of electrolyte, acid-base disorders in acute and chronic renal failure
To understand the prinicples of fluid management in patients with CKD
To understand the necessary evaluation of patients with hematuria and proteinuria
To understand the metabolic evaluation and prevention of renal lithiasis Interpersonal and Communication Skills
Able to explain to patient about their kidney disease, stones and/or other disorders
Able to explain the principles of fluid management in non-technical terms when discussing with the patient
Able to clearly and simply discuss the prevention of renal lithiasis Practice-Based Learning and Improvement
Willingly researches stone disease for both standard and new treatment options for renal lithiasis
Searches out pertinent literature on chronic kidney disease
Use information technology to manage information, access on-line medical information; and support their own education
Facilitate the learning of students and other health care professionals by presenting a Urology MEND lecture on information discovered while on the Nephrology Elective Rotation Professionalism
Respectfully and compassionately responded to patient’s concerns regardless of the patients’ culture, age, gender, and disabilities
Put patient needs above his/her own interests
Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices System-Based Learning
Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
Practice cost-effective health care and resource allocation that does not compromise quality of care
Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance These goals and objectives would be accomplished through both evaluation of inpatient and outpatient patients. No significant transplant exposure will be done as I am told by Dr. Potdar that this is already being accomplished through a transplant rotation (alternatively if the residents desired transplant exposure this could easily also be done). | 
