All goals and objectives from Urology year 1 will also carry over to the 2nd year of training.  The 2nd year resident will add to those goals and objectives the following:

Goals
The goal for the second year of urologic residency training is to solidify a broad fund of basic urologic knowledge while developing the ability to diagnose and treat all basic urologic disorders as defined under the programmatic category of ambulatory urology. The successful resident will demonstrate the professionalism and communication skills required to function as an increasingly independent member of the treatment team.

Objectives
Patient Care
The resident will demonstrate the ability to acquire clinically pertinent information during the history and physical examination of all urologic patients in a timely fashion.

The resident will acquire a complete understanding of the role for, and performance of, simple and complex urodynamic evaluations of both adult and pediatric urologic patients.

The resident will demonstrate mastery of all low to moderate complexity urologic procedures which include (but are not limited to) flexible and rigid endoscopy, ureteroscopy, TRUS, prostate biopsy, vasectomy, TUNA, TUMT, WIT, ESWL, endoscopic injections and implantations, dilation of the urinary tract, placement of urethral, bladder and ureteral catheters, bladder biopsy, retrograde pyelograms, laser lithotripsy, penile and scrotal cases.
The resident will participate in the performance of moderate to highly complex urologic procedures including (but not limited to) TURP, TEVAP, green light laser prostatectomy, PCNL, placement of urologic prosthetics, pelvic floor procedures such as mid-urethral slings and anterior/posterior repairs, pediatric urologic reconstructive and extirpative procedures, urologic laparoscopy and patient side robotics, reconstructive and oncologic procedures of all forms.

The resident will demonstrate the ability to evaluate and manage patients in a timely, empathic and organized fashion with attention to full patient education and confidentiality.
The resident demonstrates outpatient assessment and management by obtaining complete and accurate patient histories, performing thorough and appropriate physical exams, ordering appropriate laboratory and radiological tests, integrating information meaningfully and coherently, generating appropriate differential diagnosis.
The resident manages hospital inpatients by developing appropriate evaluation and treatment plans for preoperative and postoperative patients, anticipating patient needs in the hospital setting, effectively identifying and managing postoperative clinical problems, writing clear and appropriate orders, and planning outpatient follow -up visits as needed.

The resident demonstrates a preparedness for surgical cases by being able to discuss rationale and risks of commonly performed surgical cases, reading about surgical procedures in advance, demonstrating knowledge of important steps and instruments in specific surgical cases.
The resident demonstrates surgical skill in performing endoscopic procedures by demonstrating surgical proficiency and technical ability during endoscopic procedures such as cystoscopy, ureteroscopy and percutaneous renal surgery.

The resident demonstrates surgical skill in performing open surgical cases by demonstrating surgical proficiency and technical ability during commonly performed open surgical procedures.
The resident demonstrates surgical skill in performing laparoscopic procedures by demonstrating surgical proficiency and technical ability during laparoscopic procedures.      

Medical Knowledge
The resident will demonstrate a working knowledge of Campbell’s Textbook of Urology which will be augmented through independent study of the AUA updates and other textbooks as deemed necessary.

The resident will demonstrate the ability to provide comprehensive care to all urologic inpatients including up to date and accurate knowledge of clinical status, recommendations of consultants and pertinent laboratory data. This includes the ability to determine the time line for appropriate discharge from the hospital, the provision of accurate discharge instructions and the coordination of outpatient services. This will take place, at all times, under the direction of the Chief Resident and/or the attending faculty.

The resident will acquire skills that result in the ability to perform low to moderate complexity ambulatory procedures and to first assist on moderate and high complexity surgical treatments. 

The resident, with the active involvement of a research mentor, will conduct a statistically accurate analysis of clinical data and prepare and present at least one (1) project. It is expected that this project will be successfully submitted for publication.

The resident demonstrates basic science and clinical knowledge by being able to identify and discuss pathophysiology of urologic disease processes, intelligently discussing diagnosis, evaluating and treating common urologic disorders, applying knowledge to solve clinical dilemmas, and understanding rationale for varied approaches to clinical problems.

The resident demonstrates up-to-date knowledge by seeking new information by searching the literature and asking questions, citing recent literature when appropriate, asking knowledgeable and well-informed questions.

The resident uses knowledge & analytical thinking to address clinical questions by using effective problem solving techniques, demonstrating sound clinical judgment, applying an analytical approach to clinical situations, and critically assessing diagnostic information and selecting appropriate diagnostic testing.

Practice Based Learning and Improvement
The resident will attend all scheduled outpatient clinics on time and appropriately attired. The resident will demonstrate the ability to evaluate a patient and determine the appropriate course of diagnostic and therapeutic interventions. The supervising faculty member on specific ambulatory rotations will assess the fund of knowledge of the resident.

The resident will manage a complex prospective Filemaker Pro quality improvement database and interact professionally with all data managers and assistants. This includes mastery of the role of the EMR in both quality improvement and clinical research activities.

The resident will master online and computer based scientific literature search engines such as Endnote and begin to apply these tools to daily clinical care activities.

The resident will regularly attend all research conferences and is expected to present the results of the data analysis conducted above.

The resident will develop and submit an abstract (1-2) for national or international meetings where the results and conclusions of the research will be presented in an organized manner.

The resident will demonstrate the ability to read, review and statistically evaluate urologic literature during the monthly Journal Club.

The resident tracks and analyzes practice to identify areas for improvement by using a systematic approach such as chart or case analysis, or surgical log review to track his/her own practice, comparing own outcomes to accepted guidelines and national or peer data, reflecting on critical incidents to identify strengths and weaknesses, and monitoring effects of practice changes and improvements.

The resident engages in ongoing learning by determining how learning deficits or weaknesses can be addressed, seeking feedback, doing extra reading and surgical practice when needed, seeking information from the literature, critically appraising research evidence for applicability to patient care, and using information technology (IT) resources to aid learning.

The resident implements improvement activities by changing practice patterns and other behaviors in response to feedback, applying new skills or knowledge to patient care, tailoring research evidence to care of individual patients, and using IT to improve patient care.

The resident facilitates the learning of others by explaining clinical reasoning and procedures to junior colleagues and medical students, providing clinically useful information in response to learner questions, directing learners to useful resources, and providing coaching.

Interpersonal and Communication Skills
As in the first year, successful interviewing skills will be exhibited including the use of open-ended questions, focused listening, targeted questioning when necessary, empathy and attention to patient confidentiality.

The resident will provide comprehensive education to patients and obtain informed consent for all ambulatory urologic procedures. This excludes complex oncologic, robotic, pediatric or reconstructive procedures.

The successful second year resident should exhibit the analytic and communication skills necessary to serve as a consultant to other hospital services for acute urologic emergencies. Although the resident will always work under supervision of the Chief resident or attending faculty the resident should demonstrate the ability to evaluate and manage such patients independently.

The resident will demonstrate the communication skills necessary to interact with the Chief Resident and faculty during evening and night time patient encounters while on call. The resident should understand the appropriate circumstances where support is needed from a senior resident or faculty member and arrange for that support.

The resident will demonstrate the ability to guide a less experienced surgeon, PA-C and nursing staff through the performance of low complexity procedures.

The resident will interact in a professional manner and demonstrate the ability to function as a team member with nurses, PA-C’s and other medical professionals.

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 of 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.

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 hid/her own interests, recognizing and addressing ethical dilemmas and conflicts of interest, and maintaining patient confidentiality.

Systems Based Practice
The resident will demonstrate accurate and timely documentation of all medical encounters in the EMR. The second year resident should master the necessary documentation skills for inpatient EMR and paper charts, dictation of consultations and discharge summaries.

The resident will document participation in the performance of moderate to highly complex urologic procedures including (but not limited to) TURP, TEVAP, green light laser prostatectomy, PCNL, placement of urologic prosthetics, pelvic floor procedures such as mid-urethral slings and anterior/posterior repairs, pediatric urologic reconstructive and extirpative procedures, urologic laparoscopy and patient side robotics, reconstructive and oncologic procedures of all forms.

The resident will acquire the understanding of all postoperative outcomes for the above procedures and contribute independently to the patient safety and quality improvement activities of the Department of Urology including the prompt reporting of all adverse events and medical errors to the Department of Performance Improvement as required by the Department of Urology and in compliance with all hospital and state regulations.

The resident will complete all regulatory courses for patient safety, HIPAA and IRB.

The resident will demonstrate the ability to apply for IRB exemption or full review for clinical research involving one or more of the clinical databases kept in the Department of Urology.

The resident will attend all scheduled core competency sessions throughout the year including monthly Department of Urology sessions, the lectures scheduled through the Office of Medical Education and all additional sessions considered necessary by the faculty mentor and Program Director.

The resident will acquire techniques and skills for managing difficult patients and socially sensitive circumstances independently from senior residents and faculty. The resident will be mentored and evaluated on these techniques during routine self-evaluation exercises, role playing and standardized patient sessions.

The resident will develop skills managing hospital and Departmental resources, managing the EMR in system based learning exercises and the professionalism of team building and participation.

The resident will demonstrate the organizational skills and professionalism to manage time away (such as vacation and CME related travel) and coordinate the call responsibilities with the other residents and faculty.

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 works to promote patient safety by identifying system causes of medical error, anticipating and responding to patient care problems, adhering to surgical protocols that ensure patient safety, and accepting input from the patient care team.

The resident coordinates care with other healthcare providers by obtaining consultation when needed, communicating with other providers, resolving differences in treatment plans, and reconciling contradictory advice.

The resident facilitates patient care in the larger healthcare community by showing an understanding of different healthcare delivery systems and medical practices, assuring patient awareness of available care options, making appropriate referrals, and assisting with arrangements and follow -up to ensure appropriate care.       

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 works to promote patient safety by identifying system causes of medical error, anticipating and responding to patient care problems, adhering to surgical protocols that ensure patient safety, and accepting input from the patient care team.

The resident coordinates care with other healthcare providers by obtaining consultation when needed, communicating with other providers, resolving differences in treatment plans, and reconciling contradictory advice.

The resident facilitates patient care in the larger healthcare community by showing an understanding of different healthcare delivery systems and medical practices, assuring patient awareness of available care options, making appropriate referrals, and assisting with arrangements and follow -up to ensure appropriate care.        

Evaluations
The resident will expect to receive formative feedback on a prompt and ongoing basis from their assigned faculty mentor, other faculty and the program director. The resident will demonstrate the ability to integrate this feedback into a personal quality improvement process.

The resident will receive summative feedback at the end of each ambulatory rotation and on a bi-yearly basis from faculty and the program director.

The resident will demonstrate effective communication and problem solving skills by providing feedback regarding the program in a prompt and ongoing basis. This feedback is an important mechanism for programmatic improvement and the resident should come to recognize the value of both direct and anonymous feedback.

The resident will demonstrate an understanding of the established supervisory policy and the grievance policy.

The resident will demonstrate an understanding of the policy regarding promotions and probation.

If placed on probation, the resident should demonstrate the ability to participate in the development of a remedial program, which would be successful in achieving the return to resident in good standing.