All goals and objectives from Urology year 1 and 2 will carry over to the 3rd year of training. 3rd year resident will add to those goals and objectives the following:

Goal
The senior resident training year is designed to formalize the transition of an individual from supervisor directed and task oriented residency training to independent clinical judgment and evidence based clinical practice. During this year the resident will acquire and demonstrate the complete set of clinical skills required to provide medical and surgical care for low, moderate and highly complex urologic patients.

The primary clinical focus of the senior resident year is on inpatient consultative and surgical care during which the individual will acquire increasing levels of autonomy and independence. Concomitantly, the educational curriculum is designed to provide opportunities to mature an understanding of the role of evidence based medicine, familiarity with current urologic scientific literature, healthcare resource consumption and management while continuing the process of dialogue about medical ethics, professionalism and interpersonal skills.

Objectives
Patient Care
It is assumed that this level resident can perform a thorough and appropriately expeditious patient evaluation such that this information is now incorporated into an accurate assessment and treatment plan.

The resident will effectively evaluate hospitalized patients in need of urologic consultation in a timely fashion and communicate the findings of that evaluation to the consulting service and supervising faculty.

The resident will determine the time line for hospital discharge and manifest an understanding of the expected outcomes following all urologic interventions.

The senior resident will regularly attend the scheduled continuity of care activities in the outpatient office (1/2 day per week in Pelvic Floor Disorders and Pediatric Urology).

The senior resident will demonstrate the ability to function as surgeon on all low to moderate complexity urologic procedures with facility under the direction of the faculty urologist.

The senior resident will function as surgeon or as first assistant on all moderate to highly complex urologic procedures with facility under the direction of the faculty urologist.

The resident will demonstrate the ability to function as both patient side and consul surgeon on robotic cases. It is expected that the senior resident will be capable of completing specific portions of robotic procedures under guidance of the supervising faculty including (but not limited to) port placement, robotic docking, bladder mobilization for radical prostatectomy and cystectomy, complete renal dissection (other than vessels) and portions of intracorporeal suturing.

The resident will demonstrate the interviewing skills needed to effectively interact with patients with complex urologic conditions and the empathy to manage the unique social circumstances.
The resident will demonstrate the ability to educate patients and obtain informed consent for all types of urologic procedures.

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 senior resident will demonstrate a working knowledge of the standard textbooks in Urology and actively review the AUA Updates. This will be manifest, in part, by achieving at or above the median on the Urology In Service Examination.

The resident will demonstrate a working knowledge of intensive care management of urologic patients including acid base balance and fluid and electrolytes.

The senior resident will demonstrate a complete understanding of surgical anatomy and operative planning for all levels of urologic procedures.

The resident will demonstrate a thorough understanding of operative equipment names and function
The resident will understand, and perform when appropriate, the technical aspects of all pediatric urologic procedures. It is expected that several of these procedures will ultimately require fellowship training if the resident wishes to perform them in routine clinical practice.

The senior resident will develop an understanding of common molecular biologic techniques and the implications of this science to clinical practice through interactions with basic science investigators in the Weis Center and attendance of research conferences.

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 continue to manage a prospective quality improvement clinical database but will more directly manage support personnel.

The resident will develop at least 1 (one) research hypothesis and obtain IRB approval for the data analysis.

The resident will develop and submit at least 1 (one) manuscript for a national meeting and publication.

The resident will attend research conferences and regularly provide current urologic literature for group review.

The resident will demonstrate a working understanding of basic biostatistics and apply that knowledge to the analysis of medical literature during Journal Club and routine discussions.

The resident will attend at least 1 (one) national or international meeting and present the results of ongoing research projects.

The resident will demonstrate the ability to conduct effect quality improvement and scientific research while maintaining an active clinical practice.

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

The resident will conduct routine self-evaluations regarding all manners of clinical and interpersonal experiences and expect to review such evaluations with their faculty mentor.

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
The resident will demonstrate active utilization of the medical and urologic literature with facility with Endnote and other search engines. It is expected that this level resident will provide current literature to other residents and faculty as appropriate to routine clinical patient circumstances (at least 1 patient case per week).

The resident will communicate effectively and professionally with the supervising Chief Resident or (most commonly) directly with faculty about the treatment plan for each patient encountered.

The resident will communicate the findings of evaluations of hospitalized patients to the consulting service and supervising faculty.

The senior resident will work closely with the Chief Resident in regards to the consult and emergency services of the Department.

The senior resident will develop skills for directing more junior residents in the performance of low to moderate complexity procedures.

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 assist more junior residents in the self-evaluation process, as well as demonstrate an understanding to those residents about the evaluation process in general

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 will serve as the senior most resident on the pediatric urology service during the final 6 months of the senior year fulfilling all aspects of the Chief Resident goals and objectives as they pertain to this focused experience.

The resident will function effectively and professionally as a consultant to the Emergency Room and direct Department of Urology resources in this regard (interaction with PA-C, office nurses and scheduling personnel).

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 facility with the EMR and an understanding of documentation guidelines and requirements such that this resident can mentor more junior residents in their daily documentation activities.

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).
The senior resident will regularly attend the scheduled continuity of care activities in the outpatient office (1/2 day per week in Pelvic Floor Disorders and Pediatric Urology).

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 receive summative feedback at the end of each continuity of care rotation and on a bi-annual basis from the program director.

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.

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

The resident will communicate suggestions for program change or improvement to the program director at both scheduled residency discussion sessions and in private conference.

The resident will mentor more junior residents in the process of providing formative feedback to the program and program director.