Urology Residency Program: Curriculum

The Educational Program

1. The University of Connecticut Program in Urology strives to create an educational environment in which residents develop technical and intellectual skills that foster a career of life long learning. The program provides each resident with a core knowledge base in each of the domains of urology. Specifically residents receive instruction in andrology, male infertility, impotence, calculus disease, urinary obstruction, endourology, extracorporeal shock wave lithotripsy, neuro-urology, urodynamics, female urology, pediatric urology, infectious diseases, transplantation, adrenal disorders, trauma and oncology. The program also strives to provide each resident with basic technical skills needed to provide clinical care in each of these areas. This includes training in endoscopic surgery, open pelvic surgery, flank surgery, laprascopic surgery and robotic surgery. Through journal clubs, grand round presentations and basic science seminars, the program fosters an environment that encourages the search for new information and teaches the skills necessary for continuous self-improvement.

The long-term goal of the program is to prepare individuals to be competent and compassionate urologists that can compete successfully for additional fellowship training or pursue practice in a community setting. The program also strives to expose residents to the research environment with the hope of stimulating some to enter the field of academic urology and encouraging those entering clinical practice to participate in clinical research.

To accomplish these goals the residency consists of a preliminary year in general surgery followed by four years of training in urology. During the general surgery year the resident becomes familiar with basic surgical skills and the knowledge necessary to care for patients in the pre- and post-operative environment. Rotations include general surgery, trauma, intensive care management and outpatient care.

The urology program consists of a series of rotations of graded responsibility extending over four years. The first year consists of an inpatient urology experience, training in colorectal surgery and an outpatient urology experience. The second year consists of training in more sophisticated endoscopic procedures and open surgical procedures. In addition, residents obtain their first exposure to pediatric urology. During the third year, residents receive training in open pelvic surgery, flank surgery and laprascopic surgery. They spend time as chief resident on the pediatric service in addition to rotations on transplant surgery and plastic surgery. The fourth year consists of rotations as chief resident on each of the adult services or our participating institutions. During this year the resident is expected to master all endoscopic and open procedures and to be facile with basic laprascopic surgery.

The didactic component of the residency consists of three core conferences usually conducted on Thursdays. The day begins with grand round presentations. These are followed by a urology seminar that focuses on a specific urologic topic. Later in the evening a journal club is conducted at least once per month. During the summer months the residents receive intensive instruction in radiology and pathology in lieu of the grand rounds conferences.

Throughout each of the four years each resident is expected to achieve the following general goals and objectives:

General Attitudinal Objectives

• Demonstrate professionalism, empathy, and compassion by showing respect for a patient’s privacy and self-esteem during aspects of the physical examination that may be uncomfortable, frightening, or embarrassing for the patient.
• Show an awareness of, and respect for, the contributions of other office/hospital staff members such as medical students, nurses, technicians, and secretaries.

General Knowledge Objectives

• Understand the ethical and moral issues associated with the management of a urology practice.
• Understand the responsibilities of a physician in the ordering of diagnostic and therapeutic measures to include consideration of effectiveness and efficiency.
• Understand the characteristics and importance of several methodologies used in effective interpersonal communication in relations with colleagues, consultants, clinical and administrative support personnel, and patients.
• Demonstrate a working knowledge of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding and data analysis.

General Performance Objectives

• Demonstrate effective verbal communication with patients, patients’ family members and other heath care professionals.
• Demonstrate an appreciation for urgent clinical situations and respond to these in an appropriate fashion.
• Seek assistance from senior residents and/or attending faculty in a timely fashion for complex clinical problems or situations in which the best management strategy is not known or understood.
• Document in patients’ medical record and orders in a fashion which is complete, accurate and legible.

General Patient Care objectives

• Maintain continuity of care of the patient with urological diseases in both the outpatient and inpatient environment.
• Delineate the components of and discuss the importance of a focused history and physical examination performed in an outpatient setting on a patient with a urological problem.
• Demonstrate a working knowledge of the natural history of urological diseases.
• Accurately interpret clinical laboratory results, pathology reports, and radiographic studies.
• Synthesize historical findings, physical examination, and laboratory data to make an appropriate differential diagnosis.
• Develop appropriate management strategies, including obtaining appropriate consultations, for various urological problems.
• Develop the ability to counsel the patient and the patient’s family regarding various urological entities including the associated prognosis, treatment options and additional testing and treatments needed.

2. Pre-urology resident education is offered by the University of Connecticut Program in General Surgery. During this preliminary year the resident is expected to become familiar with basic surgical principles and attitudes. Didactic teaching consists of a weekly surgical conference. Practical surgical skills are taught during rotations concentrating on general surgery, vascular surgery, cardiothoracic surgery, trauma, and the intensive care unit. While on these rotations, the first year residents are expected to become proficient in the management of patients in an inpatient setting. This includes the pre-operative evaluation, post-operative management and the management of patients in an acute health care delivery setting such as the emergency room or the surgical intensive care unit. Operative assignments include basic surgical procedures such as hernia repair, abdominal incisions, and appendectomy.

3. During the first year of the urology program the resident is expected to become familiar with basic urological diseases, terminology, procedures and diagnostic studies. This is accomplished by having residents rotate through four different areas. The rotations at Hartford Hospital adult urology and St. Francis adult urology are designed to enhance skills in endoscopic surgery and minor open procedures. During this time the resident will become familiar with the language and epidemiology of urology. The rotation at St. Francis Hospital on the colorectal service for two months is designed to improve the residents’ open surgical skills especially in the area of bowel surgery. This is an important step to prepare residents for more complex reconstructive procedures performed on adult and pediatric urology. Finally, rotations at the University of Connecticut Health center for four months are designed to expose the resident to outpatient urology. Special emphasis is placed on the management of male infertility and the associated operative procedures. This rotation also exposes residents to basic office procedures such as transrectal ultrasound and biopsy, cystoscopy, urodynamics and bladder scanning.

Specific goals and objectives for each of the urology rotations include the following:

Urology Year 1

• Perform a detailed and comprehensive history and physical examination of the urology patient.
• Demonstrate a familiarity with basic diagnostic tools utilized in urology such as cystoscopy, rectal ultrasound, bladder scan, and diagnostic radiology including an intravenous urogram, CT examination, MRI examination and nuclear medicine studies.
• Demonstrate a familiarity with urological pathology.
• Demonstrate a familiarity with urological trauma and urological emergencies such as renal colic, hematuria, testicular torsion, blunt and penetrating renal trauma, pelvic fracture, urinary retention, and urinary infections of the bladder, kidney, testis and prostate.
• Demonstrate a familiarity with outpatient urological problems such as urinary obstruction, urinary frequency, urinary tract infections, hematuria, renal and ureteral stone disease, prostate problems including an elevated serum PSA, sexually transmitted diseases, impotence, prostatitis, renal cysts, renal masses, spinal cord injury, and psychic conditions.
• Demonstrate proficiency in performing common cystoscopic procedures such as cystoscopy, ureteroscopy, stent placement, collagen injection, lithotripsy of bladder and ureteral calculi, and retrograde pyelography.
• Demonstrate proficiency in performing basic urological procedures such as orchiectomy, hydrocelectomy, radical orchiectomy, circumcision, ESWL, prostate biopsy, and abdominal and flank incisions.
   

• Demonstrate proficiency in managing patients in an ambulatory setting as described above. In addition, demonstrate proficiency in the evaluation and management of the infertile male.
• Demonstrate proficiency in basic outpatient skills such as transrectal ultrasound and biopsy, bladder scan and cystoscopy. Demonstrate proficiency in performing varicocelectomy, and assisting with micro-surgical procedures such as vaso-vasostomy, vaso-epididimostomy and testicular biopsy.
   

• Demonstrate a familiarity with basic surgical skills of a pelvic surgeon. Demonstrate proficiency in performing a bowel resection and a bowel anastomosis. Demonstrate proficiency in recognizing bowel complications and how they are managed.
  

Urology Year 2

The second year of urology consists of inpatient experiences on adult urology at St. Francis Hospital and Hartford Hospital. At St. Francis Hospital the resident is expected to master basic endoscopic procedures and minor urologic procedures. At Hartford Hospital the resident will be exposed to laprascopic and robotic surgery in addition endoscopic procedures and open urology surgery. Four months are spent at the Connecticut Children’s Medical Center where the resident will be introduced to outpatient pediatric urology. This includes the outpatient clinic, the meningomyelocele clinic and urodynamic procedures. The resident will also be introduced to basic outpatient surgery including hypospadius repair and orchidopexies.

The specific goals and objectives for the second year of urology training include the following:

• Demonstrate proficiency in managing patients in an ambulatory setting. This includes knowledge of the appropriate diagnostic and management skills used to evaluate patients presenting with voiding dysfunction, hematuria, incontinence, prostatitis, flank pain, impotence, sexually transmitted diseases, testicular masses, prostate nodules renal stones, ureteral stones and other abnormalities detected on physical examination or by diagnostic imaging.
• Demonstrate familiarity in performing more complex urology procedures such as pelvic lymph node dissection, simple nephrectomy, simple prostatectomy, transurethral resection of bladder and prostate, and trans-vaginal slings and incontinence procedures.
• Demonstrate proficiency assisting during basic laprascopic procedures such as a simple hand-assisted nephrectomy.
   

• Demonstrate proficiency in managing patients in an ambulatory setting as described above. In addition, demonstrate proficiency in the evaluation and management of the incontinent female.
• Demonstrate proficiency in basic outpatient skills such as transrectal ultrasound and biopsy, bladder scan and cystoscopy. Demonstrate proficiency in urodynamic studies, sling procedures and pelvic reconstructin.
   

• Perform a detailed and comprehensive history and physical examination of the pediatric urology patient.
• Demonstrate a familiarity with basic diagnostic tools utilized in pediatric urology such as cystoscopy, bladder scan, and diagnostic radiology including an intravenous urogram, voiding cysto-urethrogram, CT examination, ultrasound (including maternal fetal ultrasonography) and nuclear medicine studies.
• Demonstrate a familiarity with pediatric urological trauma and urological emergencies such as flank mass, testicular torsion, blunt and penetrating trauma, and urinary infections of the bladder, and kidney.
• Demonstrate a familiarity with common outpatient urological problems such as urinary obstruction, posterior urethral valves, urinary frequency, urinary tract infections, ureteral reflux, hematuria, renal masses, and congenital abnormalities such as meningomyelocele, hypospadius and undescended testis.
• Demonstrate proficiency in performing common pediatric studies such as cystoscopy and urodynamic studies.

Urology Year 3

The third year in urology provides the resident with increased responsibility. The four month rotation on adult urology at Hartford Hospital is designed to expose the resident to open pelvic surgery such as radical prostatectomy and cystectomy including continent diversions. Residents also spend four months as chief resident on the pediatric service at the Connecticut Children’s Medical Center. The resident will be exposed to complex reconstructive cases and more difficult outpatient management problems. The residents spend one month on the renal transplant service at Hartford Hospital to acquaint residents with immunology and immuno-suppression and one month on the plastic surgery service to develop skills needed to perform more complex reconstructive surgery such as buccal mucosa flaps that are needed to repair urethral strictures or complete more extensive hypospadius repairs. The resident spends one month as Chief resident at the University of Connecticut Health Center. During this rotation the resident is familiarized with the expectations of the Chief resident year under the direct supervision of the program director.

The specific goals and objectives of the third year are listed as follows:

• Demonstrate mastery of the basic diagnostic tools utilized in urology such as cystoscopy, rectal ultrasound, bladder scan, and diagnostic radiology including an intravenous urogram, CT examination, MRI examination and nuclear medicine studies.
• Demonstrate proficiency managing urological trauma and urological emergencies such as renal colic, hematuria, testicular torsion, blunt and penetrating renal trauma, pelvic fracture, urinary retention, and urinary infections of the bladder, kidney, testis and prostate.
• Demonstrate proficiency managing outpatient urological problems such as urinary obstruction, urinary frequency, urinary tract infections, hematuria, renal and ureteral stone disease, prostate problems including an elevated serum PSA, sexually transmitted diseases, impotence, prostatitis, renal cysts, renal masses, spinal cord injury, and psychic conditions.
• Demonstrate familiarity in performing more complex urology procedures such as radical nephrectomy, radical cystectomy, radical prostatectomy, and continent diversions.
• Demonstrate proficiency in performing transurethral prostatectomy, transurethral bladder tumor resection, and transvaginal surgery including bladder neck suspensions and sling procedures.
   

• Demonstrate proficiency with basic diagnostic tools utilized in pediatric urology such as cystoscopy, bladder scan, and diagnostic radiology including an intravenous urogram, voiding cysto-urethrogram, CT examination, ultrasound (including maternal fetal ultrasonography) and nuclear medicine studies.
• Demonstrate proficiency managing pediatric urological trauma and urological emergencies such as flank mass, testicular torsion, blunt and penetrating trauma, and urinary infections of the bladder, and kidney.
• Demonstrate proficiency managing common outpatient urological problems such as urinary obstruction, posterior urethral valves, urinary frequency, urinary tract infections, ureteral reflux, hematuria, renal masses, and congenital abnormalities such as meningomyelocele, hypospadius and undescended testis.
• Demonstrate proficiency performing common pediatric procedures such as hypospadius repair, orchidopexy, nephrectomy, ureteral reimplantation and common endoscopic procedures.
• Demonstrate a familiarity performing more complex pediatric procedures including bladder and ureteral reconstruction, bladder neck repair, exstrophy closure, and epispadius repair.
   

• Understand basic immunology and immuno-suppression as it applies to the diagnosis and management of the renal transplant patient.
• Understand the outpatient management of patients with renal failure including the use of renal dialysis and the pharmacology of immuno-suppressive medications.
• Demonstrate proficiency as an assistant in performing laparoscopic nephrectomy.
• Demonstrate proficiency performing a ureteral reimplantation.
   

• Understand basic principles of interventional radiology.
• Demonstrate a familiarity with skills of an interventional radiologist. Master the skills of placing a percutaneous nephrostomy tube.
  

Urology Year 4

The fourth year of the urology training program consists of the most senior rotations. Residents are expected to spend four months as the chief resident at the Hartford Hospital, the St. Francis Medical Center and at the University of Connecticut Health Center. At the Hartford Hospital the chief resident is involved in the most sophisticated surgical procedures performed in urology. The Chief resident at St. Francis Hospital is involved with all open surgical procedures performed in urology. The four months spent at the UConn Health Center exposes the resident to several administrative functions. The chief resident is expected to coordinate the interesting case conferences. Furthermore, the chief resident is responsible for arranging call schedules and resolving several administrative details surrounding the management of the urology program. The chief residents rotating through the UConn Health Center are given latitude in selecting speakers for grand rounds. These speakers, however, do need to be approved by the Program Director.

The specific goals and objectives for the fourth year rotations include the following:

• Demonstrate ability to function independently in an outpatient urology environment. This includes the evaluation and management of patients presenting with urological problems to the respective hospital urology clinics. The resident is expected to obtain appropriate laboratory and imaging studies and schedule patients for appropriate surgical procedures with minimal supervision.
• Demonstrate an ability to mentor and teach more junior residents in an ambulatory setting.
• Demonstrate proficiency in performing complex urology procedures such as radical nephrectomy, radical cystectomy, radical prostatectomy, and continent diversions.
• Demonstrate proficiency in performing transurethral prostatectomy, transurethral bladder tumor resection, and transvaginal surgery including bladder neck suspensions and sling procedures.
• Demonstrate proficiency in performing and interpreting adult urodynamic studies.
• Demonstrate proficiency in adult urological pathology.
   

• Demonstrate the ability to manage outpatients and inpatients as described above.
• Demonstrate proficiency in basic organizational management skills. This includes clerical functions such as organizing call schedules, vacations schedules, grand round topics, continuing medical education requirements, and journal club articles.
• Demonstrate proficiency in urology basic science. This includes information presented in the AUA update series and self-assessment examinations.