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Atlanta VA Medical Center

Atlanta VA Medical Center (AVAMC) - UR4, UR2, UR1, UR1

1670 Clairmont Road NE, Decatur, GA 30033
Emory University Atlanta VA Aerial View

AVAMC 2Atlanta Veterans Affairs Medical Center

The Atlanta VA Medical Center (AVAMC) is a comprehensive healthcare system comprised of a tertiary medical center that is supported by twelve additional sites of care within the State of Georgia. The AVAMC is a category 1a facility, which is a national designation awarded by Veteran Heath Affairs for the most complex facilities in the US. The primary mission of the VA is to honor America’s Veterans by providing exceptional health care that improves their health and well-being. The urology section at the AVAMC is responsible for the urological care of 130,000 Veterans living in 50 counties and 10 Congressional districts in Northeast Georgia. In addition to providing all Veterans urological care within the State of Georgia as a category 1a facility, the urology section accepts and handles complex urological referrals (uro-oncology, urolithiasis, etc.) from VA facilities in neighboring states. The Atlanta VA is the seventh fastest-growing VA Medical Center in the nation. In fiscal year 2013, it provided health care for more than 90,000 veterans through over 1.1 million outpatient visits, nearly 7,800 inpatient admissions and greater than 41,000 emergency room visits. For 2014, the projected volume is 93,000 veteran patients and 1.5 million outpatient visits. Over the past 7 years (2006-1013), the Atlanta VA has experienced 72% growth rate in the number of patient visits and 53% growth rate in number of veterans treated. With large outpatient facilities and 311 inpatient-operating beds, the Atlanta VAMC provides high quality urological clinical care with state-of-the-art technology, education and research. It is also one of only four VA hospitals nationwide and one of only six hospitals in Georgia to have Magnet Designation, which recognizes the provision of exemplary nursing care.
The Atlanta VA has affiliation agreements with 57 colleges and universities involving 38 different training programs. Its primary and largest affiliation is with Emory University School of Medicine providing over 100 resident positions at the VA. The Two campuses (Emory & Atlanta VA) are located adjacent to each other (within walking distance).

Urology Section at the Atlanta VA
In a long-standing partnership, the entire urology attending staff at the AVAMC is comprised of Emory University urology faculty which includes 4 full-time (Dr. Issa, Dr. PetrosDr. Finnerty), 2 part-time (Dr. Filson 7/8th and Dr. Ritenour 4/8th), 13 voluntary attending faculty urologists and 4 residents. In addition the section has 4 urology physician assistants, 2 urology nurse coordinators and a large team of clinical and administrative support staff in the outpatient clinics, inpatient wards, endourology suites and operating rooms. Emory University and the AVAMC are fully aligned in their missions of providing the highest quality of clinical care, teaching and research/scholarly activity. Urology faculty members are available in-house for consultation, monitoring and supervision in the operating rooms, endourology suites and outpatient clinics throughout the day as well as after hours. In particular, Dr. Finnery, the director of outpatient urology clinics and diagnostic procedures together with 4 physician assistants have a primary and only responsibility of staffing the urology outpatient clinics. Dr. Finnerty recently resumed this responsibily from Dr. Sullivan.
Each resident is provided with his/her own desk, private telephone line and voicemail, high performance (on-line) computer, with extended double monitors, in a designated urology office space. Residents enjoy the privacy of this work environment that is conducive to learning.

Our Philosophy in teaching is to simplify complicated topics into incremental steps that are easy for residents to grasp.  Then we start to build up and challenge the student. Our philosophy is backed up with two important ingredients, passion towards teaching and enthusiasm towards the residents. Such environment encourages residents to be absorbed, fascinated, inquisitive and more intrinsically motivated to learn.

Our Strategy and Implementation involve standardization of the learning process through a variety of teaching tools and methods based on direct observation of resident learning and performance, test scores and feedback. We strongly beleive in promoting clinical autonomy without compromising patient safety; a delicate balance that is often challenging in our current healthcare environment. We have successfully narrowed this gap through the principal of force functioning. Force functioning ensures that you cannot start your car unless it is in "park," your washing machine will not spin unless the lid is closed and that you cannot fit the diesel nozzle in your car gas tank. Along the same lines, we designed systems that direct residents and other providers to follow appropriate pre-formatted steps to enhance their learning through standardization. These include electronic templates with force functioning (a provider cannot proceed unless he/she completed the previous step) for consultations and surgical procedures (pre-operative, operative, and post-operative). Other teaching tools and materials include innovative ways to monitor and supervise residents remotely and interactively, didactic lectures, conferences, grand rounds, one-on-one teaching, videos and others. In a recent anonymous evaluation, the resident wrote: “He (Dr. Issa) takes the junior residents through many cases and is able to strike just the right balance between allowing us to have the right amount of autonomy and appropriate supervision."

Endourology Training
A unique part of the urology section at the Atlanta VA lies is the state-of-the-art digital Integrated Endourology Suites (IES) that allows for remote monitoring and supervision of residents. This system was custom-designed for the urology section became operational in 2007. Each Endourology suite is equipped with live visual, audio, and telestration communication that allows for remote monitoring and supervision of residents by urology faculty members from a control room (CR). Visual signals were displayed in the Each Endourology on six color monitors, the main two being 24-inch High Definition (1080p) ceiling mount monitors. Audio signals were communicated to the suites through a ceiling mounted microphone and speakers or wirelessly to an earpiece. The availability of such exceptional facilities enhanced resident training on complex endourological procedures without compromising patient safety and outcomes. Our research shows unique high quality resident training (CJU; 22(5): 7959-64, 2015) as well as high patient acceptance and satisfaction rates with this system (Journal of Endourology; 27(1): 96-100, 2013).


Urology Residency Rotations at the Atlanta VA
There are four residency rotations, ranging between 3 to 6 months each, assigned to the Atlanta VA annually. A total of 12 urology residents rotate at the Atlanta VA per year.

VA Urology Residents Weekly Schedule

VA Urology Directory

Learn about VA History

UR-1 Residents (x2) – 6 Month Rotation 
This entry-level urology rotation is designed to provide first year residents with primary foundational urology training. The rotation offers large caseload that allows for significant autonomy (with supervision) upon achieving appropriate milestones. The weekly schedule is well balanced and includes 1½ days of OR, 1½ days of minor diagnostic urologic procedures (cystoscopy, prostate biopsy, etc.) and 1½ days of outpatient clinics. The first year resident get an opportunity to operate solely with a faculty member (a 1-on-1 surgical experience). Inpatient ward care and consults constitute the remaining part of the schedule.

Training Stats - Duirng the six-month rotation, each UR-1 resident will have the following urology training/experience/caseload:
• 250 flexible cystoscopy
• 75 Prostate ultrasound and biopsy
• 110 endoscopic & open OR cases
• 150 Consults (Outpatients)
• 100 Consults (Inpatients & ER)
• 80 Return patient evaluations
• 120 Case presentations at conferences
• 20 Urodynamics case exposures
• Inpatient care
• Opportunity to participate in research & discovery

UR-2 Resident – 3 Month Rotation 
This rotation includes 3 days of discovery (basic and/or clinical) and 2 days of clinical duties (primarily operative as well as discovery related). The rotation also includes covering the clinical service for 1 week when the Chief resident takes leave. This offers a unique introductory opportunity and experience to take charge a busy clinical service. During the three months, the resident will learn various aspects of research such as study hypotheses, design, methodology, literature searches, analysis of the literature, IRB process, data capturing and tabulation, basic statistical analysis, making appropriate conclusions, constructing and submitting abstracts and manuscripts. The urology section at the Atlanta VA is very active academically with many peer-reviewed publications involving residents, students, physician assistants and nurses.

UR-4 Resident (Chief Resident) – 3 Month Rotation 
This is considered the ultimate rotation for Chief Residents as it offers complete responsibility and supports to run a very active urology service. The weekly schedule includes 3 days of OR and 2 days of outpatient clinics (new referrals/pre-op and post-op cases). Operative experience include complex endourological procedures such as percutaneous nephrolithotomies as well as "large" open procedures such as radical nephrectomy, partial nephrectomy, radical cystoprostatectomy, etc.  The Chief Resident is responsible for the weekly urology grand rounds/pre-operative, GU-radiology and GU-pathology conferences. Other responsibilities include mentoring and teaching junior residents, and preparing for the in-service examination.

Training Stats - Duirng the three-month rotation, each Chief Resident will have the following urology training/experience/caseload:
• 150 Major endoscopic & open OR cases
• 100 Consults (Inpatients & ER)
• 100 Consults (Outpatients)
• 120 Return patient evaluations
• 30 Urodynamics evaluations
• Management of inpatient service including SICU
• Teaching and supervision of junior residents
• Opportunity to participate in research & discovery