Longitudinal Assessment of Adult Cases Performed by Graduating Urology Residents in the United States: 2010-2018

Abstract

Introduction: This study analyzed longitudinal growth trends, intra-resident variability and adult case volume performed at the completion of urology residency training.

Methods: National case logs of urology residents graduating from 2010 to 2018 were analyzed (1,072 residents). Compound annual growth rates were calculated for case volumes in adult case categories. Intra-resident variability was calculated as the percent difference between the 90th and 10th percentiles. Mean reported case volumes were compared with minimum requirements with the Student's t-test.

Results: Cases were performed in the role of surgeon (range 83% to 89%), assistant surgeon (range 8% to 13%) and teaching surgeon (range 2% to 4%), and total annual cases increased during the study period (compound annual growth rate 0.9%). The breakdown of cases performed by major case category was general urology (range 30% to 33%), endourology/stone disease (range 21% to 24%), oncology (range 19% to 21%), reconstructive surgery (range 13% to 14%) and laparoscopic surgery (range 10% to 13%). Urology residents consistently reported more cases than the minimum requirement (p <0.001) by severalfold (percent difference range of 170% to 550%). Mean intra-resident variability ranged from 198% for general urology to 333% for laparoscopic surgery among major case categories, with decreasing compound annual growth rates for intra-resident variability during the study period. In 2018, 2 residents did not report minimum case requirements (1.6%).

Conclusions: Reported case volume in adult urology is increasing and exceeds minimum requirements by severalfold. Future studies are needed to understand the impact of higher resident case volumes on clinical competency.

Keywords: education; internship and residency; operative; surgical procedures; urology.