AUA 2022: Urology Resident Autonomy Compared to General Surgery Resident Autonomy

( Anh Nguyen, on behalf of Kunj Jain and the team from Rutgers New Jersey Medical School, shed light on a concerning dilemma on the educational side of health care. In recent years, there has been a rise in urology and general surgery residents who voice a lack of surgical preparedness. Residents have expressed that this lack of preparedness stems from having less autonomy in the operating room. It has been hypothesized that the decrease of resident autonomy could be attributed to the concern of operating times, possible surgery related complications, and poor operation results. Jain’s team took it upon themselves to investigate just how involved residents are, the outcomes of the surgeries they participate in and determine if the common concern about resident performance holds any truth.

The data used in this study is from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) and nearly covers the span of 15 years (July 1, 2004 – September 30, 2019). Patient operations were separated into two groups, Urology, and General Surgery. Each group was further divided into three subgroups: Attending as primary (AP), Resident as primary (RP), and Attending and Resident as primary (AR). The study focused on three main factors: percentage of cases, operation time, and complication rates.

The table below shows the distribution of cases between the Urology and General Surgery groups from 2004 to 2019 for this retrospective study. A total of 127,757 patient operations were investigated.


Percentage of cases:

  • In 2004 urology RP cases started at 31.3% of all urology cases and the highest percentage was in the following year at 31.6%. Unfortunately, the percentage dropped by 2019 and the total of RP cases made up 18.6%. A similar trend occurred for general surgery RP cases; RP cases dropped from 15% to a lowly 5%. For urology, AP case percentages stayed relatively the same while AR cases increased from 33.4% to 46.7%. For general surgery, AR had very little change meanwhile AP cases increased from 17% to 32%.
  • The graph below shows the decline of RP cases for Urology and General Surgery

Operation time:

  • AR cases for both groups had longer operation times. With respect to AP cases, there was no significant time increase for RP cases.

Complication rates:

  • For both urology and general surgery, mortality did not increase between the RP and AR cases. AP cases did have higher complication rates for the general surgery group and increased returns to the operating room for the urology group.

Based on operation times and complication rates, data shows that resident involved cases tend to yield positive outcomes for both urology and general surgery. However, despite the promising data, there has been a steady decline in the number of cases residents are able to participate in for both groups. These results demonstrate a strong argument for increased resident autonomy. Less autonomy may lead to more residents feeling less confident and prepared as clinical surgeons and doctors

Presented by: Anh Nguyen, MD, Rutgers University

Written by: Seyed Amiryaghoub M. Lavasani, B.A., University of California Irvine, @amirlavasani_ on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022. 

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