Inter-Resident Variability in Urologic Operative Case Volumes Over Time: A Review of the ACGME Case Logs from 2009-2016.

To assess the effect of the changing landscape of urologic residency education and training on resident operative exposure and inter-resident variability.

The Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating urology chief residents were reviewed from Academic Year (AY) 2009-10 to 2016-17. Cases were stratified into the four ACGME categories - general urology, endourology, oncology, and reconstruction. Linear regression models analyzed the association between training year, volume, and type of cases performed. Inter-resident variability in case exposure was calculated by the difference between the ACGME reported 10th and 90th percentiles.

During the study period, the mean number of cases performed per resident was 1092 (SD 32.7). Although there was no significant change in total case volume, there were changes within case categories. Endoscopic, retroperitoneal oncology, and male reconstruction case volume all increased significantly (Δ20.1%, Δ 5.1%, Δ 8.2%, respectively, all p < 0.05). This was balanced with a concomitant decrease in pelvic oncology and female reconstruction cases (Δ 10.0% and Δ 14.5%, respectively, both p < 0.05). There was a 27.8% increase in laparoscopic/robotic cases (p < 0.001). The ratio difference between the 10th percentile and 90th percentile ranged from a low of 2.5 for retroperitoneal oncology cases to a high of 5.2 for extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL).

From AY2009-10 to 2016-17, residency case volume has remained constant, but there has been a change in types of cases performed and proliferation of minimally invasive techniques. Significant variability of inter-resident operative experience was noted.

Urology. 2020 Apr 23 [Epub ahead of print]

Jonathan Wingate, Byron Joyner, Robert M Sweet, Judith C Hagedorn, Niels V Johnsen

Department of Urology, University of Washington, Seattle, WA, USA. Electronic address: ., Children's Hospital and Regional Medical Center, Division of Pediatric Urology, Division of Urology, Seattle, WA, USA., Department of Urology, University of Washington, Seattle, WA, USA., Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.