To investigate urology resident surgical autonomy trends over time and according to procedure subtype using ACGME case log data.
A retrospective review of 364 chief urology resident ACGME case logs collected from 11 institutions spanning 2010-2021 was completed. Resident-defined role in cases as "assistant," "surgeon," or "teaching surgeon" were used as a metric of graded autonomy. An autonomy score was calculated. Analysis of variance (ANOVA) evaluated differences in autonomy between institutions, within institutions, and between procedure types. Generalized estimating equations (GEE) assessed changes in autonomy over time.
Mean autonomy scores were significantly different between procedure categories, with general urology/endourology having the highest autonomy, reconstruction/pediatrics having the second highest autonomy, and oncology having the lowest autonomy (p<0.05 across all comparators). Between institution variance in autonomy was significantly greater than within institution variance (0.09396 vs 0.01109, p<0.0001). Globally, mean autonomy scores significantly decreased from 2010 to 2021 by a value of 0.007 per year (p<0.001).
Surgical autonomy, as extrapolated from self-reported urology chief resident ACGME case logs, varied according to procedure type, with general urology and endourology ranking highest and oncology ranking lowest. Overall, chief resident autonomy scores decreased significantly over time. If validated in a larger national cohort, these findings may have implications for contemporary urologic training in terms of resident confidence and self-sufficiency for independent practice.
Urology. 2025 Jun 03 [Epub ahead of print]
Niccola B Lynch, Jonah Samuel, Zachary Corey, Prakash Gorroochurn, Gary E Lemack, Adam P Klausner, Akanksha Mehta, Mathew D Sorensen, Ryan Smith, Jill C Buckley, R Houston Thompson, Benjamin N Breyer, Eric M Wallen, Jay D Raman, Gregory A Joice, Gina M Badalato
Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032. Electronic address: ., City University of New York School of Medicine, 160 Convent Ave, New York, NY 10031., University of Colorado Hospital, 12631 East 17th Avenue, Aurora, CO 80045., Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032., UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9110., Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA 23298., Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307., University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195., University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA 22903., University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093., Mayo Clinic, 200 First St. SW, Rochester, MN 55905., University of California San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143., University of North Carolina School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599., Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033.