Resident involvement in open radical prostatectomy: a review of urology surgical training

The Royal College of Physicians and Surgeons of Canada (RCPSC) and The American Accreditation Council for Graduate Medical Education (ACGME) general objectives mandate that all residents be competent to independently perform select surgical procedures. Unfortunately, no objective standardized measures presently exist for surgical training assessment. Operative logs have been implemented to quantify the number of cases the resident has been exposed to, however, these do not assess their degree of involvement or aptitude. An analysis of what exactly a resident performs, and how well, per case may assist in measuring their training progress. Herein, we evaluate a questionnaire to quantify the level of resident participation in radical retropubic prostatectomy (RRP) and assess whether resident perception of how much involvement in a case correlates with staff surgeons.

Identical, self-administered questionnaires were distributed simultaneously to the resident and staff urologist upon completion of radical prostatectomy. The questionnaire comprised of 14 items, which were completed independently by the resident and the staff urologist. The items assessed which of the 14 specific surgical steps were actually performed by the resident. An analysis was performed to assess the level of agreement.

Among all cases performed between June 2002 and July 2003, 64 RRPs performed by two surgeons had completed questionnaires by both resident and staff. Twenty-one (32.8%) cases were performed with a senior resident (R4) and 43 (67.2%) cases were performed with a chief resident (R5). Twenty (31.3%) cases involved pelvic lymph node dissection. Resident performance of key surgical steps, namely dorsal venous ligation, urethral division, lateral pedicle dissection and urethrovesical anastamosis was 59.4%, 62.5%, 84% and 59.4% respectively. Global level of agreement between staff and resident responses was 94.9% (71.4%-100%).

Our results suggest that there exists good agreement between resident perception of their level of involvement in RRP and staff validation. As such, a residents' assessment of their participation is likely to be accurate. Designation of performance of key operative steps into logs may be more relevant than recording simple exposure to index cases. Attempts at measuring quality of key operative steps in the future may be beneficial.