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Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

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Longitudinal Changes in the Operative Experience for Junior Urology Residents.

Ezra J Margolin¹, Daniel Schoenfeld¹, Caleb H Miles²

¹Department of Urology, Columbia University Irving Medical Center, New York, NY.

|July 3, 2023

Summary

Urology residency training shows a decline in major surgical case exposure for junior residents, with a simultaneous rise in endoscopic procedures. This shift may impact surgical preparedness for new urologists.

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Published on: January 7, 2019

Area of Science:

Urology
Surgical Education
Medical Training

Background:

Growing concerns exist regarding urology residents' preparedness for independent practice.
This perceived deficit may stem from reduced exposure to complex surgical cases early in residency.

Purpose of the Study:

To analyze longitudinal trends in surgical case volume among junior urology residents.
To investigate changes in major and endoscopic case exposure during urology residency.

Main Methods:

Retrospective analysis of deidentified case logs from 244 urology residency graduates across 12 US academic medical centers (2010-2017).
Primary outcome: change in major case volume for first-year urology residents (URO1).
Negative binomial regression used to measure trends in case volume.

Main Results:

A total of 391,399 cases were logged.
Median major cases for URO1 residents decreased from 64 to 49 (2010-2017), a trend primarily in oncology.
Median endoscopic cases for URO1 residents increased from 85 to 194, disproportionately more than for senior residents.

Conclusions:

A significant shift in case distribution is observed among junior urology residents.
There is a decrease in major case exposure and an increase in endoscopic surgery for URO1 residents.
Further research is required to assess the impact of these trends on surgical proficiency.