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Trends in Urology Resident Surgical Autonomy: What Do ACGME Chief Resident Case Logs Indicate?
Niccola B Lynch1, Jonah Samuel2, Zachary Corey3
1Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
Urology
|June 5, 2025
Summary
Urology resident surgical autonomy varied by procedure type, with oncology having the lowest. Chief resident autonomy scores significantly decreased from 2010 to 2021, impacting training and future practice.
Area of Science:
- Medical Education
- Surgical Training
- Urology
Background:
- Surgical autonomy is crucial for resident development.
- Understanding trends in resident autonomy is essential for effective urology training.
Purpose of the Study:
- To analyze trends in urology resident surgical autonomy over time.
- To examine how surgical autonomy differs across urologic procedure subtypes.
Main Methods:
- Retrospective review of 364 chief urology resident Accreditation Council for Graduate Medical Education (ACGME) case logs (2010-2021).
- Autonomy assessed by resident role (assistant, surgeon, teaching surgeon) and calculated autonomy scores.
- Statistical analysis included ANOVA and generalized estimating equations.
Main Results:
- Autonomy scores differed significantly by procedure type: general urology/endourology (highest), reconstruction/pediatrics (second), and oncology (lowest).
- Variance in autonomy was greater between institutions than within institutions.
- A significant decrease in mean autonomy scores was observed from 2010 to 2021 (0.007 per year).
Conclusions:
- Surgical autonomy in urology residency varies by procedure, with oncology procedures offering the least autonomy.
- Chief resident surgical autonomy has declined significantly over time.
- These findings suggest potential implications for resident confidence and preparedness for independent practice.
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