Current State of Pediatric Urology Training: Resident Competency Expectations vs. Perceived Ability

This study aimed to evaluate the expectations of program directors (PDs) and pediatric urologists regarding chief resident autonomy in core pediatric urology procedures and to compare these expectations with pediatric urologists' observed resident performance.

Two national surveys were distributed: one to pediatric urologists through the Society of Pediatric Urology (SPU) and one to U.S. urology PDs. Both surveys evaluated expectations for chief resident performance across pediatric urology cases using the validated Zwisch scale. Only SPU surveys assessed observed resident performance.

Survey response rates were 32% (SPU) and 33% (PDs). Although 96% of PDs reported a dedicated pediatric rotation in their programs, 60% of pediatric urologists spent ≤6 months working with residents. PDs held higher expectations than pediatric urologists for chief resident autonomy across all types of pediatric cases. Autonomy was expected by most for simple cases (e.g., orchiopexy, hydrocele repair), but less so for complex cases (e.g., hypospadias repair, pyeloplasty). Notably, observed resident proficiency reported by pediatric urologists consistently fell short of both their own and PDs' expectations.

Despite structured pediatric exposure, a gap remains between expected and actual resident proficiency in pediatric urology. Discrepancies between program directors' and pediatric urologists' expectations, especially for complex procedures, may reflect sub-specialization trends and varying exposure levels. Expanding pediatric training, adjusting expectations, or realigning residency goals with realistic future practice demands may be necessary.