Factors predicting operative exposure among UK urology trainees: a national analysis from 2010 to 2024

To characterise national trends in operative experience among Urology Higher Specialty Trainees (HSTs) in the UK over time, and to identify demographic, training, and institutional factors associated with operative volume.

This national, retrospective study analysed Intercollegiate Surgical Curriculum Programme (ISCP) and electronic surgical logbook (eLogbook) data for all UK Urology HSTs between 2010 and 2024. Baseline variables included gender, age at Specialty Training (ST)3 start, ethnicity, training grade, and hospital type, i.e., district general hospital (DGH) vs tertiary centre (TC). Procedures were categorised, using the 2021 ISCP Urology curriculum, into index and special interest procedures. Analyses were made between the above factors and number of cases logged on eLogbook.

A total of 1140 trainees were included. Gender and age at ST3 start did not significantly affect total operative volume. A global difference in operative volume across ethnic groups was observed (chi-square = 11.85, P = 0.019); however, no pairwise differences remained significant after adjustment. Operative volume declined over 15 years, with trainees performing 10.8 fewer operations each year than the year before (β₁ = -10.8 procedures/trainee/year, t = -9.31, P < 0.001), with the lowest recorded volume in 2020. The total number of procedures logged decreased with increasing ST level (R_s = -0.284; P < 0.001). However, higher ST level trainees logged more fascial sling, percutaneous nephrolithotomy, nephrectomy, radical prostatectomy, radical cystectomy, ileal conduit formation, and penile straightening procedures. Trainees in DGHs logged more procedures overall (U = 2 × 10^-47, P < 0.001), although trainees in TCs logged more special interest procedures (U = 1.6 × 10^-24, P < 0.001).

Operative experience among HSTs in the UK has declined over the past 15 years with significant variation in case mix by training grade and hospital type. These findings highlight the need for effective rotation planning and targeted strategies are required to ensure adequate operative exposure to produce safe and competent consultants who can provide the best possible patient care.