Trends in Pediatric Urology Resident Operative Exposure and Autonomy: An 11-Year National Study

Fewer urology residents are pursuing pediatric urology fellowship. Studies have examined potential associations between surgical residents' operative experience, autonomy, and exposure and fellowship pursuit. This relationship has not been examined with respect to pediatric urology. Furthermore, no study has characterized national trends in pediatric urology operative exposure and autonomy. We analyzed how pediatric urology case log volume and autonomy has changed over time for urology residents.

A retrospective, national cohort study was completed utilizing Accreditation Council for Graduate Medical Education (ACGME) urology case log data. Variables analyzed included case category (major vs. minor), operative role, and autonomy score. ANOVA was performed to analyze differences in resident role and procedure type over time.

Our study included 3,391 graduating urology chief residents from 145 ACGME accredited programs who completed training from 2013 to 2023. The mean pediatric major cases per resident by graduation declined from 72.43 (SD 35.09) in 2013 to 54.14 (SD 28.05) in 2023. Pediatric minor cases remained stable, with 127.79 (SD 62.93) cases in 2013 and 124.14 (SD 65.28) in 2023. Autonomy scores declined from 2013 to 2023 for both categories (86% to 73% for major cases; 94% to 82% for minor cases).

Over time, urology residents are experiencing less operative exposure to pediatric major cases, while exposure to minor cases has remained stable. Resident autonomy during pediatric cases has decreased for both categories. Future studies should explore how decreased exposure and autonomy impacts resident confidence and preparedness, as well as the likelihood of pursuing pediatric urology fellowship.