Disparities in Pediatric Operative Experience during Urology Residency Training

Abstract

To understand trends in pediatric cases performed during urology residency including intraresident variability and cases performed relative to required minimums. Case logs of urology residents graduating from 2010 to 2018 were analyzed. Temporal trends in reported pediatric case volume were assessed via ANOVA tests and calculation of compound annual growth rates (CAGRs). Percent differences between the 90th and 10th percentiles of residents were calculated to assess intraresident variability. Reported case volumes were compared with minimum requirements with t tests. 1072 residents from 306 urology residency programs were represented in this study. Minor pediatriccases increased from 2010 to 2018 (105.4 ± 54vs 124.6 ± 65, P = .004, CAGR = 2.1%) while major pediatric cases decreased (83.9 ± 40vs 60.8 ± 30, P < .001, CAGR = -3.9%). Orchiopexy (range, 23%-27%), hypospadias (range, 19%-21%), and hydrocele / hernia (range, 15%-19%) were the highest volume case categories. Mean intraresident variability in reported case volumeswas 338% for minor pediatric (CAGR = 0%) and 382% for major pediatric (CAGR = 1.8%). Mean reported case volumes exceeded the minimum requirement for each case category by several fold (P < .001, range, percent difference 232-675%). All urology residents reported minimum pediatric case requirements in 2018. Urology residents report more cases than minimum requirements for pediatric urology by several folds. Future research is needed to understand the implications of increasing intraresident case volume variabilities on residency training in pediatric urology.