The Impact of a Fellowship on Resident Training in an Academic Pediatric Urology Practice

Abstract

The impact of a fellowship on resident operative experience and education is unclear. We sought to address this issue by comparing resident operative case logs and the pediatric portion of the American Urological Association resident inservice examination at our institution before and after establishing a pediatric urology fellowship in 2002. Pediatric operative case logs of all urological residents from 1998 to 2006 at Vanderbilt University were reviewed. We recorded index and total number of cases as specified by the Accreditation Council for Graduate Medical Education. All residents had completed 6 months of pediatric urology training. Statistical analysis was performed using 2-sample equal variance Student t tests. We compared the 8 index categories and total index cases performed by residents, scores on the pediatric portion of the American Urological Association inservice examination and resident average percentiles for index cases referenced to national data, before and after the implementation of an Accreditation Council for Graduate Medical Education accredited pediatric urology fellowship. Before implementation of the pediatric urology fellowship residents performed significantly more hypospadias procedures, pyeloplasties, renal surgeries, ureteroneocystostomies and urinary/bowel diversions (p <0.05), while the total number of index cases performed was not significantly affected (p = 0.13). In contrast, after the fellowship was started residents performed more hydrocelectomies/hernia repairs (p = 0.01). Compared to national averages for index cases in 2004 to 2005, residents maintained greater than the 50th percentile in all categories except urinary diversion, which was between the 30th and 50th percentiles. Furthermore, residents were in the 70th to 90th percentile in 3 of 9 categories, and greater than the 90th percentile in 3, including total number of index cases. No statistically significant difference in the area of pediatric urology was observed on the resident inservice examination scores before and after the fellowship was established. Residents performed significantly fewer index cases in some areas following initiation of a pediatric urology fellowship at Vanderbilt University, although the total number of index cases performed by residents remained unchanged. Despite the presence of a fellow, residents have remained at or well above the national average in all index case categories except urinary diversion. Moreover, establishment of a fellowship did not negatively impact the educational experience as measured by American Urological Association resident inservice examination scores, specifically in the area of pediatric urology. Choosing the optimal time to institute a fellowship should be made with fellow and resident education as the utmost priority. Periodic review of the data should also be performed to maintain consistent, positive experiences for fellowship and residency training.