Aligning Urology Residency Training With Real-World Workforce Needs

Abstract

Objective Research suggests recently graduated urology residents do not feel ready for independent practice. We conducted a study to determine if Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements, resident case logs, and graduating resident perceived readiness for practice are aligned with the procedural demand and needs of the current urology workforce. Design Correlative study comparing the association between (1) workforce demand and ACGME case requirements, and (2) workforce demand and perceived resident competency. Three distinct datasets were used; (1) the 2017 Medicare Part B National Summary Data File; (2) the 2017 National Data Report published by the ACGME; and (3) a graduating resident survey from Okhunov et al. Setting N/A. Participants N/A. Results In 2017, there were a total of 6,784,696 urologic cases performed through Medicare. We found nonsignificant positive associations between resident case logs (rho = 0.16, p = 0.5784), ACGME minimum procedure requirements (rho = 0.42, p = 0.1255), and Medicare procedural demand. Our 15 index procedures accounted for 21.1% (n = 1,431,775) of all Medicare cases, with a median number of 7706 procedures. Endopyelotomy was the least common procedure (n = 98), while cystoscopy was the most common (n = 980,623). Medicare case volume was positively correlated with graduating residents’ procedural confidence (r = 0.86, p < 0.0001). We identified four categories with varied alignment of training and demand: (1) high volume and high confidence, (2) high volume and low confidence, (3) low volume and high confidence, and (4) low volume and low confidence. Conclusions Optimizing urology residency training is time-sensitive and important. Using national Medicare data coupled with recently graduated urology resident survey results, we provide a guiding framework for improving the alignment of training with workforce demand. Informed by these results, we recommend altering training requirements to reflect these needs.

Functional urology: Practice patterns and training aspirations among urologists in Brazil

“…A study from Germany showed that most (70%) urology residents are interested in learning urogynecology, but only half claim to receive proper training in their residency 15 . In a survey with chief residents and recently graduated urologists in the United States, most participants reported deficient subspecialty exposure 9 …”

“…As a result, residents graduating from urology training programs throughout the world typically lack the skills to practice many urological subspecialties. In a survey that evaluated chief residents and recently graduated urologists regarding their residency program in the United States, most participants reported deficient availability of advanced skills for robotic and laparoscopic surgery and subspecialty exposure 9 . Most residents felt comfortable performing essential urological procedures such as cystoscopy, ureteroscopy, and open nephrectomy but expressed a lack of confidence in performing unsupervised advanced minimally invasive procedures.…”

“…Another important point is whether the residents who are graduating have competencies that are in line with the workforce's needs. A recent study assessed whether urologic residency training in the United States is aligned with real‐world procedural demand 9 . Authors have found that residents' current case logs and self‐rated proficiency seem to be insufficient regarding the needs of the workforce.…”

“…In a survey that evaluated chief residents and recently graduated urologists regarding their residency program in the United States, most participants reported deficient availability of advanced skills for robotic and laparoscopic surgery and subspecialty exposure. 9 Most residents felt comfortable performing essential urological procedures such as cystoscopy, ureteroscopy, and open nephrectomy but expressed a lack of confidence in performing unsupervised advanced minimally invasive procedures. In addition, most pursued fellowship training to overcome perceived training deficiencies.…”

Editorial Comment

“…In a correlative study, Cruz et al demonstrated that ACGME minimum case log volumes do not guarantee surgical competency in independent surgical practice after training and may not reflect current urologic procedural demand. 3 We are all striving to slowly recover from the profound effects of COVID and seek a return to normalcy, both in the world in general and specifically in this study, for urologic residency training. For those of us involved with graduate medical surgical training programs, we will need to carefully assess and balance not only volume-based case log requirements but also competency-based requirements, in order to ideally prepare graduates for eventual independent practice in the future.…”