The effect of trainee involvement on surgical outcomes and complications of male infertility surgical procedures

Abstract

Operating is a key component to surgical residency and fellowship training. Trainees need to have hands-on experience in the operating room to prepare them for independent postgraduate practice. The goal of academic training centres is to train future urologists without jeopardising patient outcomes. With this in mind, the concept of 'graduated responsibility' is often employed (Schnapp et al., 2019; Teman, Gauger, Mullan, Tarpley, & Minter, 2014). Improving resident education, concurrent with maintaining excellent patient outcomes, has been an area of enhanced focus with ongoing changes to resident work hours and supervision policies (Curet, 2008). There have been several studies investigating the effects of trainee involvement on patient safety and surgical outcomes (Castleberry et al., 2013). A large study by Matulewicz et al. reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for all procedures performed by 'Urology' as the primary service and compared cases with and without residents. Resident involvement was associated with significantly longer operative times but no difference in overall

Impact of residents’ involvement in urological surgeries: a systematic review

“…23,24,28,32,35 Moreover, Benjamin et al reported that reoperations were not significantly associated with residents' performance in a 6-month follow-up period. This was also reported by Ku et al, and Yip et al 26,30,31 Impact on the operative time 24,25,27,30 Interestingly, Ku et al reported that patients that underwent surgeries by residents did not significantly stay in hospitals for longer periods although the operative time was significantly prolonged in these patients. 31 Longer operative time was also reported by Holland et al 32 .…”

“…Based on the NSQIP data also, Meyer et a, Vetterlein et al and Yip et al investigated similar outcomes in patients that underwent one-stage anterior urethroplasties, orchiectomy, minimally-invasive, and male infertility procedures, respectively. [24][25][26] They reported that the presence of residents was not a significant predictor for the occurrence of adverse events and complications. This was also supported by Privé et al, Allard et al and Del Rosso et al that reported that although residents induced some complications, these were managed intraoperatively.…”

The RVU Compensation Model and Head and Neck Surgical Education

“…Residents in surgical fields require significant “hands‐on” training to learn how to operate. Several studies have demonstrated longer operative times in cases involving trainees in diverse fields such as urology, orthopedic surgery, and bariatric surgery, suggesting that in an RVU‐based evaluation system, a significant opportunity cost is borne by the attending surgeons 3–8 . In otolaryngology, the participation of trainees in the operating room has been shown to prolong operative times for common procedures such as tonsillectomy and tympanoplasty 9,10 .…”

“…Several studies have demonstrated longer operative times in cases involving trainees in diverse fields such as urology, orthopedic surgery, and bariatric surgery, suggesting that in an RVU-based evaluation system, a significant opportunity cost is borne by the attending surgeons. [3][4][5][6][7][8] In otolaryngology, the participation of trainees in the operating room has been shown to prolong operative times for common procedures such as tonsillectomy and tympanoplasty. 9,10 At the same time, there is considerable variation in the procedures performed by otolaryngologists; these opportunity costs may be more pronounced in complex procedures routinely performed by head and neck surgical oncologists, which generally require longer operative times.…”