Longitudinal Assessment of Adult Cases Performed by Graduating Urology Residents in the United States: 2010-2018

Introduction: This study analyzed longitudinal growth trends, intra-resident variability and adult case volume performed at the completion of urology residency training. Methods: National case logs of urology residents graduating from 2010 to 2018 were analyzed (1,072 residents). Compound annual growth rates were calculated for case volumes in adult case categories. Intra-resident variability was calculated as the percent difference between the 90th and 10th percentiles. Mean reported case volumes were compared with minimum requirements with the Student's t-test. Results: Cases were performed in the role of surgeon (range 83% to 89%), assistant surgeon (range 8% to 13%) and teaching surgeon (range 2% to 4%), and total annual cases increased during the study period (compound annual growth rate 0.9%). The breakdown of cases performed by major case category was general urology (range 30% to 33%), endourology/stone disease (range 21% to 24%), oncology (range 19% to 21%), reconstructive surgery (range 13% to 14%) and laparoscopic surgery (range 10% to 13%). Urology residents consistently reported more cases than the minimum requirement (p <0.001) by severalfold (percent difference range of 170% to 550%). Mean intra-resident variability ranged from 198% for general urology to 333% for laparoscopic surgery among major case categories, with decreasing compound annual growth rates for intra-resident variability during the study period. In 2018, 2 residents did not report minimum case requirements (1.6%). Conclusions: Reported case volume in adult urology is increasing and exceeds minimum requirements by severalfold. Future studies are needed to understand the impact of higher resident case volumes on clinical competency.