Male Urethral, Penile, and Incontinence Surgery: Is Resident Exposure Adequate?
OBJECTIVE
To evaluate trends in male urethral and penis/incontinence case volumes among urology residents and assess these for adequate surgical training/competency.


METHODS
Accreditation Council for Graduate Medical Education (ACGME) case logs of urology residents graduating from U.S. programs from 2009 to 2013 were reviewed to determine the surgical volume of select index categories. Male urethral cases encompass urethrectomy and urethroplasty, whereas male penis/incontinence cases include urethral slings and sphincters. Case volumes as "surgeon," "assistant," and "teaching assistant" were reviewed and compared to ACGME minimum requirements.


RESULTS
A total of 1032 graduating residents reported case logs. For male urethral surgery, residents reported weighted averages (standard deviation [SD]) of 12.7 (9.0) cases as "surgeon," 1.5 (3.5) cases as "assistant," and 0.2 (1.0) as "teaching assistant." The minimum requirement for these cases is 5. The annual 10th percentiles as "surgeon" ranged from 4 to 5 cases throughout the study period. For male penis/incontinence cases, residents reported weighted averages (SD) of 45.5 (22.7) cases as "surgeon," 3.6 (5.5) cases as "assistant," and 1.5 (3.0) cases as "teaching assistant." The minimum requirement is 10 cases. The 10th percentiles as "surgeon" ranged from 19 to 23 cases.


CONCLUSIONS
Although the majority of residents met the minimum standard for these cases, about 10% of residents did not meet the requirement for male urethral surgery. In addition, a review of learning curves for these procedures suggests that the ACGME minimum requirements may be insufficient to confer actual competency in skill. Increasing this number in training or specialized postgraduate training programs is needed to provide actual competency.
Department of Urology, NYP-Columbia University Medical Center, New York, NY. Electronic address: jamie.pak@mssm.edu.
Jamie S
JS
Pak
Department of Urology, NYP-Columbia University Medical Center, New York, NY.
Mark
M
Silva
Department of Urology, NYP-Columbia University Medical Center, New York, NY; Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
Christopher M
CM
Deibert
Department of Urology, NYP-Columbia University Medical Center, New York, NY.
Kimberly L
KL
Cooper
Department of Urology, NYP-Columbia University Medical Center, New York, NY.
Gina M
GM
Badalato
D000068:Accreditation; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010409:Penile Diseases / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States; D014522:Urethral Diseases / Q000175:diagnosis / Q000453:epidemiology; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology; D013521:Urologic Surgical Procedures, Male / Q000193:education* / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data*