Children's Hospital of Michigan, Detroit, MI, USA.
Cook Children's Health Care System, Fort Worth, TX, USA.
J Pediatr Urol. 2018 Aug;14(4):333.e1-333.e7. doi: 10.1016/j.jpurol.2018.05.021. Epub 2018 Jun 28.
Previous research suggests that pediatric urologists feel well trained by their fellowship for cases encountered early in their career. We questioned the complexity and diversity of cases new pediatric urologists were actually performing.
The aim was to identify the frequency with which newly trained pediatric urologists are performing various procedures, investigate which factors are associated with case complexity and diversity, and evaluate for differences between male and female surgeons.
Case logs of urologists from July 30, 2007, to June 30, 2013, initially applying for the certifying examination who self-identified as pediatric urologists were reviewed. Data points included cases/dates, and surgeon demographics. An in-depth analysis was performed on 51 index cases from the 71 included pediatric urologists, for which a level of complexity was assigned.
Compared with the bottom volume quartile, surgeons in the top quartile performed more cases of minimal (115.9 ± 8.7 vs. 51.7 ± 8.7, p < 0.001), moderate (31.1 ± 2.7 vs. 10.1 ± 1.0, p < 0.001) and significant (10.8 ± 1.9 vs. 2.0 ± 0.4, p < 0.001) complexity. More than 90% logged circumcisions, orchiopexies, and inguinal hernia repairs, while less than 1.5% logged open nephroureterectomies or complete male epispadias repair. Surgeons submitted at least one of 17.2 ± 0.5 (range 5-28) unique codes. The figure presents the percentage of current procedural terminology (CPT) codes performed by each urologist. Surgeons with the least case diversity performed a higher percentage of low-complexity cases, and lower percentages of moderate and complex cases (p < 0.001). Males, comprising 60.6% of urologists, performed more cases than females (342.9 ± 30.9 vs. 229.1 ± 18.1, p = 0.007), averaging more cases of minimal (95.0 ± 6.6 vs. 73.3 ± 4.6, p = 0.018) and significant (6.7 ± 1.0 vs. 2.8 ± 0.5, p = 0.005) complexity. There was no difference in cases of moderate complexity (22.0 ± 1.9 vs. 18.1 ± 2.1, p = 0.201).
In general, pediatric urologists should expect to perform many minor cases when they enter practice. Women are entering urology in increasing numbers. In our study, female urologists performed fewer cases. This could have implications for the workforce, which in urology in general is expected to decrease.
Case diversity and degree of complexity vary among newly trained pediatric urologists. The urologist with the greatest case diversity never performed 45% of the 51 analyzed CPT codes, while the one with the least case diversity never performed 90% of the codes. Male surgeons performed more operations, particularly those of minimal and significant complexity. The variability in operative experience reinforces the importance of continuing education and mentorship after completion of fellowship.
先前的研究表明，小儿泌尿科医生认为他们的专业培训对职业生涯早期遇到的病例有很好的培训效果。我们质疑新的小儿泌尿科医生实际执行的病例的复杂性和多样性。
目的是确定新培训的小儿泌尿科医生执行各种手术的频率，调查哪些因素与病例的复杂性和多样性相关，并评估男性和女性外科医生之间的差异。
对 2007 年 7 月 30 日至 2013 年 6 月 30 日期间最初申请认证考试并自认为是小儿泌尿科医生的泌尿科医生的病历进行了回顾。数据点包括病例/日期和外科医生的人口统计学信息。对 71 名小儿泌尿科医生中的 51 名索引病例进行了深入分析，为其分配了一个复杂程度级别。
与最低容量四分位相比，排名最高四分位的外科医生进行了更多的轻微（115.9±8.7 比 51.7±8.7，p<0.001）、中度（31.1±2.7 比 10.1±1.0，p<0.001）和显著（10.8±1.9 比 2.0±0.4，p<0.001）复杂程度的病例。超过 90%的医生记录了割礼、睾丸固定术和腹股沟疝修复术，而不到 1.5%的医生记录了开放性肾盂输尿管切除术或完全男性尿道下裂修复术。外科医生提交了至少 17.2±0.5（范围 5-28）个独特代码中的一个。该图显示了每位泌尿科医生执行的当前程序术语 (CPT) 代码的百分比。病例多样性最小的外科医生执行了更高比例的低复杂性病例，以及较低比例的中度和复杂病例（p<0.001）。男性占泌尿科医生的 60.6%，比女性（342.9±30.9 比 229.1±18.1，p=0.007）进行了更多的病例，平均进行了更多的轻微（95.0±6.6 比 73.3±4.6，p=0.018）和显著（6.7±1.0 比 2.8±0.5，p=0.005）复杂程度的病例。中度复杂程度的病例（22.0±1.9 比 18.1±2.1，p=0.201）没有差异。
一般来说，当小儿泌尿科医生进入实践时，他们应该期望进行许多轻微的病例。女性越来越多地进入泌尿科领域。在我们的研究中，女性泌尿科医生进行的病例较少。这可能对劳动力产生影响，预计在一般情况下，泌尿科医生的数量将会减少。
新培训的小儿泌尿科医生的病例多样性和复杂程度各不相同。具有最大病例多样性的外科医生从未执行过 51 个分析 CPT 代码中的 45%，而病例多样性最小的外科医生从未执行过 90%的代码。男性外科医生进行了更多的手术，特别是轻微和显著复杂程度的手术。手术经验的可变性强调了完成专业培训后继续教育和指导的重要性。
