Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA, 19104, USA.
Int Urogynecol J. 2023 Jul;34(7):1465-1469. doi: 10.1007/s00192-022-05394-0. Epub 2022 Oct 25.
Urogynecology fellows report low exposure to nonsling retropubic anti-incontinence procedures such as Burch urethropexy and thus may have difficulty meeting the required minimum case numbers, but there has been an even more objective exploration of this observation. Thus, our objective was to assess the feasibility of meeting the Accreditation Council for Graduate Medical Education (ACGME) requirement for each urogynecology fellow to perform five nonsling retropubic anti-incontinence procedures during fellowship.
Cross-sectional study using the National Surgical Quality Improvement Program (NSQIP) and National Resident Matching Program (NRMP) databases from 2009 to 2019. From NSQIP, the number of nonsling retropubic anti-incontinence procedures (open and laparoscopic Burch urethropexy and bladder neck needle suspension) and midurethral sling procedures was extracted using CPT codes. The number of fellows was extracted from the NRMP database. Trends in the number of anti-incontinence procedures were compared with the trend in the number of fellows using linear regression.
From 2009 to 2019 the number of fellows doubled from 81 to 176. An average of 97 nonsling retropubic anti-incontinence and 6,372 sling procedures were performed annually. Linear regression showed an increase of 10.7 fellows per year (95% CI 9.3-12.1) versus an increase of 5.8 nonsling retropubic anti-incontinence procedures per year (95% CI -0.4 to 12.1). This contrasts with an increase of 690.9 slings per year (95% CI 509.9-872.0).
The increase in the number of nonsling retropubic anti-incontinence procedures does not appear to match the increase in the number of urogynecology fellows. Supplementary educational approaches such as simulation may be prudent.
尿妇科住院医师报告称，他们对非吊带耻骨后抗失禁手术（如 Burch 尿道悬吊带术）的接触较少，因此可能难以达到所需的最低病例数，但对此观察结果进行了更客观的探讨。因此，我们的目的是评估每位尿妇科住院医师在住院医师培训期间完成 5 例非吊带耻骨后抗失禁手术的可行性，以满足研究生医学教育认证委员会（ACGME）的要求。
使用 2009 年至 2019 年期间的国家外科质量改进计划（NSQIP）和全国住院医师匹配计划（NRMP）数据库进行横断面研究。从 NSQIP 中，使用 CPT 代码提取非吊带耻骨后抗失禁手术（开放和腹腔镜 Burch 尿道悬吊带术和膀胱颈悬带术）和中尿道吊带术的数量。从 NRMP 数据库中提取住院医师的数量。使用线性回归比较抗失禁手术数量的趋势与住院医师数量的趋势。
2009 年至 2019 年，住院医师人数翻了一番，从 81 人增加到 176 人。平均每年进行 97 例非吊带耻骨后抗失禁手术和 6372 例吊带手术。线性回归显示，每年住院医师增加 10.7 人（95%CI 9.3-12.1），而非吊带耻骨后抗失禁手术每年增加 5.8 例（95%CI-0.4-12.1）。这与每年增加 690.9 个吊带形成鲜明对比（95%CI 509.9-872.0）。
非吊带耻骨后抗失禁手术数量的增加似乎与尿妇科住院医师数量的增加不匹配。补充教育方法，如模拟，可能是谨慎的。
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