Mercedes Raidizon, Corey Zachary, Gaither Talmadge, Lehman Erik, Lemack Gary E, Clifton Marisa M, Klausner Adam P, Mehta Akanksha, Atiemo Humphrey, Lee Richard, Sorensen Mathew D, Smith Ryan, Buckley Jill, Thompson R Houston, Breyer Benjamin N, Badalato Gina M, Wallen Eric M, Raman Jay D
Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Department of Urology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
J Surg Educ. 2025 Apr;82(4):103433. doi: 10.1016/j.jsurg.2025.103433. Epub 2025 Jan 22.
To characterize the impact of subsequent fellowship on the case log experience of trainees throughout their residency and specifically their chief resident year.
Urology resident case logs from 2010 to 2022 were obtained from 13 institutions for total residency and chief years. Five categorized index procedures were included for analysis: General Urology; Endourology; Reconstructive Urology; Urologic Oncology; and Pediatric Urology. Subsequent fellowship data (yes/no and type) were available for 338. Regression models analyzed the interactions of case log volumes and subsequent fellowship RESULTS: Of the 338 residents, 141 (42%) went onto practice and 197 (58%) completed a fellowship including 53 in oncology, 44 in reconstruction, 43 in endourology, 29 in pediatric, and 28 in another nonindexed domain. A total of 419,353 cases were logged during training, including 125,319 (30%) during the chief resident year. The median number of total cases completed per resident increased irrespective of subsequent fellowship. Conversely, the median number of total cases completed during chief year declined with the slope of decline being significant in those residents not completing a fellowship [slope = -2.44, CI: (-4.66, -0.23), p-value = 0.031]. Temporal trends demonstrated that absence of subsequent fellowship was associated with decrease in chief resident cases across all index domains (p for all < 0.001). The specific type of fellowship, however, had no association with chief year trends.
The median number of chief resident cases has declined, most significantly in those trainees not pursuing a fellowship, possibly reflecting a focus on urology encounters which are not captured in ACGME logs.
描述后续专科培训对住院医师在整个住院医师培训期间，尤其是担任总住院医师期间的病例记录经验的影响。
从13家机构获取了2010年至2022年泌尿外科住院医师的病例记录，涵盖整个住院医师培训期和担任总住院医师的年份。分析纳入了五种分类的索引手术：普通泌尿外科；腔内泌尿外科；重建泌尿外科；泌尿肿瘤学；以及小儿泌尿外科。有338名住院医师的后续专科培训数据（是/否及类型）可供分析。回归模型分析了病例记录数量与后续专科培训之间的相互作用。结果：在338名住院医师中，141名（42%）进入临床实践，197名（58%）完成了专科培训，其中53名从事肿瘤学，44名从事重建外科，43名从事腔内泌尿外科，29名从事小儿泌尿外科，28名从事其他非索引领域。培训期间共记录了419,353例病例，其中125,319例（30%）是在总住院医师期间记录的。无论后续是否接受专科培训，每位住院医师完成的病例总数中位数均有所增加。相反，总住院医师期间完成的病例总数中位数下降，未完成专科培训的住院医师下降斜率显著[斜率 = -2.44，置信区间：(-4.66, -0.23)，p值 = 0.031]。时间趋势表明，未进行后续专科培训与所有索引领域总住院医师病例数减少相关（所有p值均 < 0.001）。然而，专科培训的具体类型与总住院医师期间的趋势无关。
总住院医师病例数中位数有所下降，未参加专科培训的住院医师下降最为显著，这可能反映出对美国毕业后医学教育认证委员会（ACGME）病例记录中未涵盖的泌尿外科诊疗的关注。
