Trends in Urology Resident Surgical Autonomy: What do ACGME Chief Resident Case Logs Indicate?

Objective: To investigate urology resident surgical autonomy trends over time and according to procedure subtype using ACGME case log data.

Methods: A retrospective review of 364 chief urology resident ACGME case logs collected from 11 institutions spanning 2010-2021 was completed. Resident-defined role in cases as "assistant," "surgeon," or "teaching surgeon" were used as a metric of graded autonomy. An autonomy score was calculated. Analysis of variance (ANOVA) evaluated differences in autonomy between institutions, within institutions, and between procedure types. Generalized estimating equations (GEE) assessed changes in autonomy over time.

Results: Mean autonomy scores were significantly different between procedure categories, with general urology/endourology having the highest autonomy, reconstruction/pediatrics having the second highest autonomy, and oncology having the lowest autonomy (p<0.05 across all comparators). Between institution variance in autonomy was significantly greater than within institution variance (0.09396 vs 0.01109, p<0.0001). Globally, mean autonomy scores significantly decreased from 2010 to 2021 by a value of 0.007 per year (p<0.001).

Conclusions: Surgical autonomy, as extrapolated from self-reported urology chief resident ACGME case logs, varied according to procedure type, with general urology and endourology ranking highest and oncology ranking lowest. Overall, chief resident autonomy scores decreased significantly over time. If validated in a larger national cohort, these findings may have implications for contemporary urologic training in terms of resident confidence and self-sufficiency for independent practice.