The Impact of Teaching on Fundamental General Urologic Procedures: Do Residents Help or Hurt?

• Published in: Urology (Ridgewood, N.J.) Vol. 121; pp. 44 - 50
• Main Authors: Aisen, Carrie M., James, Maxwell, Chung, Doreen E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2018
• Subjects: Aged; Clinical Competence; Databases, Factual - statistics & numerical data; Education - methods; Education - standards; Female; Hospitals, Teaching - statistics & numerical data; Humans; Internship and Residency - methods; Male; Middle Aged; Operative Time; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Quality Improvement; United States; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - methods; Urologic Surgical Procedures - standards; Urologic Surgical Procedures - statistics & numerical data; Urology - education; Urology - methods; Urology - standards; United States
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2018.05.044

To examine the effects of trainee involvement on fundamental urology procedures.
Current Procedural Terminology codes were used to identify patients within the National Surgical Quality Improvement Program database who underwent a selection of fundamental general urology procedures (2005-2013). Operative time and perioperative complications (30-day) were compared between cases with and without trainee involvement.
29,488 patients had general urology procedures with information regarding trainee involvement, 13,251 (44.9%) with trainee involvement, and 16,237 (55.1%) without. Overall patients who underwent procedures with trainee involvement were younger and had fewer comorbidities (Table 1). Trainee involvement showed significant increase in operative time in all procedures included in the study (Table 2). On multivariate analysis trainee involvement increased the risk of complications (Odds Ratio (OR) 1.61, 95% CI 1.45-1.78, P < .001). Other factors that increased the risk of complications were: American Society of Anesthesiologists (ASA) class 3-4 (OR 2.01, 95% CI 1.46-2.77, P < .001), partially or totally dependent functional status (OR 2.22, 95% CI 1.68-2.94, P < .001), diabetes mellitus (OR 1.21, 95% CI 1.05-1.39, P = .008), heart disease (OR 1.19, 95% CI 1.02-1.38, P = .027), and respiratory disease (OR 1.33, 95% CI 1.09-1.63, P = .027).
While trainees are valuable members of the urology team at teaching hospitals and training is necessary, their involvement in urologic surgery appears to increase operative time for all procedures and complications in certain procedures. Further research needs to be done on how to mitigate these effects while preserving surgical education quality.