From the inception of formalized surgical training, resident physicians have undergone supervised medical education. Throughout their training, residents are granted gradual increases in surgical autonomy and are expected to fulfill a minimum number of key procedures to graduate per the Accreditation Council of Graduate Medical Education.¹ Despite this, surgical resident autonomy in the operating room has been declining for all specialties.² There has been concern for resident readiness for independent practice in surveys of residents, faculty, and fellowship directors.³

Our project analyzed the VASQIP (Veterans Affairs Surgical Quality Improvement Program) database to determine how autonomy in the operating room has changed over a 15-year time frame in both urology residency and general surgery residency.

We found that there was a decline in urological resident primary cases from 31.3% to 18.6%, a 41% decline compared to a 66% decline for general surgery residents (see Figure). The decrease in primary urological resident surgeries was matched by an increase in cases performed by an attending and resident. On the other hand, the decrease in general surgery resident primary cases resulted in an increase in attending primary cases. While there was an increase in 30-day reoperation rates, there was no increase in 30-day mortality or morbidity for resident primary ­surgeries.

Figure. A, resident primary cases per year in urology and general surgery. B, comparison of outcomes among resident primary and attending primary surgeries. The bolded numbers signify statistical significance.

This abstract was part of a larger project which was recently featured in AUANews in an article by Dr. Anh Nguyen and Dr. Hossein Sadeghi-Nejad.⁴ This larger study analyzed resident involvement across various procedures in urology as well as the socioeconomic patterns in cases with resident involvement.