Suzanne B Merrill1, Brian S Sohl2, R Houston Thompson3, Adam C Reese4, Dipen J Parekh5, John H Lynch6, Baruch M Grob7, Daniel H Williams8, Richard K Lee9, Stanley Zaslau10, Thomas J Guzzo11, Patrick J Shenot12, Erik B Lehman13, Jay D Raman1. 1. Department of Surgery, Division of Urology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. 2. The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. 3. Department of Urology, Mayo Clinic, Rochester, Minnesota. 4. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. 5. Department of Urology, University of Miami Miller School of Medicine, Miami, Florida. 6. Department of Urology, MedStar Georgetown University Hospital, Washington, D.C. 7. Division of Urology, Virginia Commonwealth University, Richmond, Virginia. 8. Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin. 9. Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York. 10. Department of Urology, West Virginia University, Morgantown, West Virginia. 11. Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 12. Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania. 13. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
Abstract
PURPOSE: A minimum number of index procedures is required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. We assessed the distribution of robotic and open surgeries performed by residents upon graduation. MATERIALS AND METHODS: Voluntary Accreditation Council for Graduate Medical Education resident case logs from 11 institutions were de-identified and trends in robotic and open major surgeries were compared using Wilcoxon rank sum and 2-sample t-tests. RESULTS: A total of 89,199 major cases were recorded by 209 graduates from 2011 to 2017. The median proportion of robotic cases increased from 2011 to 2017 in reconstruction (4.7% to 15.2%), oncology (27.5% to 54.2%) and pediatrics (0% to 10.9%) (all values p <0.001). Robotic and open cases remained most divergent in reconstruction, with a median of 12 robotic (IQR 9-19) to 70 open cases (IQR 55-106) being performed by residents in 2017. Similar observations occurred in pediatrics. In oncology the number of robotic procedures superseded that of open in 2016 and rose to a median of 148 robotic (IQR 108-214) to 121 open cases (IQR 90-169) in 2017, with the driver being robotic prostatectomy. Substantial differences in surgical technique were observed between institutions and among graduates from the same institution. CONCLUSIONS: Although robotic volume is increasing, the balance of surgical technique and the pace of change differ in reconstruction, oncology and pediatrics, as well as among individual institutions and graduates themselves. This raises questions about whether more specific guidelines are needed to ensure equity and standardization in training.
PURPOSE: A minimum number of index procedures is required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. We assessed the distribution of robotic and open surgeries performed by residents upon graduation. MATERIALS AND METHODS: Voluntary Accreditation Council for Graduate Medical Education resident case logs from 11 institutions were de-identified and trends in robotic and open major surgeries were compared using Wilcoxon rank sum and 2-sample t-tests. RESULTS: A total of 89,199 major cases were recorded by 209 graduates from 2011 to 2017. The median proportion of robotic cases increased from 2011 to 2017 in reconstruction (4.7% to 15.2%), oncology (27.5% to 54.2%) and pediatrics (0% to 10.9%) (all values p <0.001). Robotic and open cases remained most divergent in reconstruction, with a median of 12 robotic (IQR 9-19) to 70 open cases (IQR 55-106) being performed by residents in 2017. Similar observations occurred in pediatrics. In oncology the number of robotic procedures superseded that of open in 2016 and rose to a median of 148 robotic (IQR 108-214) to 121 open cases (IQR 90-169) in 2017, with the driver being robotic prostatectomy. Substantial differences in surgical technique were observed between institutions and among graduates from the same institution. CONCLUSIONS: Although robotic volume is increasing, the balance of surgical technique and the pace of change differ in reconstruction, oncology and pediatrics, as well as among individual institutions and graduates themselves. This raises questions about whether more specific guidelines are needed to ensure equity and standardization in training.
Entities:
Keywords:
internship and residency; learning; robotic surgical procedures; urology
Authors: Ridwan Alam; Matthew J Rabinowitz; Taylor P Kohn; Vanessa N Peña; James L Liu; Yasin Bhanji; Amin S Herati Journal: Asian J Androl Date: 2021 Nov-Dec Impact factor: 3.285