Changes in Chief Resident Surgical Volume and Case Type across 70 Years: Lessons Learned from a Urology Training Program.

Introduction: We compared urology resident case logs from the mid 20th century to the modern period to learn about case volume, category and the contribution of open cases in today's training programs.

Methods: We performed a retrospective review and comparison of operative case logs from 1946 to 1953 and 2009 to 2015. Early logs were obtained from a Veterans Affairs Medical Center which served as a single center urology training program at that time. Modern logs were obtained from the descendant program which now combines training with an affiliated University Medical Center. Case logs were analyzed for chief resident case volume, top 5 procedures, surgical approach and procedure category.

Results: Mean case volume was 105.8 per year (early) and 315.7 per year (modern, p <0.001). Top early period procedures were transurethral resection of the prostate, ureterolithotomy, nephrostomy, hydrocelectomy and suprapubic cystostomy, and mean transurethral prostate resection frequency was 28.4 per year (early) compared to 4.6 per year (modern, p <0.005). Mean procedures per year by approach were 125.9 open and 50.5 endoscopic (early) compared to 199.8 open and 151 endoscopic (modern, p <0.001). For procedure category the proportion of general urology and endourology did not change while that of oncology and reconstruction increased.

Conclusions: Findings from the comparison of chief resident surgical case logs over 70 years show that modern residents perform a higher number of cases and continue to perform a large portion of open cases despite the widespread use of minimally invasive surgical techniques. These changes may serve to highlight the adaptability of urology as a surgical subspecialty.