350 ARE WE DONE YET? THE EFFECT OF RESIDENT TRAINING ON SURGEON PRODUCTIVITY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2010350 ARE WE DONE YET? THE EFFECT OF RESIDENT TRAINING ON SURGEON PRODUCTIVITY Aaron D. Martin, Sneha S. Vaish, Erik P. Castle, Robert G. Ferrigni, and Paul E. Andrews Aaron D. MartinAaron D. Martin More articles by this author , Sneha S. VaishSneha S. Vaish More articles by this author , Erik P. CastleErik P. Castle More articles by this author , Robert G. FerrigniRobert G. Ferrigni More articles by this author , and Paul E. AndrewsPaul E. Andrews More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.416AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Residency is arguably the most important phase of surgical training, but its impact on surgeon productivity is not well described in the urologic literature. This study aims to examine this relationship more closely in a mentorship model residency program. METHODS All planned surgical procedures between January 2008 and September 2009 for two established urologic surgeons were examined. A total of 1476 cases were identified and classified by type of procedure, presence of resident involvement, educational level of resident, and total operative time. The surgeons' schedules were queried to detect changes in scheduled daily case volumes due to expectations of resident involvement. Common procedures of varying complexities (i.e. robot assisted radical prostatectomy (RARP), laparoscopic nephrectomy, and cystoscopy, biopsy, and fulguration (CBF)) were selected to compare operative times with and without resident involvement and further subdivided by resident level. Statistical analysis was performed using the Student's T test and one way ANOVA. RESULTS No difference was seen in number of cases per day scheduled based on expectation of resident involvement for either surgeon. Resident involvement in CBF cases did not show any significant operative time differences at any level (staff only= 21 min vs any resident= 25 min, p=0.26). Laparoscopic nephrectomy times did reveal statistically significant differences between residency years. There was improvement with resident advancement, but times were still slightly longer than staff(p=0.04). In regards to RARP, any resident involvement added a mean of 34 minutes per case with chief resident cases taking the longest likely due to increased participation (staff only= 154 min vs chief resident= 198 min, p<0.001). This represents an average of ∼ $740 increase in operative room cost. These data seem to reflect an expected increase in resident participation with time and subsequently longer operative times in more complex procedures. Less complex procedures reveal comparable surgical times even with increased participation proving effective skill learning. CONCLUSIONS Resident participation increases operative times as resident independence increases especially in complex cases. However, overall case loads for attending surgeons can be maintained in a mentorship model residency program with appropriate progression of resident independence. Alternative training resources should be focused on more complex procedures to maximize productivity gains. Phoenix, AZ© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e139 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron D. Martin More articles by this author Sneha S. Vaish More articles by this author Erik P. Castle More articles by this author Robert G. Ferrigni More articles by this author Paul E. Andrews More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...