TY - JOUR
T1 - Trends in urology resident exposure to minimally invasive surgery for index procedures
T2 - A tale of two countries
AU - Hoag, Nathan A.
AU - Mamut, Adiel
AU - Afshar, Kourosh
AU - Amling, Christopher
AU - Mickelson, Jennifer J.
AU - MacNeily, Andrew E.
PY - 2012/9
Y1 - 2012/9
N2 - Objective: To interrogate case-log data for American and Canadian urology residents to define trends in minimally invasive surgery (MIS) and open surgery and compare operative experiences between these 2 groups. Methods: Case-log data from 2004 to 2009 for American urology residents was compared with Canadian residents for 8 index cases, which are routinely performed in both an MIS and open approach. These included nephrectomy (donor, radical, simple, partial), prostatectomy (radical), adrenalectomy, pyeloplasty, and nephroureterectomy. Results: Linear regression analysis demonstrated a significant increase in the percentage of MIS radical prostatectomies performed by American residents (11.2%-52%), compared with Canadian residents (0.74%-11.2%). There was also a significant increase in the percentage of MIS donor nephrectomies by Canadian residents (5.6%-68.7%), compared with American residents (70.1%-89.1%). For Canadian residents, exposure to the following 3 MIS procedures increased significantly over open approaches: adrenalectomy, radical prostatectomy, and donor nephrectomy. For American residents, all index procedures with the exception of adrenalectomy underwent a significant increasing trend (all p < 0.05). Conclusions: Trends for 8 index procedures confirm a continuing shift towards MIS for the majority of procedures in both countries. Differences may be only temporal and relate to dissimilar health care delivery models with a resultant lag in the adoption of laparoscopy and robotics in Canada. The impact of these trends upon ultimate surgical competence of graduates remains to be seen.
AB - Objective: To interrogate case-log data for American and Canadian urology residents to define trends in minimally invasive surgery (MIS) and open surgery and compare operative experiences between these 2 groups. Methods: Case-log data from 2004 to 2009 for American urology residents was compared with Canadian residents for 8 index cases, which are routinely performed in both an MIS and open approach. These included nephrectomy (donor, radical, simple, partial), prostatectomy (radical), adrenalectomy, pyeloplasty, and nephroureterectomy. Results: Linear regression analysis demonstrated a significant increase in the percentage of MIS radical prostatectomies performed by American residents (11.2%-52%), compared with Canadian residents (0.74%-11.2%). There was also a significant increase in the percentage of MIS donor nephrectomies by Canadian residents (5.6%-68.7%), compared with American residents (70.1%-89.1%). For Canadian residents, exposure to the following 3 MIS procedures increased significantly over open approaches: adrenalectomy, radical prostatectomy, and donor nephrectomy. For American residents, all index procedures with the exception of adrenalectomy underwent a significant increasing trend (all p < 0.05). Conclusions: Trends for 8 index procedures confirm a continuing shift towards MIS for the majority of procedures in both countries. Differences may be only temporal and relate to dissimilar health care delivery models with a resultant lag in the adoption of laparoscopy and robotics in Canada. The impact of these trends upon ultimate surgical competence of graduates remains to be seen.
KW - education
KW - medical
KW - minimally invasive
KW - residency
KW - surgical procedures
KW - urology
UR - http://www.scopus.com/inward/record.url?scp=84865275794&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84865275794&partnerID=8YFLogxK
U2 - 10.1016/j.jsurg.2012.04.007
DO - 10.1016/j.jsurg.2012.04.007
M3 - Article
C2 - 22910168
AN - SCOPUS:84865275794
SN - 1931-7204
VL - 69
SP - 670
EP - 675
JO - Journal of Surgical Education
JF - Journal of Surgical Education
IS - 5
ER -