Impact of Subsequent Fellowship on Urology Chief Resident Case Log Volumes

OBJECTIVE: To characterize the impact of subsequent fellowship on the case log experience of trainees throughout their residency and specifically their chief resident year. MATERIALS AND METHODS: Urology resident case logs from 2010 to 2022 were obtained from 13 institutions for total residency and chief years. Five categorized index procedures were included for analysis: General Urology; Endourology; Reconstructive Urology; Urologic Oncology; and Pediatric Urology. Subsequent fellowship data (yes/no and type) were available for 338. Regression models analyzed the interactions of case log volumes and subsequent fellowship RESULTS: Of the 338 residents, 141 (42%) went onto practice and 197 (58%) completed a fellowship including 53 in oncology, 44 in reconstruction, 43 in endourology, 29 in pediatric, and 28 in another nonindexed domain. A total of 419,353 cases were logged during training, including 125,319 (30%) during the chief resident year. The median number of total cases completed per resident increased irrespective of subsequent fellowship. Conversely, the median number of total cases completed during chief year declined with the slope of decline being significant in those residents not completing a fellowship [slope = −2.44, CI: (−4.66, −0.23), p-value = 0.031]. Temporal trends demonstrated that absence of subsequent fellowship was associated with decrease in chief resident cases across all index domains (p for all < 0.001). The specific type of fellowship, however, had no association with chief year trends. CONCLUSIONS: The median number of chief resident cases has declined, most significantly in those trainees not pursuing a fellowship, possibly reflecting a focus on urology encounters which are not captured in ACGME logs.