Early Subspecialization Alignment: How Residents Tailor Experiences Before Fellowship.
Academic Article
Overview
abstract
INTRODUCTION: Urology residency is designed to equip trainees with the skills necessary for independent practice. Over recent decades, however, the educational landscape has evolved, with fellowship trained urologists constituting > 45% of the workforce. We examine whether residents perform a greater number of cases aligned with their intended fellowship and whether, after matching, they tailor their chief resident year to reinforce their chosen subspecialty. METHODS: We conducted a multi-institutional, retrospective analysis of ACGME case logs from residents of 14 programs from 2010-2022. Cases were categorized into five domains: Endourology, Reconstruction, Oncology, Pediatrics, and General. Residents who pursued fellowship training were identified, and case volumes were compared between those who matched into a given subspecialty and those who entered directly into practice/other fellowships. RESULTS: Of 340 residents, 199 (58.5%) pursued fellowship. Residents entering fellowship logged significantly more cases in their aligned domains: Oncology (Median 274 vs. 259, p = 0.034), Pediatrics (259 vs. 186, p < 0.001), and Endourology (260 vs. 229, p = 0.027). No significant difference was observed in Reconstructive Surgery (160.5 vs. 154.5, p = 0.489). During the chief year, residents continued to align case selection with fellowship: Oncology (173 vs. 136.5, p < 0.001), Pediatrics (13 vs 4, p = 0.025), and Endourology (48 vs. 32, p = 0.003). Reconstructive case volume did not follow this trend (47.5 vs. 43, p = 0.383). CONCLUSIONS: These findings suggest that, for most specialties, sub-specialization appears to begin during residency, with residents aligning their operative experience with future fellowship plans. Chief year case selection appears to reflect strategic preparation for fellowship.
