Background: The traditional urology residency is predominantly focused on training in an academic center. However, recent trends in practice patterns and residency requirements have highlighted the need for exposure to a private practice environment during the time of residency training. On the other hand, the involvement of residents into a private urology practice is a challenging endeavor. The urology residency program at DHMC has a 6-month rotation in the PGY-5 year in a private practice setting at Concord hospital. We here review this experience.
Methods: A retrospective chart review was performed of two commonly performed operative procedures prior to and with the presence of residents. 21 consecutive cases of transurethral resection of the prostate (TUR-P) and 21 cases of pubovaginal sling procedures each, were reviewed without and with the involvement of residents. Operative times, complications, estimated blood loss (EBL), length of stay (LOS) and weight of TUR-P specimen were assessed and compared using a t-test. In order to adjust for prostate-size, a quotient of time per prostate-weight was calculated (min/g).
Results: For the TUR-P, there were no statistical differences between the two groups OR-time (mean 60.6 vs. 60.8 minutes), length of stay (mean 1.6 vs. 1.5 days), weight of specimen (mean 17.4 vs. 16.2 g) and minutes per gram (mean 4.28 vs. 4.66 min/g). There were no complications in either of the TUR-P groups. Similarly, for PVS, there were no statistical differences between the two groups in OR-time (mean 101.6 vs. 102.8 minutes), EBL (mean 245 vs. 127 cc), or length of stay (mean 1.47 vs. 1.57 days), With the exception of one patient who developed a fever on postoperative day 1, there were no complications in the PV-sling database.
Conclusions: In conclusion, we were not able to demonstrate any statistically significant dis-advantage with regards to involvement of residents in these common urologic procedures. However, the benefit of urology residents in a private practice setting is quite evident. Not only does a resident eliminate the need for a practice partner to assist with large open procedures, but the additional benefits of inpatient management, inpatient consult service and call-coverage are obvious. In addition, the advantages provided by weekly educational conferences, including M+M, journal club and X-ray rounds, are unequivocal.

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