O3338: Pediatric Urology Fellowships: Differences in Surgical Volume and Growth Over Time

Background: Pediatric urologic fellowship training experiences can vary greatly depending on training program. These surgical volume differences could have an effect on competency and confidence of individual fellows, especially if some programs fail to meet minimum case volume requirements. This study sought to better understand differences between programs based on cases logged by fellows.

Methods: Case log data from all ACGME Pediatric urologic fellowship programs from 2015-2024, were analyzed using compound annual growth rate (CAGR) with the formula CAGR = (Total cases final year/Total cases starting year)^(1/number of years) - 1. Fold difference of total cases between the 10th percentile and 90th percentile was also calculated for each year.

Results: Total index case count showed that the lowest volume fellowship programs failed to meet case log minimums in four out of nine years (2016, 2019, 2020, and 2021), with the 90th percentile program logging almost twice the total cases as the 10th percentile program. Differences were even more stark for specific common index cases, with 1.5 to 5.5x differences (Chart 1). Despite overall low case volumes, the programs with lowest case volumes and 10th percentile showed greater growth with CAGR of 6% and 5%, respectively, compared to CAGR of 3% and 3% for the median and 90th percentile programs between 2015-2024 (Chart 2).

Conclusion: Our results highlight the stark differences between case volumes in pediatric urology fellowships, and by extension, differences in fellows’ training experiences. While more analysis is warranted for specific procedure subsets (hypospadias, pyeloplasty, ureteral reimplant, etc.), overall case volumes have met the minimum requirement by 2024. Of note, the lowest volumes were recorded between 2019-2021, during the initial wave of the COVID-19 pandemic. This is unsurprising, given the elective nature of many pediatric urologic procedures.