Summary
Background
Trainee autonomy has eroded over time as surgery has become more subspecialized and
as attending oversight has increased, causing many trainees to seek additional fellowship
training beyond residency. Less clear is whether there are cases that attendings view
as “fellowship-level” or “privileged” cases in which resident-level trainees should
not have high levels of autonomy due to complexity or high-stakes outcomes.
Objective
We sought to better understand current attitudes and practices with regards to trainee
autonomy in hypospadias repair as it represents a high complexity procedure within
pediatric urology.
Study design
We administered a RedCap survey to the SPU membership, asking respondents to describe
the level of autonomy afforded to trainees in various types of hypospadias repair
(distal, midshaft, proximal, perineal) as measured by the Zwisch scale. The Zwisch
scale describes the role of the attending in the attending-trainee relationship in
a low-to-high trainee autonomy fashion: show and tell; active help; passive help;
supervision only.
Results
177 of 761 (23%) unique recipients completed our survey and 174 of 177 (98%) of respondents
felt that trainees should not perform hypospadias repair independently in practice
without additional fellowship training. Among pediatric urologists who train residents,
trainee autonomy as measured by the Zwisch scale decreased as the type of hypospadias
repair moved from distal to proximal.
Discussion
There was near unanimous agreement among respondents that urology trainees should
not perform hypospadias repair in practice without additional pediatric urology fellowship
training, and that current practice affords little trainee autonomy in hypospadias
repair at the resident level. These findings introduce a new wrinkle into the issue
of trainee autonomy: cases in which trainees perhaps should not have autonomy. Concurrently,
the concern with such findings is that this intentional lack of autonomy may extend
to other urologic procedures that one would expect trainees to be able to perform
independently.
Conclusion
Graphical AbstractTrainee autonomy as assessed by the Zwisch scale for distal, midshaft, proximal, and
perineal hypospadias repair.
Keywords
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Article info
Publication history
Published online: March 04, 2023
Accepted:
February 22,
2023
Received in revised form:
February 15,
2023
Received:
December 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
