Urology Autonomy Maps: Evaluation of Attending Surgeon Expectations for Resident Competencies in Common Urology Procedures.

Abstract

Objectives: To improve resident education by assessing attending urologists' expectations for resident competency in common urological procedures and to create procedure-specific "autonomy maps" to visually present expected progression of surgical independence.

Methods: This cross-sectional survey of urologists at a single institution evaluated ten common urologic procedures. Faculty were asked to identify procedural steps and assign a postgraduate year (PGY) at which a resident should be able to complete each surgical step with passive help. Linear regression and ANOVA tests were conducted to assess whether faculty demographics influenced assigned PGY competency levels for each procedure. Aggregated responses were used to create color-coded autonomy maps by PGY level.

Results: 20 faculty members across six urologic subspecialties completed the survey. More complex surgical steps (e.g., lobe resection in TURP) were assigned higher PGY levels, while competency in foundational tasks (e.g., cystoscopy) was expected earlier. No faculty assigned identical expectations, highlighting variability in expectations. Faculty demographics were not significantly associated with autonomy expectations.

Conclusions: The created autonomy maps provide a standardized, visual framework to clarify faculty expectations and guide resident development. These maps are intended to supplement rather than displace validated tools such as the Zwisch scale, OSATS, and OpTrust. Used together, these tools may enhance transparency, structure, and educational outcomes in surgical training.