Slower but safe? Resident involvement in urological surgeries

Academic urologists have dual roles. We are required to educate residents while simultaneously providing excellent surgical care. This is of course done in a publicly funded healthcare system, where efficiency and fiscal responsibility is also necessary. All things considered, it seems very relevant to ask the question, “What is the effect of resident involvement on surgical times, costs, and outcomes?” The manuscript by Welk et al assesses the effect of an academic environment on operative times in a cohort of 114 225 patients undergoing five urological procedures in Ontario.1 In a multivariate model, even when accounting for referral bias and patient comorbidity, all five procedures took significantly longer in academic hospitals when compared to non-teaching centres. Operative time increased by 10–21% and likely resulted in an estimated additional cost of $4.25 million dollars over the 11-year study period