Introduction: Vasectomy is one of the most common procedures urologists perform, usually under local anesthesia on the awake patient. Supervised resident performance of vasectomy in the awake patient has been demonstrated to be safe and well-tolerated, but resident exposure to vasectomy may still be limited. The aim of this study is to better understand resident experiences with vasectomy training in the office and operating room and to identify potential barriers to learning the procedure.
Methods: An 18-question anonymous survey was distributed by email to urology residents of the 135 ACGME-accredited urology residencies in the United States. Residents were asked to specify the total number of vasectomies they had performed, the environment where they performed the procedure (OR vs. office), their comfort level performing vasectomy independently, and any perceived barriers to learning the procedure. Demographic data collected included AUA region and resident year of training.
Results: A total of 119 residents responded to the survey (10% response rate). Each AUA section was represented, and respondents were fairly evenly distributed by post-graduate year. 36.7% of residents had performed 20 or fewer vasectomies by their final year of training. 24.4% said they had received no formal training in perioperative counseling for patients considering vasectomy. Only 64.5% of residents felt comfortable performing vasectomy in the office setting versus 89.1% who felt comfortable performing vasectomy in the operating room (p<0.01). While comfort level increased with year of training in both environments, 16.7% of residents in their final year of residency were still uncomfortable performing vasectomy in the office. 61.5% of residents surveyed cited one or more barriers to learning vasectomy with lack of surgical volume (38.7%), lack of vasectomies being performed in resident clinic (29.4%), and lack of resident autonomy when performing the procedure (22.7%) being the most commonly cited barriers.
Conclusions: While a majority of residents feel comfortable performing vasectomy independently, they are significantly less comfortable doing so in the office setting, even in their final year of training. Residents describe low volume of vasectomies performed and lack of autonomy as barriers to developing skill in this procedure. Allowing residents to spend more time in the outpatient setting to gain exposure to vasectomy, especially if the procedures are can be clustered in a single morning or afternoon clinic, may improve resident training in vasectomy and increase confidence in the procedure. Source of