Demographics and Career Trends of Urology Fellowship Directors in the United States.

INTRODUCTION: Fellowship directors (FDs) hold significant leadership roles within the academic urology community. We sought to characterize common trends in training and academic productivity among urology FDs. Moreover, we aimed to characterize gender differences across subspecialties to better inform gender-based inclusion efforts and contemporary leadership pathways. METHODS: FDs were studied across 6 urologic subspecialties. Society and institutional websites were queried for demographics, education/training institutions, timelines of career milestones, and academic productivity. χ2, Mann-Whitney U, and Kruskal-Wallis tests and Kendall tau rank correlation were employed with an alpha cutoff of .05. RESULTS: There were 219 FDs included, representing 208 fellowship programs at 93 institutions. FDs were 176 (80%) males and 43 (20%) females. There was a significant association between gender and subspecialty. The median age for all FDs was 52 years old. Significant differences in age were demonstrated across subspecialties. For all FDs, females were younger than males, at 49 and 53 years, respectively (P = .001). The median H-index for all FDs was 23.5. H-index was significantly different between genders and subspecialities. There was a strong, positive correlation between age vs H-index for all FDs. Half of FDs had completed fellowship training at one of 14 institutions. CONCLUSIONS: We describe the landscape of leadership in urology subspecialty training. There are an increasing number of female FDs. Composition of leadership varies by subspecialty; however, the careers of all current urology FDs are marked by lifelong achievements in academic productivity. Moreover, a small group of institutions produce a substantial number of FDs.

Gender-based Disparity Exists in the Surgical Experience of Female and Male Urology Residents.

OBJECTIVE: To determine if a discrepancy exists in the number and type of cases logged between female and male urology residents. MATERIALS AND METHODS: ACGME case log data from 13 urology residency programs was collected from 2007 to 2020. The number and type of cases for each resident were recorded and correlated with resident gender and year of graduation. The median, 25th and 75th percentiles number of cases were calculated by gender, and then compared between female and male residents using Wilcoxon rank sum test. RESULTS: A total of 473 residents were included in the study, 100 (21%) were female. Female residents completed significantly fewer cases, 2174, compared to male residents, 2273 (P = .038). Analysis by case type revealed male residents completed significantly more general urology (526 vs 571, P = .011) and oncology cases (261 vs 280, P = .026). Additionally, female residents had a 1.3-fold increased odds of logging a case in the assistant role than male residents (95% confidence interval: 1.27-1.34, P < .001). CONCLUSION: Gender-based disparity exists within the urology training of female and male residents. Male residents logged nearly 100 more cases than female residents over 4years, with significant differences in certain case subtypes and resident roles. The ACGME works to provide an equal training environment for all residents. Addressing this finding within individual training programs is critical.

Costs and challenges of the curriculum vitae for SET Urology training positions: a qualitative analysis.

BACKGROUND: Surgical training programs within Australia and Aotearoa New Zealand have become more competitive. Applicants are required to build a strong application over curriculum vitae (CV), references and interview. The building of the CV often comes at significant financial and time cost with challenges. This study explores successful applicants' experiences of the costs and challenges to build a successful CV for acceptance onto the Urology training program within Australia and New Zealand. METHODS: Qualitative content analysis (QCA) was undertaken of semi-structured interviews conducted with 11 nSET Urology trainees. QCA focused on the identification and evaluation of costs and challenges experienced. Analysis was reviewed over the domain of CV components. RESULTS: Costs of building each domain differed significantly between trainees as they focussed on various domains. Challenges encountered were identified with four themes were identified with associated subthemes: Passion/Commitment (two subthemes); Researching Pathways (six subthemes); Challenges (two subthemes) and Acceptance Success (two subthemes). CONCLUSIONS: The commitment to a surgical specialty begins before acceptance onto a training program. A high-level CV is an integral component of acceptance onto the Urology training program. Each trainee had a different journey, including time and financial sacrifices, to obtain acceptance whilst demonstrating a strong motivation for success. The average cost of each trainee who gained acceptance was $50 779 over 3 years. Consideration should be given to making the CV component less onerous.

Gender Bias in Letters of Recommendation: Relevance to Urology Match Outcomes and Pursuit of Fellowship Training/Academic Career.

OBJECTIVE: To review applications to a single urology residency program to determine application characteristics predictive of (1) successful match into urology residency and (2) pursuit of fellowship training and/or academic practice after completion of residency. Our principal variables of interest were gender bias as assessed in letters of recommendation (LOR), personal statements, Medical Student Performance Evaluation (MSPE), race, and gender. MATERIALS AND METHODS: Applications submitted to our urology residency program in the 2014 cycle were reviewed. Twenty-three variables were analyzed, including applicant demographics, application materials, and gender bias. Deidentified text from LOR, personal statements, and MSPE was evaluated for gender bias using an open-source gender bias calculator. A subanalysis of applicants who matched at a top 25 urology program was performed. Logistic regression analysis was performed to identify applicant variables associated with (1) match success and (2) fellowship training or academic employment as of September 2021. RESULTS: Two hundred and twenty-two completed applications were analyzed. First authorship of a published manuscript was significantly associated with greater odds of matching. Female gender and top 25 medical school attendance were both significant predictors of matching at a top 25 urology program. The number of first-author publications was associated with completion of fellowship training or current employment in an academic position. CONCLUSION: First-author publications are the most important preinterview determinant of match success and subsequent pursuit of academic practice/fellowship training. Certain applicant characteristics are associated with matching at highly ranked programs. Gender bias in application materials (including LOR) does not appear to exert a significant influence on match and early career outcomes.

The Financial Relationship Between the Medical Industry and Residency Leadership in OB/GYN and Urology.

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P<.01; $1,689,519.48 vs $4,352,066.40, P<.01). Department chairs received more payments per year than program directors (8 vs 4, P<.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P<.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

Assessing the Finances of Applying to Surgical Residency in 2019-2020: A US Nationwide Surgical Specialties Comparison.

Background The costs of applying to residency programs may affect which students choose to apply to a specialty, yet few studies have compared expenses of applying to different surgical specialties. Objective To compare individual and total expenses for applicants applying to 5 US surgical specialties during an in-person interview and recruitment period. Methods Post-match survey data from 2019-2020, from senior applicants of 123 of 141 (87.2%) US medical schools, to orthopaedic surgery (OS), neurological surgery (NS), urology (UR), plastic surgery (PS), otolaryngology (OTO) programs, was analyzed for applicant characteristics and mean application, away rotation, interview, and total expenses. Kruskal-Wallis H tests compared differences in costs between specialties. P values <.05 were significant. Results The survey data included 1136 applicants, representing a response rate of 27%, with 459 applicants to OS, 121 to NS, 191 to UR, 117 to PS, and 248 to OTO. Mean application costs were different among the specialties: OS, $1,990; NS, $1,711; UR, $1,570; PS, $1,638; and OTO, $1,612 (P≤.003). Mean interview expenses also differed: OS, $3,129; NS, $6,400; UR, $3,915; PS, $5,486; and OTO, $3,540 (P≤.001) as well as away rotation expenses: OS, $3,182; NS, $3,840; UR, $2,640; PS, $4,074; and OTO, $2,437 (P≤.029). Mean total costs were high and differed among specialties: OS, $8,205; NS, $11,882; UR, $8,207; PS, $10,845; and OTO, $7,516 (P≤.029). Conclusions Applying to surgical residencies in the pre-pandemic era was expensive, with mean costs over $10,000 for NS and PS. The largest contribution to total costs were interview expenses.

Design, implementation and assessment of a novel, introductory curriculum into female, neurological and urodynamic urology: a 7-year experience of urology simulation bootcamp course.

PURPOSE: To present the seven-year experience of a multi-component and interactive module on female, neurological and urodynamic urology (FNUU) training at the UK National Urology Simulation Bootcamp Course (USBC) and demonstrate trainee satisfaction and competency progression. METHODS: During the week-long USBC, a four-hour module on FNUU was designed which consisted of short interactive presentations with an emphasis on practical stations in urodynamics, intravesical botulinum toxin injection, urethral bulking injection, female pelvic examination and, initially, mid-urethral tapes (subsequently replaced with percutaneous sacral nerve evaluation). The trainee's level of knowledge, operative experience and confidence were assessed pre- and post-course. The practical assessment consisted of preparation and intravesical administration of botulinum toxin, female pelvic examination, urodynamic trace interpretation or mid-urethral tape simulation. Trainee feedback was also collected. RESULTS: Two-hundred sixty-one newly appointed urology trainees participated in the USBC during this period. A high level of satisfaction was constantly reported. The highest rated session was urethral bulking with 72% being very satisfied, followed by Botox and urodynamics. The final assessment showed 70% had achieved level 4 competency in cystoscopy and Botox. Qualitative feedback was also obtained. CONCLUSION: To our knowledge, this is the first module of its kind, and it shows that it is feasible to develop, implement and evaluate an introductory curriculum into FNUU that is reproducible over a 7-year period with very positive feedback.

Pregnancy and Urology Residency: Towards Equity-centred Practice.

For urology to be truly inclusive in the future, an equity-centred approach to pregnancy is required. Conditions for pregnant women and those caring for a newborn must be optimised to achieve this goal. The European Association of Urology could play a role in addressing the key issues and priorities and set an example for national urological associations.

Who Is Shaping the Future of Academic Urology? A Descriptive Analysis of Residency Program Directors.

OBJECTIVE: To characterize the demographics, educational background, and scholarly characteristics of current urology residency program directors (PDs). METHODS: Urology programs were identified by the listing on the "Accredited US Urology Programs" section of American Urological Association website as of October 2021. Demographics and academic data were collected via publicly available department website and Google search engine. Metrics obtained included years of service as PD from time of appointment, sex, medical school/residency/fellowship, all-time H-index, dual degrees obtained, and professorial ranking. RESULTS: One hundred and forty-seven accredited urological residencies were reviewed; every PD was included. The majority were male (78%) and fellowship trained (68%). Women represented only 22% of PDs. The median active time served as PD, as of 11/2021, was 4years (IQR: 2-7). Forty (28%) were faculty at the same program they completed their residency. The median all-time H-index was 12 (IQR: 7-19; range 1-61). Twelve PDs also served as chair of their department. CONCLUSION: The vast majority of PDs are male, fellowship trained, and have served for less than 5years. Future studies are necessary to follow the trends of representation in leaders of urology residency programs.

Current Landscape of Surgical Assessment Models in Urology Residency Training.

PURPOSE: Assessing trainees' surgical proficiency is an important aspect of urological surgical training. The current standard is the Urology Milestone Project, initially implemented in 2013. This evaluation is limited in that it contains only 3 questions on surgical competency per surgical modality with assessments occurring semi-annually without real-time operative feedback. However, since the Urology Milestones Project's inception a plethora of competency-based surgical assessment tools have been described. We aim to perform a comprehensive review of the literature of these available tools and analyze their strengths and weaknesses as a way of providing a repository of available assessment strategies for further development of a more comprehensive and standardized assessment tool. MATERIALS AND METHODS: A review of the primary literature was performed using key words such as "surgical assessment tools urology," "surgical assessment tools prostate," "bladder surgical assessment tools," "renal surgical assessment tools urology," and "surgical assessment tools urology task specific." Technical and nontechnical skill assessments were included. One reviewer identified and analyzed studies that published assessment tools for use in surgical and urological training. RESULTS: A total of 1,497 articles published between 1997-2022 were identified. Of these, 34 met the inclusion criteria. Eighteen (52.9%) were specialty nonspecific and 16 (47.1%) were specific for urological training. Of the 18 tools developed for general surgical principles, 12 (66.7%) had some form of validity, 9 (50.0%) were significantly reliable, and 2 (11.1%) were externally validated. Of the 16 tools developed specifically for use in urology training, 13 (81.3%) had some form of validity, 7 (43.8%) were significantly reliable, and none were externally validated. Of these 16 tools, 12 (75.0%) were procedure-specific and 4 (25.0%) were developed for general use in endourological procedures. CONCLUSIONS: Surgical training is evolving toward a competency-based model, as evidenced by the increase in assessment tools created within the past 10 years. These instruments not only provide objective feedback to trainees, but also monitor progression. However, they are heterogeneous in construct and utilization. There remains a need for the adoption of a standardized, valid, and reliable tool, ie, both procedure-specific and generalizable across multiple procedures for use in urology training.

[Complications in urological surgery. The urologist as a player in risk management]. / Les complications en chirurgie urologique. L'urologue acteur de la gestion des risques.

The first part of this article deals with accreditation of the quality of the professional practice of urologists and medical teams working in public or private health care institutions. This is a voluntary national risk management process based on the reporting and analysis of medical risk events and the development and implementation of recommendations. The fundamental objective of the system is to reduce the frequency and severity of adverse events associated with care for the patient. The second part aims to describe the mechanisms and management of surgical complications. The perception of complications by the urologist is discussed, as it may be distorted by cognitive biases leading to inappropriate actions. Two important points were also emphasized: communication with the patient following an injury, therapeutic hazard or complication following an error, and proper maintenance of the medical record. A joint effort to cultivate a culture of safety and quality in urological surgical practice should be encouraged. Collective actions by urologists in the future should help to maintain a proactive attitude: - generalization of quality accreditation of urologic physicians' professional practice; - national registry: which has demonstrated its advantages in the world of aeronautics; - creation of a specific module "Management of complications in urology" in teaching (ECU) and continuing education (SUC, website); - creation of an AFU "Complications" Committee; - management of social networks.

How do pediatric urology fellows learn outside of direct patient care? A qualitative study.

BACKGROUND: A large proportion of time during pediatric urology fellowship training is focused on surgical skill development. While fellows begin their fellowship training with some knowledge of pediatric urology from residency, they rely on self-directed learning to expand their knowledge base. OBJECTIVE: To assess how pediatric urology fellows learn about their field outside of direct patient care experiences. Additionally, we were interested in how the pandemic affected fellows self-directed learning. METHODS: First and second year pediatric urology fellows at Accreditation Council of Graduate Medical Education (ACGME)-accredited programs were asked to participate in the study. Individual virtual interviews were conducted and transcribed. Each transcript was coded shortly after transcription. Constructivist grounded theory was used in the data collection and analysis. As interviews progressed, a constant comparative analysis was used iteratively to generate themes. RESULTS: A convenience sample of thirteen fellows from programs across the U.S. agreed to participate; eight were male and five were female. The following four themes emerged from the interviews: most learning in fellowship is self-directed, fellows are not the target audience for didactics, fellows have little independent study time, and there is a lack of organization and guidance for formal didactics (Summary Table). Additionally, we found that teleconferences were used for the majority of teaching after the start of the coronavirus pandemic. CONCLUSION: Fellows in pediatric urology programs are independent learners who understand the need for self-directed learning outside of the setting of formal didactics in fellowship. However, many lack appropriate time, guidance and/or mentorship to facilitate self-directed learning. We identified a need for more structure in pediatric urology fellowship clinical didactics. Videoconferencing software may enable the creation of a national pediatric urology fellowship curriculum.

[Promoting women in urology using the example of habilitation]. / Frauenförderung in der Urologie am Beispiel der Habilitation.

BACKGROUND: The proportion of female urologists is steadily increasing, yet they continue to be underrepresented in academic leadership positions. A postdoctoral lecture qualification (habilitation), which is mandatory for a successful scientific career, is achieved significantly less often by female urologists in Germany than by their male colleagues. OBJECTIVE: To identify factors to effectively promote female urologists into academic leadership positions, the current situation, as well as factors influencing successful habilitation of women who are members of the German Society of Urology (Deutsche Gesellschaft für Urologie [DGU]) were investigated. METHODS: An online questionnaire was distributed to 1343 female members of the DGU in Germany, Austria, and Switzerland. The responses of 521 women were statistically analyzed with respect to baseline characteristics and in relation to research funding. The primary endpoint of our study was the habilitation rate. RESULTS: The average age of the 521 participating female urologists who completed the questionnaire was 37 years (range 21-67 years). Of these, most female physicians were in postgraduate training (n = 168, 32%), worked full-time (n = 324, 62%), and had children (n = 277, 53%). Overall, 359 (69%) of the participants had a PhD and 63 (12%) were still working on their PhD. Thirty (5.8%) female urologists had a habilitation. In univariable logistic regression models, age (odds ratio [OR] 1.06), working time model (part-time OR 0.19), a research fellowship (OR 21.4), release from clinical work for research purposes (OR 13.7), and participation in a funding program (OR 6.9) or mentoring program (OR 7.0) were independent predictors of achieving habilitation. Whether a urologist had children was not an independent predictor of achieving habilitation. In multivariable logistic regression models, age (OR 1.08), and a research fellowship (OR 9.04) were independent predictors of achieving habilitation. CONCLUSIONS: Promoting habilitation among female urologists is required in order to increase the proportion of women in leading academic positions. The results of the data analysis show that the promotion of research fellowships explicitly for women could be a promising approach.

An Assessment of Residency Wellness Programming in Urology Training Programs.

OBJECTIVE: To assess the prevalence and characteristics of wellness programming provided in urology residency programs (URPs). METHODS: Websites for all 145 ACGME-accredited URPs in the United States were assessed for mention of "wellness" or "well-being." Program directors and/or coordinators for each URP were e-mailed asking about the presence of formal wellness programming, informal wellness activities, and wellness programming offered by the institution or graduate medical education. A description of what wellness programming was offered was also requested. RESULTS: Assessment of program websites found that 29 programs (20%) mentioned "wellness" or "well-being." Representatives from 58 URPs (40%) responded to the survey, with 38 programs (65.5%) indicating formal wellness programming and 54 programs (93.1%) indicating informal wellness programming. Compilation of data from e-mail responses and information from program websites revealed that 112 URPs (77.2%) offer residents wellness resources from the institution or graduate medical education, 58 (40%) provide wellness events for residents, and 29 (20%) provide wellness lectures to residents. Other metrics noted included presence of wellness committees, scheduled check-ins from program directors/faculty, and conferences for open resident discussion of issues. CONCLUSIONS: Given that wellness programming is a requirement for ACGME, it is unsurprising that most programs have institutional wellness programming available. Wellness programing from individual URPs appears limited, showing that there is significant room for improvement.

How a Large Academic Training Program Influences Early Career Decision-making and Employment Stability in Urology.

OBJECTIVE: To characterize training and practice factors that influence early career stability and satisfaction in urology residency and fellowship graduates. METHODS: A computer-based survey was distributed to residency and fellowship graduates from a single, large US training program from 1992 to 2015. Queries encompassed training program specifics, post-training practice characteristics, and a validated burnout assessment. RESULTS: Of 108 surveyed individuals there were 77 (71.3%) respondents. Fifty-one (67.1%) remained in their first position after residency. While 52 (67.5%) urologists reported that the program did not formally assist in finding their first post-residency position, no respondent reported difficulty securing a position. Proximity to family was a major factor in selecting a post-residency position in 40 (51.9%) of respondents. Twenty-nine (37.7%) participants joined practices with at least one other graduate of the same urology training program on staff and 24 remain in this position (82%). CONCLUSION: Urology graduates from a large US training program did not have difficulty finding employment after training and most remain in their first post-training position. While proximity to family was a strong consideration for graduates, the perceived importance of first-position characteristics varied widely. 37.7% of our cohort took initial positions at a practice already employing a graduate from the same training program with >80% staying in this position. Surveying a broader range of programs may help future graduates and training programs better tailor their mentorship curricula and alumni networks to trainee goals.