Evaluating Urology Residency Applications: What Matters Most and What Comes Next?

PURPOSE OF REVIEW: In light of the announcement that the United States Medical Licensing Examination Step 1 exam will transition to pass/fail reporting, we reviewed recent literature on evaluating residency applicants with a focus on identifying objective measurements of applicant potential. RECENT FINDINGS: References from attending urologists, Step 1 scores, overall academic performance, and research publications are among the most important criteria used to assess applicants. There has been a substantial increase in the average number of applications submitted per applicant, with both applicants and residency directors indicating support for a cap on the number of applications that may be submitted. Additionally, there are increasing efforts to promote diversity with the goal of improving care and representation in urology. Despite progress in standardizing interview protocols, inappropriate questioning remains an issue. Opportunities to improve residency application include promoting diversity, enforcing prohibitions of illegal practices, limiting application numbers, and finding more transparent and equitable screening measures to replace Step 1.

The New PGY-1 Year: Lessons Learned.

PURPOSE OF REVIEW: Describe the ACGME's changes to the PGY-1 year in urology and discuss the benefits and challenges faced by training programs. RECENT FINDINGS: There are no publications detailing the integration of the PGY-1 year in urology; however, response of other surgical subspecialties to their own integration has been studied. Benefits of integration include earlier exposure to techniques and knowledge specific to urology, potentially leading to increased preparedness for next steps in training and exams. Program directors have more flexibility to select rotations relevant to urology. Resident wellness may be improved as interns are incorporated into the department earlier and can help distribute the workload for senior residents. Challenges include decreased exposure to basic surgical knowledge and skills, decreased camaraderie with general surgery colleagues, and difficulties associated with evaluating interns who are spending limited time with urology departments. Overall, the change seems to have a positive impact on urological training.

[UROLOGY LESSONS FOR COLORECTAL SURGEONS].

The anatomical and functional relationship of the pelvic organs is a prerequisite to the development of complications when performing surgical procedures in this anatomical region. Prevention and timely diagnosis of intraoperative injuries of both the urinary system organs and intestine, as well as well-coordinated work of urologist and colorectal surgeon team offer the opportunity to employ optimal tactics for the patient management.

Representation Matters: One Urology Residency Program's Approach to Increasing Workforce Diversity.

OBJECTIVE: To address the challenge in urology in recruiting physicians from backgrounds racially and ethnically underrepresented in medicine (URiM), we sought to design, implement, and evaluate methods for recruiting URiM candidates to our urology residency program. METHODS: We developed a 3-pronged approach aimed at increasing the number of interviewed applicants, and subsequently number of URiM residents recruited to our program. The 3 facets included: (1) funded visiting student rotation, (2) holistic evaluation of applications, (3) implemented targeted outreach. Statistical analysis of the applicants interviewed and matched into our residency program, as well as traditional metrics used for residency recruitment, were performed from 2015 to 2022. RESULTS: The number of URiM interviewees significantly increased from 6.1% in 2015 to its peak, 40%, in 2020. In 2015, there were no URiM residents in our urology residency program. By 2022, the total URiM complement increased to 35%. In evaluating traditional metrics of residency recruitment, there was no significant difference in mean USMLE Step 1 score before compared with after the implementation of our recruitment approach. The maximum rank number reached to fill the urology residency positions also remained relatively stable throughout the study period, with a range from 5 to 38. CONCLUSION: We demonstrate that the implementation of our innovative and intentional 3-pronged recruitment approach effectively increased the number of URiM interviewees and residents in our residency program. The diversification of our urology workforce depends on the implementation of such efforts, and we encourage urologists to lead the way on such initiatives.

Path to Parity: Trends in Female Representation Among Physicians, Trainees, and Applicants in Urology and Surgical Specialties.

OBJECTIVE: To characterize recent trends among practicing female surgeons, surgical trainees, and surgical residency applicants to assess potential progress toward gender parity. METHODS: Workforce statistics on U.S. practicing surgeons, trainees, and applicants among 9 surgical specialties were obtained from the Association of American Medical Colleges and Electronic Residency Application Service public databases. Physician and trainee data during 2007-2019 and residency applicant data during 2016-2020 were analyzed by surgical specialty. We used Cochrane Armitage trend tests to assess changes over time. RESULTS: Female practicing urologists increased 104% during the study period, the third-largest increase among 9 surgical specialties (range 36%-114%, all P < .01), representing continued growth in the prevalence and proportion of women among surgical trainees in all surgical disciplines. In contrast, the overall change for female urology residents (28%) lagged significantly, ranking eighth among the 9 specialties (range 9%-149%, all P < .01), suggesting slowing growth in the training pipeline. Finally, while the proportional change in urology applicants has been significant (33%, P < .01), growth rates have markedly slowed in the past 5 years compared to women in practice and training since 2007. CONCLUSION: While female representation among practicing urologists has improved relative to other surgical disciplines, declining rates of women entering and applying to urology residency suggest a longer trajectory toward gender parity.

Academic Productivity Among Underrepresented Minority and Women Urologists at Academic Institutions.

OBJECTIVE: To characterize academic productivity for underrepresented minorities (URMs) vs non-URMs and by gender in Urology. METHODS: A database was created from 145 Urology residency programs. URM status was determined by origin of name, photo, biography, Twitter, LinkedIn, and Doximity. A PubMed query was performed for publication output. URM status, gender, post-graduate year/years of practice, and Doximity residency rank were factors in multivariable analysis. RESULTS: For residents, the median total publications was 2 [1,5] for URMs and 2 [1,5] for non-URMs (P=.54). The median first/last author publications was 1 [0,2] for URMs and 1 [0,2] for non-URMs (P=.79). The median total publications was 2 [0,4] for women and 2 [1,6] for men (P=.003). The median first/last author publications was 1 [0,2] for women and 1 [0,2] for men (P=.14). For faculty, the median total publications was 12 [3,32] for URMs and 19 [6,45] for non-URMs (P=.0002). The median first/last author publications was 4.5 [1,12] for URMs and 7 [2,20] for non-URM faculty (P=.0002). The median total publications was 11 [5,25] for women and 20 [6,49] for men (P<.0001). The median first/last author publications was 4 [1,11] for women and 8 [2,22] for men (P<.0001). On multivariable analysis, there was no difference in total publications and first/last author publications for URMs vs non-URMs. There remained a difference between genders for residents and faculty with total publications but not first/last author publications (P=.002/P=.10 residents, P=.004/P=.07 faculty). CONCLUSION: Academic productivity was not different in URMs and non-URMs for both residents and faculty. Men residents and faculty had more total publications compared to women.

[Promotion of next generation urologists-Construct urology of the future]. / Förderung des urologischen Nachwuchses ­ Urologie der Zukunft gestalten.

In view of the growing demand for urological care and the simultaneous demographic change, the need for urologists in Germany is increasing. Therefore, young professionals are urgently needed to ensure urological care in the future. This objective can be achieved by fascinating medical students for urology and by implementing satisfactory residency programs in clinical departments and outpatient offices. Perspectives and possible career paths should be shown to junior colleagues at an early stage. Structured research funding is needed to reconcile academic with clinical work. The German Society for Residents in Urology (GeSRU) offers young urologists a platform for networking, for representation of interests as well as for education and training.

[Experiencing continuing education-experience of future urologists]. / Weiterbildung erlebt ­ Erfahrung des urologischen Nachwuchses.

Structured residency programmes within dedicated associations of hospitals, practices and medical care centres offer the opportunity to improve the quality of training and to increase the attractiveness of urology through fixed rotations of doctors in continued training. The implementation of such programmes is guided by the framework conditions of the respective location. Possible rotations range from andrology to paediatric urology and uro-gynaecology to interdisciplinary uro-oncology. An outpatient training period also offers the chance for a change of perspective and supports career orientation. Rotations in the interdisciplinary intermediate care unit offer the opportunity to become familiar with the care of complex disease processes, including the differential diagnostic assessment of abdominal diseases, which is important in urology. In summary, the diversity of urological training available can enable junior urologists to receive more individualised and targeted training by promoting multilayered, intersectoral as well as interprofessional training.

[Influence of the working model on the education of young urologists : Education through the ages]. / Auswirkung eines Arbeitszeitmodells auf den Facharzt für Urologie : Eine Ausbildung im Wandel der Zeit.

BACKGROUND: There is a trend of increasing discontent of urologic residents with educational programs. One point being mentioned is lack of time during residency for education and self-training. We analyzed the available time for education in our department depending on the used working model through the last 25 years. MATERIALS AND METHODS: We calculated the absolute availability of residents during their residency for working models in 1996, 2000, 2007 and 2017. As a basis we used the working model of 1996 as no compensatory time-off for being on call was used. All days on which a delayed start is planned and no schedule in daily routine is possible had been excluded from education time. The numbers implemented in the regulation on further education in the corresponding years had been used to calculate the expenditure of time on the basis of median length of the different intervention. In addition, the patient numbers on the ward and our outpatient clinic had been documented over time. RESULTS: With increasing patient numbers in the in- and outpatient clinic there is a continuous decreasing time available for education. The absolute available time in our department is calculated to be 3.1 years compared to 5 years in 1996. With the first day of training a resident has to complete 66.9 min of self-contained diagnostics or interventions per day in addition to clinical routine and administration to meet the requested numbers of the regulation on further education. CONCLUSIONS: The limited time being available for the educational program is improved by the current regulation of education. To teach the complex segments of urology there is an urgent need for a well-structured curriculum, which should be used nationwide.

Home grown: the development and structure of urological training in the Caribbean.

Training in general surgery at the University of the West Indies commenced in Jamaica in 1972 and urology training followed just over a decade later. Since then, the 'Doctor of Medicine' diploma offered by the university has also expanded to include the Trinidadian campus. Most urologists in the English-speaking Caribbean are, in fact, graduates of this programme. Residents follow a two-part training plan and two years of core surgical training are followed by four years of urology training. Despite the tremendous regional impact of this training programme, there is a lack of awareness of its existence among the wider urology community. This article reviews the history, development and structure of urology training in the English-speaking Caribbean.

The value of andrology medical-surgical training programs for Urology residents. / Importancia de la formación médico-quirúrgica andrológica para los residentes de Urología.

Nowadays, sub-specialty expertise in andrology is required within the Urology training program. These practices -during the MIR (Medical Intern Residency) program and once the specialty studies are over- should be performed under supervision and have a multidisciplinary nature. In fact, the urologist's andrology training program does not finish with his residency period. The unceasingly increasing knowledge related to infertility, reproduction, sexual medicine and reconstructive surgery require a high level of dedication and engagement with continuing education. The field of Andrology has evolved significantly in Europe and in the United States in the past 30 years. Although the andrology training programs in these 2regions share some common aspects, there are also substantial differences between them. This chapter includes a review of the Spanish training programs and those in our international environment, with the objective to comprehend the importance of andrology medical-surgical training for Urology residents.