Gender trends in match rate to surgical specialties in Canada: A retrospective study from 2003-2022.

BACKGROUND: In Canada, there is a recognized underrepresentation of women in the field of surgery. However, the extent to which this trend applies across various surgical specialties is not well delineated. The aim of this study is to identify existing disparities and trends over time to inform the need for future interventions to make the match process more equitable for applicants. METHODS: Data regarding surgical specialty applicants was extracted from the Canadian Resident Matching Service (CaRMS)'s 2003 to 2022 reports. RESULTS: A total of 9,488 applicants ranked surgical specialties as their first choice from 2003-2022. Increases in the proportion of women applicants comparing periods 2003-2007 to 2018-2022 were significant for cardiac surgery (22% to 43%, p = 0.03), general surgery (46% to 60%, p<0.001), orthopedic surgery (23% to 35%, p<0.001), urology (23% to 38%, p<0.001), and all aggregated surgical specialties ('all surgery') (45% to 55%, p<0.001). An increase in the proportion of women applicants who matched over the same periods was observed for general surgery (+47% to 60%, p<0.001), orthopedic surgery (24% to 35%, p<0.01), urology (21% to 34%, p<0.001), and all surgery (46% to 54%, p<0.001). From 2003-2022, a lower match rate for women compared to men was observed for otolaryngology (0.60 v 0.69, p = 0.008), urology (0.61 v 0.72, p = 0.003), and all surgery (0.71 v 0.73, p = 0.038), while higher match rates were observed for ophthalmology (0.65 v 0.58, p = 0.04). No statistically significant differences in match rate were observed from 2018-2022. CONCLUSIONS: While the proportion of women applicants to surgical specialties in Canada has been increasing, women remain underrepresented in several surgical specialties. This underrepresentation cannot be solely attributed to fewer women applying to these specialties, as women experience lower success rates when matching to specific surgical specialties. Further research is essential to identify and address the underlying causes of these disparities.

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.

Pathways to paediatric urology subspecialisation: a study of casemix, incumbent attitudes and opinions.

OBJECTIVE: To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. METHODS: An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS: A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting (p = 0.04), bladder bowel dysfunction (p = 0.02), endourological procedures (p = 0.04), and robotics (p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction (p = 0.03), and posterior urethral valve ablation (p = 0.002). CONCLUSION: This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.

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.

Predictors of Excellent Urology Residents at the Time of the Urology Match.

OBJECTIVE: To update our experience and report on features predictive of high-quality urology residents at the time of the urology match, because data predicting which medical students will mature into excellent urology residents are sparse. METHODS: We reviewed our experience with 84 urology residents who graduated from 2006 to 2023. Residents were independently scored 1-10 based on overall quality by the current and former Program Director. Discrepant scoring by >2 was resolved by an independent review. Associations of features from the medical student application with an excellent score (defined as 8-10) were evaluated with logistic regression. RESULTS: Discrepant scoring >2 was noted in only 5 (6%) residents. Among the 84 residents, the median overall score was 7 (range 1-10) and 36 (43%) residents had an excellent score of 8-10. Univariably, higher USMLE step II score (P = .03), election to alpha omega alpha (P = .004), no negative interview comments (P = .002), honors in OB/Gyn (P = .048) and psychiatry clerkships (P = .04), and honors in all core clinical clerkships (P < .001) were significantly associated with an excellent score. In a multivariable model, no negative interview comments (P = .003) and honors in all core clinical clerkships (P = .001) were independently associated with an excellent score (c-index 0.76). There were several notable features (sex, letters of recommendation, USMLE step I, externship at our institution, surgery clerkship grade, and rank list) that were not significantly associated with excellent residents. CONCLUSION: We demonstrate features associated with excellent urology residents, most notably no negative interview comments and an honors grade in all core clinical clerkships.

Urology Match: Important Factors Women Consider When Choosing a Residency Training Program.

OBJECTIVE: To determine factors that women urology resident physicians rate as most influential when selecting residency programs. METHODS: Surveys were emailed to female urology residents during the 2021-2022 academic year. Residents scored 19 factors influencing residency program choice from 1 "least" to 5 "most" important and ranked their top 5 most influential factors. Data were analyzed via descriptive statistics and quantile regression. RESULTS: One hundred thirty-six (37%) of 367 female urology residents who received the survey participated. Eighty-two percent had no children and 57% did not plan to have children during residency. The three highest scoring factors derived from Likert scale ratings were resident camaraderie (4.6 ±â€¯0.5 [mean ±â€¯SD]), resident happiness (4.6 ±â€¯0.6), and case variety/number (4.4 ±â€¯0.8). As a whole, the lowest scoring characteristics were attitudes toward maternity leave (2.6 ±â€¯1.2) and maternity leave policies (2.5 ±â€¯1.2). Married residents were more likely than those who were single and engaged/in a committed relationship to rank attitudes and policies toward maternity leave as more important (3 vs 2 vs 2, P <.0001). Residents with children were more likely than those without children to rank maternity leave policies as more important (3 vs 2, P <.0001). CONCLUSION: As a whole, women urology residents prioritized non-gender-related factors. However, gender-specific factors were rated highly by married residents and those with children or planning to have children. Urology training programs may use these results to highlight desirable characteristics to aid recruitment of female residents.

Radiation Safety Education and Practices in Urology: A Review.

Introduction: Radiation safety education is important as fluoroscopy is commonly used for diagnostic and therapeutic purposes. Exposure to high levels of ionizing radiation is associated with an increased risk of cancer and other adverse health effects; therefore, it is essential that urologists and trainees are educated on the safe use of radiation. Unfortunately, radiation education and occupational safety is not standardized for this group and there are currently no review studies examining radiation safety for urologists in the clinical setting. This review aims at investigating the various levels of radiation safety education and practices used in urology. Methods: MEDLINE and EMBASE databases were searched for relevant publications reporting on radiation knowledge and randomized controlled trials, non-randomized comparative studies, and observational studies were included. Reviews, abstracts, editorial comments, non-urologic studies, and incomplete articles were excluded. Results: Within these articles, there were 16 observational studies. Frequency of radiation exposure ranged from <1 × to >15 × /week. There were higher rates of adherence to use of lead aprons and thyroid shields than lead eyeglasses and gloves. Radiation safety education was infrequent. Radiation safety knowledge was especially low for the risks of radiation exposure. Most studies highlight the need for increased awareness and training on radiation safety for both urology trainees and consultants. Conclusions: Radiation safety education and practices are an important issue in urology. Improvements to education and compliance to radiation safety practices are critical to ensuring urologists and trainees use ionizing radiation in a safe and responsible manner.

Practice Readiness? Trends in Chief Resident Year Training Experience Across 13 Residency Programs.

INTRODUCTION: Urology residency prepares trainees for independent practice. The optimal operative chief resident year experience to prepare for practice is undefined. We analyzed the temporal arc of cases residents complete during their residency compared to their chief year in a multi-institutional cohort. METHODS: Accreditation Council for Graduate Medical Education case logs of graduating residents from 2010 to 2022 from participating urology residency programs were aggregated. Resident data for 5 categorized index procedures were recorded: (1) general urology, (2) endourology, (3) reconstructive urology, (4) urologic oncology, and (5) pediatric urology. Interactions were tested between the trends for total case exposure in residency training relative to the chief resident year. RESULTS: From a sample of 479 resident graduates, a total of 1,287,433 total cases were logged, including 375,703 during the chief year (29%). Urologic oncology cases had the highest median percentage completed during chief year (56%) followed by reconstructive urology (27%), general urology (24%), endourology (17%), and pediatric urology (2%). Across the study period, all categories of cases had a downward trend in median percentage completed during chief year except for urologic oncology. However, only trends in general urology (slope of -0.68, P = .013) and endourology (slope of -1.71, P ≤ .001) were significant. CONCLUSIONS: Over 50% of cases completed by chief residents are urologic oncology procedures. Current declining trends indicate that residents are being exposed to proportionally fewer general urology and endourology cases during their chief year prior to entering independent practice.

Simulation training in urology.

PURPOSE OF REVIEW: This review outlines recent innovations in simulation technology as it applies to urology. It is essential for the next generation of urologists to attain a solid foundation of technical and nontechnical skills, and simulation technology provides a variety of safe, controlled environments to acquire this baseline knowledge. RECENT FINDINGS: With a focus on urology, this review first outlines the evidence to support surgical simulation, then discusses the strides being made in the development of 3D-printed models for surgical skill training and preoperative planning, virtual reality models for different urologic procedures, surgical skill assessment for simulation, and integration of simulation into urology residency curricula. SUMMARY: Simulation continues to be an integral part of the journey towards the mastery of skills necessary for becoming an expert urologist. Clinicians and researchers should consider how to further incorporate simulation technology into residency training and help future generations of urologists throughout their career.

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.

Low-fidelity simulation models in urology resident's microsurgery training.

PURPOSE: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. METHODS: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). RESULTS: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. CONCLUSIONS: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

The value of residency program characteristics changes throughout urology training.

INTRODUCTION: The purpose of this study was to determine which characteristics of urology residency programs are most highly valued by medical students and residents, and how these change during training. MATERIALS AND METHODS: We distributed a survey to urology residents and medical students interested in urology via program director email and social media. The survey collected demographic data, future career plans, and asked respondents to rank the relative importance of six categories of residency program characteristics and specific characteristics within each category. RESULTS: Among the six categories of residency characteristics, resident experience was ranked most important by both medical students and residents, followed by geography and clinical experience which were tied. Medical students ranked clinic experience and formal mentorship with greater importance while residents placed higher value on the active role of clinical faculty and help from advanced practice providers. Trainees planning for an academic career ranked research experiences and resident diversity as more important than those entering private practice. CONCLUSIONS: Residents and medical students mostly agreed on the relative importance of residency program characteristics. The differences observed suggest that as trainees gain experience they place greater importance on informal relationships with faculty and value characteristics that enhance surgical training such as support from advanced practice providers and less time in clinic. These findings may guide programs on what information to include on their websites and presentations.

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.