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

Abstract

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. Summary 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.

Disparate Responses in Match Outcome across Competitive Surgical Subspecialties to Pandemic Era Constraints: An Analysis of Impacts of Minimal Auditions

“…Program directors have rated interaction with residents or faculty as the perceived objective of visiting sub-internships. 2 , 7 , 8 , 19 …”

“…Another potential influence of home match rates may be the differing number of IMGs and non-senior medical graduates who historically are more likely to match in neurosurgery and urology as compared to plastic surgery and otolaryngology. Analysis of NRMP and American Urological Association match data (the urology match does not participate in NRMP) found that neurosurgery programs matched a significantly higher number of IMGs (p < 0.001), while urology residencies matched a significantly higher number of non-seniors (p < 0.001; Table 3 ), compared to plastic surgery and otolaryngology 12 , 13 This discrepancy underscored an important and prevalent pathway likely through dedicated research for IMGs and non-seniors to have a successful match in neurosurgery and urology 2 , 20 Not surprisingly, these non-traditional applicants may have had exposure to programs at which they matched, emphasizing the notion that applicant familiarity (other than through traditional clinical away rotations) may still be held in high regard. We suspect that the high number of IMGs and non-senior medical graduates among neurosurgery and urology residencies may have washed out the home matching effect as seen in plastic surgery and otolaryngology during the 2020 to 21 application cycle.…”

“…The selection process for matching into surgical subspecialties continues to be stringent each year. In order to match successfully into surgical subspecialties such as plastic surgery, otolaryngology, neurosurgery, or urology, students are expected to be highly competitive with above average USMLE Step 1/2 scores, research publications, and Alpha Omega Alpha Honors Society status 1 , 2 Furthermore, subjective evaluations of student applicants, including letters of recommendation and visiting sub-internships, appraise applicant characteristics beyond those found on CVs and board scores. In particular, while recommendation letters can be highly variable and inconsistent in the eyes of the evaluators, 3 visiting sub-internships offer residency programs the ability to evaluate student performance amongst the residents and faculty at their institution, giving them valuable insight into the student's intangible traits such as work ethic, preparedness for operative cases, and integration into the program should they match there.…”

“…The importance of the in-person experience for both applicants and residency programs has been well documented in recent literature. A survey of fourth year medical students found that nearly 100% of students applying into plastic surgery, otolaryngology, neurosurgery and urology had performed a visiting sub-internship 2 , 6 Varying interpretations of visiting sub-internships were seen among program directors in these surgical subspecialties. A survey of plastic surgery program directors found that 67% of first year residents in their programs had previously performed a visiting sub-internship at their institution 7 72% of otolaryngology program directors felt that away rotations were “extremely” or “very” important in evaluating candidates, 8 and 87% of urology program directors noted that special consideration is given to applicants who completed a visiting sub-internship at their institution 2 Interestingly, while neurosurgery applicants reported attending an average of three away rotations, 9 a survey of program directors found that performance on visiting sub-internships was ranked near the bottom of factors influencing resident selection.…”

COVID-19 Increased Residency Applications and How Virtual Interviews Impacted Applicants

“…While the trend of increased application numbers for individual specialties has been published [8][9][10][11][12][13][14][15][16], the comparison between applications, interview invites, and interviews attended across the spectrum of virtual and in-person interviews has not been examined.…”