Understanding the Urology Program Directors Perspective on the Current Resident Selection Process: The Society of Academic Urologists National Survey of Urology Program Directors.

OBJECTIVE: The traditional residency selection process was altered dramatically by the SARS CoV-2 (COVID-19) pandemic. For the 2020-2021 application cycle in-person interviews were transitioned to the virtual format. What was thought to be a temporary transition has now become the new standard with continued endorsement from the Association of American Medical Colleges (AAMC) and the Society of Academic Urologists (SAU) for virtual interviews (VI). We sought to assess the perceived efficacy and satisfaction of the VI format from the urology residency program director's (PDs) perspective. DESIGN: A designated SAU Taskforce on "Optimizing the Applicant Experience in the Virtual Interview Era" developed and refined a survey composed of 69 questions on VI and was distributed to all urology program directors (PD) of member institutions of the SAU. The survey focused on candidate selection, faculty preparation, and interview day logistics. PDs were also asked to reflect on the impact of VI on their match results, recruitment of underrepresented minorities and female gender, and what their preference would be for future applications cycles. PARTICIPANTS: Urology residency PDs (84.7% response rate) between January 13, 2022 - February 10, 2022 were included in the study. RESULTS: Most programs interviewed a total of 36 to 50 applicants (80%), with an average of 10 to 20 applicants per interview day. The top 3 ranked criteria for interview selection reported by urology PDs surveyed included letters of recommendation, clerkship grades, and USMLE Step 1 score. The most common areas of formal training for faculty interviewers were diversity, equity and inclusion (55%), implicit bias (66%), and review of the SAU guidelines on illegal questions (83%). Over half (61.4%) of PDs believed that they were able to accurately represent their training program through the virtual platform, while 51% felt that VI did not afford similar assessments of applicant as in-person interviews. Two-thirds of PDs believed the VI platform improve access for all applicants to attend interviews. Focusing on the impact of the VI platform for recruitment of underrepresented minorities (URM) and female gender applicants, 15% and 24% reported improved visibility respectively for their program, and 24% and 11% reported increased ability to interview URM and female gender applicants respectively. Overall, in-person interviews were reported to be preferred by 42%, and 51% of PDs desired VIs to be included in future years. CONCLUSIONS: PDs opinion and role of the VIs into the future is variable. Despite uniform agreement of cost savings and belief that VI platform improves access for all, only half of PDs expressed interest of the VI format being continued in some form. PDs note limitation of VI in the ability to comprehensively assess applicants as well as the in-person format. Many programs have begun to incorporate vital training in the areas of diversity equity and inclusion bias, and illegal questions. There is a role for continued development and research on ways to optimize virtual interviews.

The Impact of COVID-19 on the Urology Residency Match and Geographic Proximity of Applicants.

OBJECTIVE: To determine the impacts of COVID-19 pandemic-related changes and program-specific characteristics on the geographic diversity of the 2021 and 2022 urology match classes. METHODS: We gathered publicly available information to compare match outcomes in 2021 and 2022 to the previous 5 application cycles (2016-2020). Variables included residency program class size, program and resident AUA section, and program and resident medical school. Univariate comparisons were made with Fisher's t-tests. Odds ratios were calculated following multivariable analysis. RESULTS: Comparing the previous 5 application cycles to the 2 pandemic years individually and together showed no significant changes in home or in-section matches. However, when comparisons were stratified by small (1-2 residents) vs large (3+ residents) programs, a significant increase in at-home and in-section matches was observed for small programs in 2021. Large programs did not experience significant changes in match patterns. Multivariate analysis showed that small programs had significantly lower odds of matching applicants from home institutions and within AUA sections. Additionally, certain AUA sections demonstrated significantly increased likelihood of accepting in-section applicants. CONCLUSION: The changes from in-person to virtual application cycles during the pandemic particularly affected small residency programs in 2021. With easing restrictions and logistical improvements in the 2022 cycle, locoregional match rates partially shifted back to prepandemic patterns, though not completely. Although the pandemic did not affect geographic diversity in urology as much as in other surgical subspecialties, these findings and further study should be considered to optimize upcoming cycles.

Urology Residency Applications in the COVID-19 Era.

OBJECTIVE: To evaluate urology applicants' opinions about the interview process during the COVID-19 pandemic. MATERIAL AND METHODS: An anonymous survey was emailed to applicants to our institution from the 2019 and 2020 urology matches prior to issuance of professional organization guidelines. The survey inquired about attitudes toward the residency interview process in the era of COVID-19 and which interview elements could be replicated virtually. Descriptive statistics were utilized. RESULTS: Eighty percent of urology applicants from the 2019 and 2020 matches received our survey. One hundred fifty-six people (24% of recipients) responded. Thirty-four percent preferred virtual interviews, while 41% in-person interviews at each program, and 25% regional/centralized interviews. Sixty-four percent said that interactions with residents (pre/postinterview social and informal time) were the most important interview day component and 81% said it could not be replicated virtually. Conversely, 81% believed faculty interviews could be replicated virtually. Eighty-seven percent believed that city visits could not be accomplished virtually. A plurality felt that away rotations and second-looks should be allowed (both 45%). COMMENT: Applicants feel that faculty interviews can be replicated virtually, while resident interactions cannot. Steps such as a low-stakes second looks after programs submit rank lists (potentially extending this window) and small virtual encounters with residents could ease applicant concerns. CONCLUSION: Applicants have concerns about changes to the match processes. Programs can adopt virtual best practices to address these issues.

Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study.

OBJECTIVE: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. MATERIALS AND METHODS: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents. In the survey, Online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. RESULTS: Over 70% of urology residents agreed or were neutral to the statement that Online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. CONCLUSIONS: An overwhelming majority of urology residents in the United States believe Online education models should continue to be adopted once the pandemic is over.

Online Collaborative Learning in Urology.

REASON FOR REVIEW: A recent shift towards use of telehealth and remote learning has significant implications on resident and fellow education in urology. Implementation of multi-institutional online didactic programs, spurred on by the COVID epidemic, has changed the traditional resident teaching paradigm from individual institutional silos of knowledge and expertise to a shared nationwide database of learning.  RECENT FINDINGS: In this article, we explore the current trend towards virtual education and its progress to date, lessons learned on the optimization of this teaching modality, and future direction and sustainability of collaborated, standardized and accessible didactic education in urology. Multi-institutional collaborative remote video didactics has emerged as a critical part of resident education. These lectures have been overwhelmingly successful and have persisted beyond the pandemic to become a part of the urologic training curricula. This collaborative and standardized approach to resident education provides access to national and international experts, encourages cross-institutional collaboration and discussion, and builds a repository of lectures with easy access for learners. Utilization of this teaching modality will continue to be impactful in urologic training and will require ongoing efforts and input from both collaborating intuitions and professional societies to continue to improve on and engage in this important learning tool.

Influence of Webinar-Based Learning on Practice of Percutaneous Nephrolithotomy: Outcomes of a Global Survey.

Background: With webinars looking to be the mainstay post-pandemic, it is important to demonstrate whether webinars are, indeed, effective educational tools for professional training and skill acquisition. We aim at demonstrating, via a global survey, the efficacy of webinars on percutaneous nephrolithotomy (PCNL) and how this knowledge transforms clinical practice. Methods: A structured online survey covering the following sections: (1) Demographics, (2) PCNL techniques, and (3) PCNL equipment was circulated. The target study population were practicing urologists and residents. Categorical data were presented with counts and percentages, and they were compared by using Chi-square test. Continuous data were analyzed with non-parametric methods. Respondents were dichotomized according to attendance of webinar type, attendees of dedicated PCNL webinars (Group A), or attendees of endourological webinars that discussed some aspects of PCNL (Group B). Results: A total of 303 respondents from 38 countries participated. Overall, 91.7% (n = 278) were in Group A and 8.3% (n = 25) were in Group B; 77.9% were younger than 50 years, whereas 51.8% had more than 10 years of urology experience. In group A, urologists of all ages, in academic institutions and private practitioners, significantly benefited in gaining knowledge about the merits of newer devices and the role of suction-assisted devices in modern PCNL. The majority of group A also reflected that by attending a dedicated PCNL-based webinar they benefited in learning newer positions for PCNL access, especially supine, and how to effectively use laser as energy devices for lithotripsy. In Group B, the only area of benefit was in lasing techniques and the use of newer lasers such as the thulium fibre laser. Conclusion: Our survey positively validates the two proposed hypothesis, that is, webinars as a medium of education do benefit practicing urologists in knowledge and the clinical practice domains. Age, experience, or place of practice is no barrier to adopting newer mediums of education such as webinars.

Effect of COVID-19 on Graduating Urology Resident Case Logs: Analysis of the Accreditation Council of Graduate Medical Education National Data Reports.

OBJECTIVE: To assess the national case logs of the first graduating urologic resident cohorts to have trained during the COVID-19 pandemic for effects on surgical volumes. METHODS: The nationally aggregated Accreditation Council for Graduate Medical Education urology resident case logs were obtained for graduates of academic years (AYs) 2015-2016 through 2020-2021. Case volume differences for tracked index categories were compared between AYs with a 1-way analysis of variance. Data were then combined into pre-COVID and COVID-affected resident cohorts and differences in average cases logged were analyzed with 2-tailed student's t-tests. RESULTS: Graduating urology residents logged an average of 1322 (SD 24.8) cases over their residency during the examined period. Total cases had multiple statistical differences between AYs but the only index category with a statistically significant decrease for a COVID-affected AY compared to pre-COVID AY was pediatric majors: AY 2020-2021 logged fewer cases than AY 2015-2016 (53.9 vs 63.0, P = .004) and AY 2018-2019 (53.9 vs 61.2, P = .04). When aggregated into pre- and COVID-affected cohorts, both pediatric minor (123.4 vs 117.5, P = .049) and pediatric major (61.4 vs 56.8, P = .003) case averages decreased for the COVID-affected cohort of residents, but no adult index category decreased. CONCLUSION: National graduating urology resident surgical volume for adult index categories was maintained through the pandemic. Pediatric cases saw a statistical decrease in volume of questionable clinical significance. This does not eliminate concern that individuals may have experienced a detrimental impact on their resident education.

Virtual "Matchmaking": Stakeholder Perspectives on the Future of the Urology Residency Match.

OBJECTIVE: To examine stakeholder perspectives regarding the lack of in-person externships and transition to a virtual urology residency interview format. The unprecedented disruption from the COVID-19 pandemic forced an abrupt pivot to a "virtual" Urology Match for the 2021 cycle. We aim for our study to inform ongoing deliberations on the future of the Urology Match. MATERIALS AND METHODS: Following Urology Match day in February 2021, two surveys were distributed by the Society of Academic Urologists to all applicants and program directors (PDs) who participated in the 2021 Urology Match. RESULTS: Overall, 192 of 481 applicants (40%) and 63 of 160 PDs (39%) responded. Most applicants (67%) were satisfied with their match outcomes, although unmatched applicants were significantly more likely to be unsatisfied than matched applicants (98% vs 9%, P <.0001). Most PDs were equally (79%) or more satisfied (13%) with their match outcomes compared with prior years. Nearly all applicants (93%) and PDs (94%) recommended retaining an in-person externship option. Most applicants (61%) and PDs (71%) felt their outcomes would not have changed with in-person interviews. Applicants and PDs were evenly split as to whether interviews should be conducted in-person or virtually in the future. CONCLUSION: The vast majority of applicants and PDs recommended retaining in-person externships for future match cycles despite high costs. In contrast, there was ambivalence amongst both groups of stakeholders regarding the format of interviews for future match cycles. We recommend virtual interviews moving forward to help alleviate the financial burden placed on applicants and increase equity.

Twitter Engagement of Medical Students Applying to Urology Residency During COVID-19: A Mixed Methods Study.

OBJECTIVE: To determine how medical students' Twitter engagement impacted the urology residency match and overall student perception of Twitter. METHODS: We utilized a mixed methods approach with (1) Twitter metrics data, (2) online student surveys, and (3) qualitative semi-structured interviews. Interviews were evaluated with iterative thematic content analysis, while quantitative data were analyzed with descriptive statistics, and univariate analyses. RESULTS: We identified 245 Twitter accounts of Urology residency applicants from the 2021 cycle. Matched students were more likely to have a Twitter account (59% matched vs 28% unmatched, P = .002) and account creation increased following the COVID-19 pandemic announcement. Matched students' profiles were associated with more followers, bios mentioning Urology, home Urology residency programs, and no international flags and/or references. The online survey had a 16% response rate. A majority reported utilizing Twitter for residency information (95%), wanting to continue Twitter throughout residency (67%), and feeling uncomfortable tweeting about racial, political, or diversity issues (64%). Nine interviews revealed 4 themes: Twitter's opportunities for networking, Twitter's role in the application process, the burden of social media use, and professionalism. CONCLUSION: Students applying to Urology residency increasingly utilized Twitter during the COVID-19 pandemic and having a Twitter account was associated with matching. While Twitter may not be necessary to succeed in the match and can pose an additional time burden, applicants view it as an opportunity for learning, networking, and personal branding.

Telementoring for communication between residents and faculty physicians: Results from a survey on attitudes and perceptions in an Academic Tertiary Urology Referral Department in Italy.

INTRODUCTION: Telemedicine has been adopted successfully in various urological scenarios. The aim of the present study was to explore attitudes and perceptions by urology residents toward the use of telementoring in the context of residents-faculty physicians communication for patient-related care. METHODS: An online survey consisting of 19 multiple choice questions was designed including three sections: respondents' demographics, attitudes and perceptions towards the use of telementoring. Invitations to participate in this anonymous survey were e-mailed to urology residents at University of Naples Federico II. RESULTS: In total 60 responses were received (participation rate 86%). The frequency of telementoring use was described as occasional, frequent, very frequent, and rare by 51,3%, 41.0%, 5,1%, and 2,6% of respondents, respectively. WhatsApp messenger was used by 89.5% of respondents and photos were the most common type of media content shared (73.7%). Most of respondents declared a moderate and a strong agreement with respect to the utility of telementoring in improving the communication in relation to the interpretation of clinical, radiological, endoscopic, and functional findings. Overall, 78% of participants individuated risks of information flow distortions and misinterpretations as the major limit of telementoring. CONCLUSIONS: The use of telementoring is widespread and perceived as useful by urology residents in the context of residentsfaculty physicians communication in multiple settings of patientrelated care.

National Implementation and Evaluation of a Virtual Subinternship in Urology.

OBJECTIVE: To conduct a nationwide evaluation of student and program director (PD) perspectives of virtual subinternships that took place during the COVID-19 pandemic. MATERIALS AND METHODS: In December 2020, we distributed anonymous surveys to all 534 urology residency applicants and 161 urology PDs at academic medical centers across the United States to evaluate virtual subinternships. Surveys assessed curriculum composition, goals, satisfaction, barriers, and future reusability. The primary outcome was overall satisfaction with the subinternship, evaluated on a 5-point Likert scale. RESULTS: The survey was completed by 174 students (33%) and 82 PDs (51%), including 81 students (47%) and 32 PDs (41%) who participated in virtual subinternships at 29 institutions. Overall, 77% of students and 78% of PDs rated the electives "excellent" or "very good." On ordinal logistic regression, higher student ratings were associated with duration ≥3 weeks (odds ratio [OR] 4.64, P = .003) and class size ≤4 students (OR 3.33, P = .015). Higher PD ratings were associated with full-time electives (OR 11.18, P = .019), class size ≤4 students (OR 13.99, P = .042), and utilization of the standardized Guidebook from the Society of Academic Urologists (OR 11.89, P = .038). The most commonly reported challenge to the subinternship's efficacy was lack of hands-on learning (87% of students and 81% of PDs). Looking forward, 45% of students and 66% of PDs recommended incorporating virtual components into future electives. CONCLUSION: The virtual subinternship was a coordinated nationwide initiative to provide urologic education to medical students during a pandemic. The most successful courses were structured with longer duration, full-time commitment, and small class size.

Twitter and Instagram Use in the Urology Residency Application Process.

OBJECTIVE: To define urology applicant attitudes and usage trends of social media (SM) during the 2021 urology match cycle. METHODS: We emailed an anonymous, de-identified 22-question, multiple choice survey to all applicants to our institution for the 2021 Urology Residency Match. We asked participants about use of SM and which aspects they found useful in the application process. Univariate descriptive analyses were conducted based on survey responses. Chi-square analyses were performed to define significant differences in use of social media and resultant match outcomes. RESULTS: Of the 528 students who registered for the 2021 AUA Match, 398 received our survey (75%), and 144 responded (27% of applicants nationwide). Of survey participants, 49% made a new account on Twitter while 30% had a preexisting account. Most participants (71%) had a preexisting Instagram account, while only 3% made a new account. Most participants agreed Twitter was used as a source to gather information about programs (84%) and learn about events (89%). Participants found SM most helpful for announcing event dates (71%) and highlighting resident social life (59%). Applicants did not match more highly on their rank lists if they used Twitter (P = .427) or Instagram (P = .166) and were not more likely to get more interviews if they used Twitter (P = .246) or Instagram (P = .114) CONCLUSION: Applicants found Twitter to be an important source of information through the virtual interview process. Despite the use of SM by most applicants, published content did not impact rank list decisions nor did SM engagement predict match outcomes.

Perspectives of Residency Applicants and Program Directors on the Role of Social Media in the 2021 Urology Residency Match.

OBJECTIVES: To perform a survey assessing the use of, attitudes towards, and perceived utility of social media (SoMe) in the 2021 urology residency match. METHODS: We distributed surveys to urology residency applicants and program directors (PDs) via the Urology Match 2021 Google Spreadsheet and email. The survey collected demographic information as well as SoMe activity, perceived pressure to use SoMe, match results, and attitudes regarding the utility of SoMe in the match process. RESULTS: A total of 108/528 (20%) applicants registered for the 2021 match and 61/142 (43%) PDs completed the survey. More applicants than PDs felt that SoMe helped them gain better insight into residency programs or applicants, respectively. Fewer applicants than PDs felt that SoMe activity provided a benefit to them in the match process. No significant relationship was found between SoMe viewing frequency, posting frequency, or tweetorial use with match outcomes. The majority of PDs believed that SoMe played a more important role in the 2021 match process than previous years while 15% and 12% reported that an applicant's SoMe activity helped or hurt the chances of matching to their program respectively. CONCLUSIONS: SoMe, particularly Twitter, was widely used in the 2021 match by both applicants and PDs. A majority of applicants and PDs believed that SoMe use aided them in some way in the match process, yet there was no relationship between the volume or type of applicant SoMe activity and match outcomes.

The Impact of the COVID-19 Pandemic on Urology Residents: a Narrative Review.

PURPOSE OF REVIEW: The COVID-19 pandemic brought unprecedented challenges for urology resident education. In this review, we discuss the pandemic's impact on urology trainees and their education. RECENT FINDINGS: Urology trainees were often redeployed to frontline services in unfamiliar clinical settings. Residents often experienced increased levels of stress, anxiety, and depression. Many programs instituted virtual "check-ins" and formed liaisons with mental health services to foster cohesiveness. Urology trainees experienced the integration of telehealth into the clinical realm. Virtual surgery lectures and simulations were utilized to augment surgical education. Academic governing bodies upheld resident protections and provided dynamic guidance for training requirement throughout the pandemic. Medical students were unable to participate in traditional in-person away rotations and interviews, complicating the residency application process. The COVID-19 pandemic shook the healthcare system and ushered in seismic changes for urology trainees worldwide. Though the longstanding effects of the pandemic remain to be seen, urology residents have demonstrated tremendous resilience and bravery throughout this challenging period, and those qualities will undeniably withstand the test of time.

#UroStream101: Social Media as a Medium for Mentorship in Urology.

OBJECTIVE: Show feasibility of and develop a program to provide mentorship for applicants to urology residency during COVID-19 using a virtual program, #UroStream101. METHODS: Urology resident volunteers were paired with fourth year medical students based on shared areas of urologic interest and geographic location. A mentorship guide was provided. Mentees were offered an opportunity to design a twitter based educational resource, tweetorial, with mentor supervision. Program success was assessed by participation and with MEMeQ, a validated mentorship assessment survey. RESULTS: A total of 111 students and 93 urology residents enlisted in #Urostream101. All AUA sections were represented. At time of enrollment, 19% (n = 21) of medical students lacked affiliation with urology department, 24% (n = 27) lacked urology mentors, and 32% (n = 36) had no formal clinical exposure to urology. Many students joined twitter during the application cycle (45% within 1 month of enrollment, n = 50) for solely professional reasons (71% of participants, n = 79). When asked their top priority in participating in #UroStream101, most students answered resident mentorship (61%, n = 68) followed by exposure to a geographically distant urology program (32%, n = 36). Twenty tweetorials were created spanning the breadth of urology. A total of 29 students (26%) completed the full MEMeQ evaluation survey, assessing a student's goals and satisfaction with mentor. Overall program satisfaction was 6.1/7 on Likert scale, "very satisfied." Students identified program selection and ERAS application assistance as their main goals. CONCLUSION: #UroStream101 was a successful mentorship program for students interested in urology. This was desperately needed during an atypical application cycle and provides invaluable insight into further development of formal mentorship programs.

The COVID-19 Residency Application Cycle Did Not Affect Geographic Dispersal Patterns Among Applicants Entering the Urology Match: A Quantitative Mapping Study.

OBJECTIVE: To assess whether pandemic-related restrictions with video-based interviewing increased geographic clustering of urology applicants matching at a residency program near where they were raised or attended medical school. MATERIALS AND METHODS: We utilized publicly available data from the urology match to compare dispersal patterns between applicants matching during the COVID-19 application cycle (2021) and those matching in the 5 prior application cycles (2016-2020). Variables included home state, undergraduate institution, medical school, and residency. Latitudes and longitudes were obtained for each institution and home state. The primary endpoint was distance (miles, as the most direct path) between medical school and residency program. We also assessed dispersal patterns by American Urological Association section. RESULTS: Of the 1965 applicants matching to a urology program between 2016 and 2021, medical school was identified for 1956 (99.7%) applicants, undergraduate program for 1551 (79%) applicants, and home state for 1351 (69%) applicants. Comparing the COVID-19 application cycle to the 5 prior application cycles, there was no significant difference in the median distance between medical school and residency, undergraduate university and residency, or home state and residency. Similarly, there was no significant difference in the proportion of applicants matching at their home institution, matching from medical schools without a home urology program, matching from medical schools with a historically low volume of urology applicants (<1 matched applicant per year), or matching from a D.O. CONCLUSION: Virtual interviewing and the loss of in-person clinical rotations did not significantly alter dispersal patterns or hamper an applicant's ability to match at program outside their geographic region.

The Virtual Urology Residency Match Process: Moving Beyond the Pandemic.

OBJECTIVES: To define applicant response to the 2021 Urology Residency Match Process in the COVID-19 Pandemic and to extrapolate lessons to optimize the urology resident selection process after the pandemic. METHODS: We emailed an anonymous, de-identified 22-question, multiple choice survey to all applicants to our institution for the 2021 Urology Residency Match, including a summary of the study with a survey link (RedCap). RESULTS: Of the 398 survey recipients, 144 responded (36%). Even if the match process were not limited by COVID-19, 39% of applicants thought interviews should remain in virtual format, 23% said "no," and 30% said "not sure." Nearly all applicants (97%) thought all interview offers should be released on the same day. Regarding the early match, 84% thought this should remain. When asked what factors had the most impact on rank lists, faculty and resident interviews were overwhelmingly favored. Open houses and resident "happy hours" were less important. Most applicants agreed that the faculty and resident interviews and informational talks were adequately replicated on the virtual platform. A majority of applicants (65%) spent under $2000 for the application cycle. CONCLUSION: The COVID-19 pandemic dramatically changed the urology match process. The faculty and resident interviews remained the most important factors in program ranking, and most applicants agreed those were adequately replicated in the virtual format. A plurality of applicants felt that the interview process should remain virtual in a post-COVID-19 environment. The virtual application cycle reduced the cost of applying to residency.