National Implementation of a Virtual Subinternship in Urology

ABSTRACT

Introduction & Objective: In-person subinternships for visiting medical students were discouraged during the COVID-19 pandemic. The Society of Academic Urologists (SAU) endorsed virtual subinternships in urology (vSIU) and provided all institutions with a standardized vSIU Guidebook containing a structured curriculum and curated resources. We sought to evaluate the successes and limitations of the vSIU at a national level. Methods: In December 2020, we sent anonymous surveys via email to all medical students who submitted applications to the urology residency match and to all urology residency program directors (PDs) and associate PDs on the SAU email list. Surveys evaluated goals, curriculum composition, satisfaction, and future reusability. Outcomes were evaluated on a 5-point Likert scale. Results: A total of 162 students (30%) and 78 PDs (48%) completed the survey, including 76 students (47%) and 32 PDs (41%) who participated in vSIU at 29 institutions. Of these electives, 66% were 1-2 weeks in duration, 48% were full-time, and 76% utilized the SAU guidebook. Electives consisted of a wide range of curricular elements (Figure). The most important goals for both students and PDs were experiencing/demonstrating program culture and evaluating whether the program/student are a good fit (≥ 50% rated ''extremely important''). These goals were achieved by >80% of students and PDs. Overall, 79% of students and 78% of PDs rated the vSIU ''excellent'' or ''very good.'' On multivariable ordinal logistic regression, duration ≥3 weeks and class size ≤4 students were associated with higher student ratings (p < 0.05). Full-time electives, class size ≤4 students, and utilization of the SAU guidebook were associated with higher PD ratings (p < 0.05). Although the majority of respondents found the vSIU less effective overall than in-person subinternships, 46% of students and 66% of PDs recommended incorporating virtual components into future electives. Conclusions: Amid a global pandemic, the vSIU was a successful nationwide initiative to provide virtual urological education to medical students. Though the vSIU should not replace in-person subinternships, the electives were highly rated and achieved the most important goals for students and PDs. The most successful courses were full-time, longer, had smaller class sizes and utilized the SAU Guidebook.