Monday, December 15, 2014

Application Season for Urology Residency: What to look for in a resident? A residency program?

Each year, medical students around the country apply for a position in a residency program. Urology is an extremely competitive "match" process in which each applicants submits a rank list of programs they would prefer to train. In turn, each program submits a rank list of the applicants they would prefer. In the end, a computer algorithm matches applicants and programs. In 2014, 534 applicants registered for 285 positions in 118 urology programs around the country. Of those 534, 446 participated in the match. Approximately 75% of the applicants are men. Interestingly, men and women have the same match rate – approximately 65%.


THE INTERVIEW TRAIL

The application process can be an exciting and brutal process for resident applicants. Applicants have the opportunity to travel around the country, meet a variety of urologists in a variety of settings, and learn a tremendous amount about the field. Practically, most graduating medical students seeking a residency in urology apply to between 30 and 40 programs. On average, they participate in 12 interviews (range 8-15) over a 20 day (14-30) period. Interview-related expenses (mostly travel-related) are approximately $4,000 ($2,000-5,200) per applicant, averaging out to be approximately $330 per interview.[1]



At the Brady Urological Institute at Johns Hopkins in 2014, 260 applications were submitted for review (national average is 253 applications). Of those 260 applicants, we selected 39 (15%) for interviews and accept 3 (1.2% of applicants to the Brady, 0.5% of all applicants) to continue on as residents.

 

THE INTERVIEW PROCESS

Each urology program conducts their selection and interview process in an independent fashion that suits their needs. Programs can vary by the number of residents they accept on a yearly basis (between one and five), number of faculty, clinical (patient) volume and areas of focus or expertise; geographic location as well as urban or rural hospital and number of hospitals; patient population, and academic versus clinically-focused program.

The Brady Urological Institute, located in Baltimore City, Maryland, graduates three residents per year. Residents are trained in a three hospital settings: the Johns Hopkins Hospital, the Johns Hopkins Bayview Medical Center, and the Johns Hopkins Children's Center. Residents are trained by a large, clinically and academically-productive faculty. While the Brady is most well-known for the treatment of urologic oncology, the faculty is composed of experts in sexual medicine, infertility, stone disease, endourology, robotic surgery, reconstructive urology, female and neurourology in both adult and pediatric populations.


Misop Han, MD. Program Director
of the Brady Residency Program.
The Brady holds two interview days for applicants, typically at the end of November or early December. The night before the interview applicants are invited to dinner with current residents (preceded by "happy hour" with the faculty). Interestingly, most resident applicants find the time with the residents to be the most important interview day activity – highlighting the "feel" of the program given off by interacting with current residents.[2] Therefore a dedicated dinner away from faculty, allows both resident applicants and residents to get a good feel for each other in a pressure-free environment.


The applicants are invited to a breakfast with the faculty, which is followed by Grand Rounds. The Grand Rounds topic is typically a senior resident presenting the summation of their lab year of research. Following Grand Rounds, Misop Han, MD and Program Director of the Urology Program, gives a general overview of the program followed by Dr. Patrick C. Walsh's "A Brief History of Urology at Hopkins" – a perennial applicant favorite. From there the applicants are interviewed by the majority of the faculty, usually in pairs. In a survey, most medical students indicated they preferred from 5-7 faculty interviews throughout the course of a work-day.[2] While respondents of this survey indicated that interviewing with more than one faculty member at a time would be "intimidating," we have excellent feedback from our applicants about our "teamed" approach to applicant interviews. Participants recognize that meeting with two faculty at a time allows them to meet more faculty and often provides contrasting interview styles that generates a more comfortable discussion and understanding of the applicant.


CHOOSING A RESIDENT

There is much more art than science to picking a good residency class. Performance as a surgical intern has been shown to predict future "excellence" as a urology resident.[3] And while higher applicant rank and better letters of recommendation are more common for "excellent" residents, determining the quality of resident from medical school performance can be challenging.


H. Ballentine Carter, MD
Each program may have different criteria for selecting incoming residents based on their identity and needs. Some programs rely more heavily on clinical acumen while some focus on academic productivity. At the Brady, we are looking for future leaders of the field. First, we are looking for pleasant and reliable people with whom to work. The relationship between faculty and resident requires an incredible amount of trust, as residents are often entrusted to "care" for a faculty members' patients to varying degrees. Dr. H. Ballentine Carter, MD makes the summation, "First, a nice person that would be enjoyable to work with, someone who has good communication skills. Secondly, a track record of academic excellence, not necessarily basic science record."


Arthur L. Burnett, MD
While academic productivity prior to residency is not a requisite, Dr. Arthur L. Burnett, MD explains, "The best residency applicant is one who shows commitment to excellence and aspires to make meaningful contributions in urology. A track record of accomplishment suggests who this person is." Urology residents who write more papers during residency have greater academic "productivity" following graduation – however, there is no data on medical students.[4]




Lastly, enthusiasm, initiative and drive are important qualities. "Whether they share your exact academic interests or not, the best residents and mentees are the ones who are enthusiastic about their interests – it's easy to guide them to success, while trying to motivate the unmotivated is difficult," says Phillip M. Pierorazio, MD.

 

CHOOSING A PROGRAM

Similarly, choosing a program is also more art than science and choosing a program is an incredibly individualized process. There are many wonderful training programs in urology around the country – most applicants will be highly successful at a variety of those programs. There are certainly factors that play a role that should be considered. We recommend each applicant create their own "deal-breakers" and consider how any combination of the following factors may contribute to their professional development.

  • Clinical Volume: How busy are the faculty? How busy are the residents? The feeling is always that more surgery leads to better training, but that is not always the case. Some students learn better in volume, some with a more focused, mentored approach. Certainly considering the volume of specialty cases is important for someone considering a career in subspecialty care (i.e. oncology, female urology, etc.). However, urology is certainly a surgical specialty and resident operative experience is consistently among the highest ranked criteria by applicants.[2]
  • Perceived Strength of Faculty: These are your teachers and mentors. How well do they teach and mentor? How well do you think you will get along with them?
  • Academic Productivity: Some programs are incredibly academically focused and productive; others pride themselves on excellent clinical and patient care.
  • Vision of the Program/Vision of the Chairman: where is the program now and where is it going? Residency training is either five or six years. Things can change over that time, considering the trajectory of the program over a given time is important.
  • Geography: Urban versus rural setting? Nearness to family or support structure? Good for families or a young, professional population for single residents? Consider the proximity to arts, leisure and travel which are important "escapes" from residency.
  • Resident Life: Are the residents married? Single? With children? How many per year? Do they get along? Your co-residents do not need to be your best friends, but you do need to work with them for many years.
  • Five or Six Years: 70% of residents want to participate in research or scholarly activity, however only 33.5% preferred or are indifferent to a dedicated year of research. 76% preferred to do a year of research in fellowship.[5] However, greater research time during residency is associated with more publications, and a greater number of publications during residency is associated with future academic productivity.[4]
Number of Publications as related to Months of Research.  From Yang et al [4].
  • Specialty Hospitals: Veterans Association (VA) and Children's Hospitals offer unique opportunities for residency training.


 

When selecting a program for residency, these criteria should be considered and prioritized by each applicant. It may offer an improved framework, from which to create a rank-list. Advice from faculty at the Brady includes:

"First, a talented faculty with broad experience and views. Second, a strong research program in place for those interested in academics."
H. Ballentine Carter, MD


"An excellent residency training program provides quality role models and mentors in diverse academic areas foremost and opportunities to develop one's expertise and knowledge."

Arthur L. Burnett, MD


 

As interview season is wrapping up we wish all residency applicants good luck and we look forward to meeting our future residents!

 


 

[1] Kerfoot BP, Asher KP, McCullough DL. Financial and educational costs of the residency interview process for urology applicants. Urology. 2008 Jun;71(6):990-4. doi: 10.1016/j.urology.2007.11.102. Epub 2008 Mar 4.
[2] Jacobs JC, Guralnick ML, Sandlow JI, Langenstroer P, Begun FP, See WA, O'Connor RC. Senior medical student opinions regarding the ideal urology interview day. J Surg Educ. 2014 Nov-Dec;71(6):878-82. doi: 10.1016/j.jsurg.2014.05.009. Epub 2014 Jun 26.
[3] Grewal SG, Yeung LS, Brandes SB. Predictors of success in a urology residency program. J Surg Educ. 2013 Jan-Feb;70(1):138-43. doi: 10.1016/j.jsurg.2012.06.015. Epub 2012 Aug 2.
[4] Yang G, Zaid UB, Erickson BA, Blaschko SD, Carroll PR, Breyer BN. Urology resident publication output and its relationship to future academic achievement. J Urol. 2011 Feb;185(2):642-6. doi: 10.1016/j.juro.2010.09.097. Epub 2010 Dec 18.
[5] Peyton CC, Badlani GH. Dedicated research time in urology residency: current status. Urology. 2014 Apr;83(4):719-24. doi: 10.1016/j.urology.2013.09.072. Epub 2014 Feb 5.

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