The R Frank Jones Urology Interest Group: An Intentional and Strategic Pipeline Program to Increase Diversity in Urology

Analyzing the Current State and Visibility of Diversity, Equity, and Inclusion Initiatives at Urology Residency Programs

OBJECTIVE

To analyze AUA urology residency program websites to determine visibility of diversity, equity, and inclusion (DEI) initiatives. There is growing interest in DEI initiatives by urology applicants, and in recent years, urology programs have invested in efforts to promote DEI.

METHODS

All ACGME-accredited urology residency program with a website were assessed. Military programs were excluded. A DEI Score Card was developed using published pillars of DEI, including five domains: departmental inclusion, pipeline growth, departmental education, community engagement, and faculty demographics. Program Doximity rank, address, and surrounding demographics were collected to determine predictors of investing in DEI.

RESULTS

One hundred forty-one urology residency websites were included for analysis. Only 40.7% of programs referenced DEI on their webpage, and 21.4% offered funded mentorship opportunities. Department education and community engagement were the least popular initiatives. The Western, Northeastern, and North Central sections had the highest DEI total score with wide variation across domains. Mention of DEI was not associated with program's county-level social vulnerability or percent minority but was associated with being a top 50 program (OR=4.0; 95% CI 1.8, 8.9; P = .0007).

CONCLUSION

Less than half of academic urology programs' websites referenced DEI initiatives. Using a DEI score card, our study shows that investment in DEI varies widely by AUA section, and greater investment is positively correlated with program rank. Our DEI score card serves as a tool that programs can use to assess their current DEI investment, identify areas for improvement, and ensure existing initiatives are visible to applicants.

Diversity in Urology, Are We Moving in the Right Direction?: Analysis of American Urologic Association Urology Residency Match Statistics 2019-2023

Analysis of the urology match statistics provides a window into the future of the urology workforce. Match statistics from 2019 to 2023 were analyzed to determine whether the efforts to promote diversity in 2020 have been impactful. The popularity in the field of urology among all racial/ethnic groups peaked interest in application in 2022. However despite an increase in URIM applicants over the last 5 years, 2023 URM applicants have 1/3 the odds of matching into urology as white applicants.

Perceived Barriers Among Underrepresented and Historically Marginalized Medical Students Pursuing a Career in Urology

OBJECTIVE

To assess perceived barriers to pursuing urology among medical students and to determine if marginalized groups identified greater challenges to entry.

METHODS

The Deans of all New York medical schools were asked to disseminate a survey to their students. The survey collected demographic information to identify underrepresented minorities, students of low socioeconomic background, and lesbian, gay, bisexual, transgender, queer, intersex, and asexual individuals. Students were asked to rate various survey items on a five-point Likert scale to determine which factors were perceived as barriers to applying to urology residency. Student t tests and ANOVA were used to compare mean Likert ratings between groups.

RESULTS

A total of 256 students responded to the survey from 47% of medical institutions. Underrepresented minorities students cited lack of evident diversity within the field as a more significant barrier than counterparts (3.2 vs 2.7, P= .025). Lesbian, gay, bisexual, transgender, queer, intersex, and asexual students perceived the lack of evident diversity within urology (3.1 vs 2.65, P = .01), exclusivity of the field (3.73 vs 3.29, P = .04), and fear that residency programs would have negative perceptions of them as students (3.0 vs 2.1, P < .0001) as substantial obstacles compared to peers. Students with childhood household incomes less than $40,000 cited socioeconomic concerns as a higher barrier compared to students with household incomes greater than $40,000 (3.2 vs 2.3, P = .001).

CONCLUSION

Underrepresented and historically marginalized students perceive more significant barriers to pursuing urology than their peers. Urology training programs must continue to foster an inclusive environment to recruit prospective students from already marginalized groups.

The Revolving Door of Residency: Predictors of Residency Attrition for Urology Matriculants Between 2001 and 2016

OBJECTIVE

To add to the literature which has reported higher attrition rates amongst General Surgery residents who identify as female or underrepresented in medicine (URM), we aimed to determine how these factors contribute to attrition within Urology. We hypothesized that women and URM Urology residents will similarly have higher attrition rates.

METHODS

The Association of American Medical Colleges surveyed residents to obtain matriculation and attrition status from 2001 to 2016. Data included demographics, medical school type, and specialty. A multivariable logistic regression model was performed to identify predictors of attrition amongst Urology residents.

RESULTS

In our sample of 4321 Urology residents, 22.5% were female, 9.9% were URM, 25.8% were older than 30 years, 2.5% were Doctor of Osteopathic Medicine graduates and 4.7% were International Medical Graduates. On multivariable analysis, being female (Odds ratio [OR] = 2.3, P < .001) was associated with increased residency attrition when compared to male residents. Additionally, residents who matriculated between 30 and 39 years old (OR = 1.9, P < .001) or ≥40 years old (OR = 10.7, P < .001) had an increased risk of residency attrition when compared to residents who matriculated between 26 and 29 years old. Attrition rates for URM trainees have recently increased.

CONCLUSION

Women, older, and URM Urology residents experience higher rates of attrition compared to their peers. It is essential to identify trainees with a higher likelihood of attrition to determine system-level changes to combat departures from training programs. Our study highlights the need to foster more inclusive training environments and change institutional cultures to diversify the surgical workforce.

Applying Representation Quotient Methodology to Racial, Ethnic, and Gender Trends of Applicants and Matriculants to Urology Residency Programs From 2010-2018

OBJECTIVE

To accurately examine the trends in the racial and gender composition of medical students applying and matriculating to urology residency programs.

METHODS

Reports on race/ethnicity and gender for medical school graduates, and urology residency applicants and matriculants were obtained for years 2010-2018. The proportions of individuals representing different racial and gender identities among urology applicants and matriculants were divided by a denominator of their proportion in medical school graduating classes to produce representation quotients (RQ_app and RQ_mat, respectively). Linear regression models were performed on yearly RQs to estimate the RQ changes over time. Nonparametric testing was used to evaluate for differences in applicant to matriculant representation within each identity. ANOVA was performed separately on RQ_app and RQ_mat values to assess differences in representation between identities in the applicant and matriculant populations.

RESULTS

Asian men experienced increases in representation among urology applicants (RQ_app: slope 2.04 × 10^-2; P = .03) and matriculants (RQ_mat slope: 7.46 × 10^-2; P = .0076) during the study period. Black men trended towards under-representation among applicants (RQ_app slope -1.51 × 10^-1; P = .03) and matriculants (RQ_mat slope: -1.71 × 10^-1; P = .02). When examining genders, both men (RQ_app=1.43 vs RQ_mat=1.44; P = .80) and women (RQ_app=0.52 vs RQ_mat = 0.51; P = .67) had unchanged representation in the applicant and matriculant cohorts, but women severely underrepresented on average.

CONCLUSIONS

Women and Black men are underrepresented in the urology workforce. These concerning findings demonstrate the dire need for initiatives regarding recruitment into urology to support and to ensure successful entry into the field for minority groups.

Interventions Associated With Racial and Ethnic Diversity in US Graduate Medical Education: A Scoping Review

IMPORTANCE

Racially and ethnically minoritized individuals remain underrepresented in graduate medical education relative to their proportion in the population. While many programs and initiatives have been developed to address this problem, there is little consensus regarding strategies that work to improve representation across specialties.

OBJECTIVE

To examine and synthesize evidence-based practices that have been used to increase the proportions of underrepresented in medicine (URiM) trainees at US residency and fellowship programs.

EVIDENCE REVIEW

The authors searched PubMed, Google Scholar, Embase, PsycInfo, ERIC, Cochrane Reviews, Cochrane Trials, CINAHL, Scopus, and PROSPERO electronic databases to identify relevant studies published through January 2022. They screened all titles and abstracts for relevance and read full-text articles to identify articles reporting reliable data describing the outcomes of interventions to improve racial and ethnic diversity among trainees.

FINDINGS

Twenty-seven articles were included in this review. Two studies reported on fellowship programs. The most common interventions included holistic review (48%), decreased emphasis on United States Medical Licensing Examination Step 1 scores (48%), and explicit institutional messaging regarding the importance of diversity (37%). A combination of interventions was associated with an increased number of URiM applicants, interviewees, and matriculants across various medical and surgical specialties.

CONCLUSIONS AND RELEVANCE

In this scoping review, approaches and interventions associated with increased diversity in residency and fellowship programs were identified. Continued efforts are necessary to sustain such efforts and assess long-term outcomes.

A Review of Mentorship in Urology: Are We Satisfied?

PURPOSE OF REVIEW

To evaluate the state of mentorship in the field of urology.

RECENT FINDINGS

Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured. Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.