Current status of uro-oncology training during urology residency and the need for fellowship programs: An international questionnaire study

Investigation of Disparity of Urologic Fellowship Match Rates by Gender and US Versus International Medical Graduates Over the Past Decade

OBJECTIVE

To investigate the influence of postgraduate medical education (US vs. international) and gender on applicant matching for postgraduate training across different urologic sub-specialties.

METHODS

Match statistics of five societies that participated in the AUA fellowship match between 2010-2024 were retrospectively reviewed. Societies included: Endourology Society (EUS), Society for Urological oncology (SUO), American Society of Andrology (AMA), Society of Genitourinary Reconstructive Surgeons (GURS), and Society of Pediatric Urology (SPU). Candidates were classified based on gender (male/female) and their postgraduate medical education: local graduates from the United States or Canada (US/Ca) and international medical graduates (IMG). The match odds were analyzed using the Chi-square test, while trends were assessed through the Mann-Kendall test.

RESULTS

Overall, 2429 applicants applied for 1627 programs from 2010 to 2024, comprising 1998 males (81.8%), 399 females (16.4%), and 42 undisclosed (1.7%). There were 1486 US/Ca graduates (60.8%) and 953 IMGs (39.2%). 1471 (60.6%) applicants were matched with a program, compared to 958 (39.4%) unmatched. The likelihood of US/Ca graduates matching (83.8%) was significantly higher than IMGs (23.3%), OR = 17.5, 95% CI: (14.3, 21.5), p < 0.001. IMGs had the highest match rate with GURS (33.8%, 47/118) and the lowest with SPU (7%, 1/14). Female applicants had a significantly higher chance of matching 324/399 (81.2%) than male applicants 1139/1998 (57%), OR = 3.26, 95% CI: (2.5, 4.3), p < 0.001. US/Ca-to-IMGs ratios and the male-to-female ratios were stable throughout the match years.

CONCLUSIONS

Compared to IMGs, U.S./Ca graduates had remarkably higher matching rates. Matching outcomes were also significantly better for female applicants. Further assessment of international involvement and diversity in urological subspecialty roles is warranted.

The Association of Trainee Involvement in Radical Cystectomy With Perioperative and Oncologic Outcomes

OBJECTIVE

To assess the impact of trainee involvement in surgery on perioperative and oncological outcomes of patients undergoing radical cystectomy (RC).

MATERIALS AND METHODS

We reviewed the records of patients undergoing RC for urothelial carcinoma between 2000 and 2015 at our institution. Trainee level was categorized as fellow, chief, senior and junior residents. Demographic, perioperative and oncological outcomes were recorded and compared between the groups. Specifically, operative time, 30-day complications, severe complications (Clavien III-V) and oncological outcomes (overall, cancer-specific and recurrence-free survival) were assessed.

RESULTS

A total of 895 patients were included for study. On multivariable analysis, operative times were 30-40 minutes longer in procedures assisted by junior residents as compared to more senior trainees. Notably, trainee level was not associated with overall or severe complications on multivariable analyses. Similarly, trainee level was not associated with oncologic outcomes.

CONCLUSION

While cases assisted by junior residents had longer operative times, complication rates and oncological outcomes were comparable across trainee groups. Trainee level does not appear to have an impact on perioperative and oncological outcomes of RC for urothelial carcinoma.