The worldwide urological community is heavily invested in the education of the next generation of urologists as evidenced by the abstracts presented on surgical education during the virtual AUA Annual Meeting in September 2021. A total of 75 abstracts were presented across the Podium Education Research I–V, Moderated Poster Education Research II and MP Education Research II sessions on numerous topics related to medical and urological education, training, and clinical practice. Significant themes emerged, including 1) process improvement and use of social media in the AUA/SAU (Society of Academic Urologists) Urology Match, 2) the effect of COVID-19 on clinical education, 3) implementation of surgical simulation and video surgical skills, and 4) trends in publications and scholarly activity with a focus on diversity, equity, and inclusion (DEI; see figure).

Within the theme of the AUA/SAU Urology Match, abstracts addressed bias reduction in letters of recommendation (LOR), program directors’ (PDs’) criteria in application selection, holistic review of applicants in the context of diversification of the workforce, and the evolving role of social media in the match process. Nabavizadeh et al evaluated 90 standardized LORs introduced to overcome ambiguity and bias in traditional LORs and found applicants were highly rated among top tiers despite the structured format and recommend further revisions to the structure and domains to distinguish between highly qualified urology applicants (MP12-08). Sidhu et al found the gender of the LOR author impacted the length and frequency of achieve and risk words in over 54 LORs written by letters of both genders (MP12-09). Women authors were more likely to write longer LORs and include more risk and achieve words. In the subtopic of criteria for interview selection and holistic application review, Alamiri et al surveyed U.S. PDs with a 49% response rate and determined that PDs value LORs, urology clerkship grades, research, and visa status as the most important factors in selection of applicants for interview (MP12-07). Nussbaum et al reported a 13% increase in underrepresented minorities as well as out-of-state applicants selected for interview with a comprehensive scoring tool based on attributes of manual dexterity, academic performance, research, leadership, resilience, and commitment to underserved populations (MP12-10).

Figure 1. Themes for surgical education research abstracts, AUA2021.

Ho et al surveyed applicants on use of social media and revealed a large proportion of applicants are using Twitter to connect directly with residents and faculty, make decisions about applying, interviewing, and ranking programs, certainly increased from the prior cycle (MP20-01). Ernst et al demonstrated that their novel structured mentorship “tweetorial” pilot paired 111 students with 93 residents to develop mentoring relationships as well as educational resources released thru social media (MP20-03). High levels of satisfaction were identified using a validated mentorship assessment survey and over 20 “tweetorials” covering a wide breadth of educational topics were published on Twitter.

Within the theme of COVID-19’s effect on surgical education, abstracts analyzed online didactics, virtual rotations, and burnout as the pandemic spurred challenge and innovation. Tuong et al analyzed the impact of the Urology Collaborative Online Video Didactic (COViD) lecture series created to supplement resident education by administering pre- and post-tests based on 5 lectures and found a significant overall increase in scores for those who watched 4–5 lectures without any difference by post-graduate year, showing short-term increased knowledge base (PD02-08). Whiles et al implemented a 2-week virtual interactive synchronous and individual learning rotation with self-reflective exercise amid pandemic restrictions on medical education (PD02-09). Post-rotation student evaluations were completed by 89% and 87% rated the experience as strongly positive. Johnstone et al administered the Maslach burnout inventory questionnaire to graduating chief residents at the time of the Canadian Urology examination skills test and found significant increase in emotional exhaustion and depersonalization scores comparing pre-pandemic and pandemic graduates (MP20-17). LeBlanc et al showed mean total volume on national case logs decreased during the 6-month period following March 2020 (PD24-05).

Within the theme of simulation, virtual reality and video data collection have been used to expand place and time limitations for learners. Leung et al demonstrated use of online virtual reality technology during a regional live cadaveric course where attendees used personal smartphones and headsets to observe procedures such as reimplant to provide real-time electronic immersive experiences (PD02-11). Vanstrum et al used the Delphi method to validate the content of dissection assessment for robotic technique specifically on the lymph node and seminal vesical dissection of robotic prostatectomy and found the process to be reproducible to differentiate between expert and trainee surgeons (PD02-01). Li et al surveyed trainees on feasibility of video data collection in the operating room as a means for objective surgical skills assessment and at a 23% response rate reported that 89% had no experience with their own operative skills being recorded but that 92% were receptive with limited concerns for their personal privacy or obtrusiveness, and that it would be more objective but should not be used for summative evaluation (MP12-05).

Within the theme of scholarship, trends for publication rates during and after training, academic writing assessed by gender and diversity and inclusion topics were studied. Johnson et al analyzed publication rates for residents and correlated this to academic scholarship after practice and a moderate positive correlation between the number of publications obtained during and after residency (MP20-12). Prunty et al analyzed publication records for an 18-year period of the 10 highest impact factor urology journals of over 59,000 articles and found the proportion of female authors increased, as did the female first authorship, but female senior authors did not have the same growth (MP20-14). Findlay et al analyzed the pipeline or racial and ethnic diversity of applicants to urology from 2016–2020 and found a 92% increase in Black applicants from 4% to 7% (37) of the pool, but despite this significant increase Black and Hispanic applicants remain underrepresented overall (MP12-13). Ghanney Simons et al surveyed all medical students at a single institution and found those underrepresented in medicine had interest in pursing a career in urology but lack role models, which may impact the pipeline of students choosing urology as a subspecialty (MP12-12).

As evidenced by these highlighted projects and many others, the urological community is deeply engaged in training and education, and the take home message is that despite the challenges of the pandemic and social inequity, urologists dedicate themselves to advancing and innovating in teaching and education.