Applying to residency is a uniquely structured and competitive process of employment for medical trainees, and previous work has shown the interview process and development of match rank lists are not free from bias. Despite employment law prohibiting discrimination based on age, gender, sexual orientation, religion and disability, our study from the 2017 Urology Match revealed female applicants were more likely to encounter questions on these topics than their male counterparts. ¹ Other studies examining factors that may influence match rank lists have found that program communication with an applicant was associated with better odds of an applicant matching at that program. ^{2, 3}

To address match violations and to set a clear policy as done by the National Resident Match Program, the Society of Academic Urologists (SAU) and the American Urological Association published revised guidelines for the 2020 Urology Match. The guidelines state that programs should not ask an applicant to disclose names, specialties, geographic location or other identifying information about programs they may apply to, nor ask questions pertaining to age, gender, religion, sexual orientation and family status. After the interview is complete, programs are prohibited from contacting applicants for any reason and may not respond to contact initiated by an applicant. ⁴

Following the release of the 2020 Urology Match results, we sent applicants to our program an anonymous survey about restricted interview questions and post-interview contact. We hypothesized that in response to the new guidelines, applicants would encounter fewer restricted questions during interviews and there would be little to no program initiated contact after interviews compared to prior studies.

Surveys were sent to 361 applicants and 100 responses were received. Almost all respondents (98%) reported they had encountered at least 1 question in a restricted topic area. Female respondents were more likely to report they had encountered a personal question they felt was inappropriate compared to their male counterparts (50% vs 25%, p=0.01). Despite this, as of 3 months after the match not a single match violation had been reported by applicants to an anonymous portal administered by the SAU.

The most commonly encountered restricted interview topic was regarding other programs to which the applicant applied, reported by 95% of respondents, followed by current parental status, encountered by a third of respondents. Other restricted topics encountered by applicants included questions pertaining to their political preference (20%), intent to have children (18%), religious affiliation (11%), sexual orientation (3%), or preexisting condition/disability (1%).

Although there was no difference between genders in the frequency of encountering questions regarding parental status (31.8% females vs 33.9% males, p=0.82), female respondents were significantly more likely to be questioned on their intent to have children (27.3% vs 10.7%, p=0.032). Female applicants were also more likely to be asked about other programs to which they applied (100% vs 91%, p=0.04). There were no differences between genders among other aforementioned restricted topics.

Compared to previous work suggesting that up to 60% of applicants were contacted by a program post-interview, ^{2, 3} our study encouragingly showed a significant reduction in program initiated post-interview contact. Only 2% of survey respondents reported unsolicited contact by a program following an interview, and no respondents reported receiving match commitments. Although program initiated contact was infrequent, the majority of respondents (70%) initiated contact with programs after an interview. Following applicant initiated contact, more than half of applicants (54%) received responses from programs.

Our results indicate that there is an ongoing need to reduce bias and discrimination and to educate urology interviewers on employment law. Despite restrictions prohibiting programs from asking applicants about age, religion, political preferences, intent to have children, sexual orientation, and disability, 36% of participants in this study reported being asked a question that they considered inappropriate, unchanged from our study of the 2017 application cycle, in which 35% of respondents reported encountering inappropriate questions.

To minimize bias, programs should require all interviewers to participate in implicit bias training and consider using standard interview templates that include a series of nonrestricted questions for interviewers to ask all applicants, strategies shown to decrease bias in interviews. Program directors and faculty interviewers should review the Association of American Medical Colleges Best Practices for Conducting Residency Program Interviews. It may also be helpful to include a list of restricted topics at the top of applicant evaluation forms provided to interviewers.

At a minimum, this study highlights the continued need for program directors to ensure interviewers review and adhere to the Urology Match Guidelines. Urology applicants continue to be asked questions that violate employment law during residency interviews, and female applicants are asked these questions at a significantly higher rate than male applicants. For our field to truly move forward in diversity and equity, ongoing biases such as these must be condemned and corrected. We are hopeful that current efforts by such initiatives as Urologists for Equity ⁵ and by the SAU itself will result in such progress.