The residency application process in 2020–2021 was significantly affected by the COVID-19 pandemic. As it became clear that travel and in-person meetings were restricted, the urology residency community restructured the application cycle. Medical students applying to urology reported concerns about decreased exposure to urology, difficulty learning about different programs and fewer opportunities to obtain letters of recommendation.¹

As a result of the limitations imposed by the pandemic, there have been significant adaptations to the application process. These include virtual subinternships, virtual open houses, increased social media presence, standardized interview invitation process, virtual interview format, decreased letter of recommendation requirement and delayed match date.

External subinternships typically play a major role in urological education. They provide a platform for students to learn foundational knowledge, strengthen their residency applications and evaluate their degree of “fit” with a program. For 2020–2021, in accordance with the Coalition for Physician Accountability, the Society of Academic Urologists (SAU) recommended deferring in-person external rotations, except for medical students who did not have a urology program at their home institution. Because of the lack of external rotations, the SAU decreased the required number of letters of recommendation to 2, rather than the traditional 3 or 4.

With guidance from the SAU, urology programs saw an opportunity to develop virtual subinternships that could meet many of the same objectives as the traditional rotations. The SAU formed a committee of academic urologists to develop a standardized curriculum for the virtual subinternship. There were 17 virtual subinternships listed on the SAU website, with 8 others listed on the UroResidency website and several more promoted on social media. These were a combination of 2-week and 4-week electives ranging from part-time to full-time commitments. Many were accredited by their institutions and were listed on student transcripts. They consisted largely of small group didactic sessions and self-directed learning. Several programs also incorporated technical skills training and allowed students to engage in surgical and/or clinical care using videoconferences. Other programs added research and online modules. Many required grand rounds presentations, group projects and reflective writing pieces.

While these virtual subinternships had the obvious limitation of lacking hands-on surgical training, they were able to achieve many of the other goals of traditional subinternships. Most importantly, the virtual didactic and clinical sessions were able to convey foundational urological knowledge to prepare for residency. Additionally, the virtual subinternships gave students the opportunity to demonstrate their abilities through presentations and other deliverables, providing a platform for programs to evaluate students in a manner similar to the traditional rotation. Through a variety of interactive sessions that showcased each department’s faculty and residents, students were exposed to the culture of the program. The interactive nature allowed these rotations to serve as “auditions” for students and programs to assess their compatibility and fit for a potential match. Students also had an opportunity to receive letters of recommendation from many of these subinternships that could strengthen their applications–a process that was largely standardized by the SAU committee.

Figure. Programs with virtual open houses and virtual subinternships.

Virtual subinternships have the advantage of eliminating the regional and financial biases that exist in the current system. Traditional subinternships impose a significant financial burden on medical students, who are already strained by educational debt as well as the other expenses of the residency application process. Virtual subinternships offer an alternative to make this process more accessible and less biased.

While virtual subinternships were offered by a minority of programs, many organizations held virtual sessions to showcase their program and get to know the medical students through town halls, open houses etc (see figure). The SAU and UroResidency websites listed a total of 105 programs that offered these virtual events, and there were likely more programs that were not listed. Some meetings had more of a lecture format that displayed the structure of the urology department and residency structure. Some meetings were more casual, with open question-and-answer sessions and/or happy hours with just the residents. Zoom has a breakout function that divides participants of a large meeting into many small sessions; these small sessions can be timed and then reverted back to the large group to then divide into different small groups again.

Social media and especially Twitter became very prevalent this year, both for the urology programs as well as applicants. The Twitter urology world previously was more research and clinically inclined. This year, many programs created residency-specific Twitter and Instagram accounts to offer a closer glimpse of the residents and residency programs, as well as posting pictures of residents, attendings and staff. Resident bios were more prevalent this year. Announcements were made online publicly. A number of Twitter accounts were created to help compile application resources and mentorship opportunities for students and programs, notably @UroResidency, @UrologyList, @Uro_Stream and @Uro_Res.

The interview invitation process is a potentially enduring part of this cycle’s restructuring. In years past, invitations were given on a random rolling schedule. Applicants waited for an email from the programs and had to respond within minutes to secure a spot. As other programs released interview invitations, students shuffled their interview schedules constantly. This past year, all invitations were sent out on Friday, November 6. Students had the weekend to decide which interviews to accept. Acceptances were due on Monday, November 9. This one cycle of interview invitations may be a method to keep for future application cycles. The interview dates were slightly delayed, ranging from November through January. The match date was similarly slightly delayed from mid January until early February.

Interviews were also recommended to be all virtual by the SAU. Traditionally, urology applicants met multiple people in the department separated into small groups (1 to 3 people). This translated readily to virtual interviews.

The urology match application cycle for 2020–2021 was significantly affected by the pandemic, with a transition to virtual learning, communication and networking. While it is unclear which of these changes will endure in future years, these modifications provide opportunities for permanent change to streamline the application process. The match was February 1. Congratulations to everyone; welcome to the urology world!