Research years (RYs) are increasingly common among medical students pursuing competitive specialties. In a nationwide survey of 115 medical schools, 8% of this year’s matched applicants completed a RY.¹ Successful applicants to all but one of the surgical subspecialties surpassed this average, with matched urology applicants nearly doubling it at 14%. Research has historically been an important component of a strong urology residency application, and nearly 50% of program directors identify publications as “extremely important” in the selection process.²

As the number of applications received by urology residency programs continues to rise and students struggle to differentiate themselves, research experience may grow in perceived importance. The COVID-19 pandemic is causing unprecedented disturbances to medical education, threatening traditionally important aspects of residency applications such as visiting student rotations and letters of recommendation (LORs).³ As a result, research may play an even larger role in upcoming application cycles.

Despite their rising popularity, no recent reports exist on medical students’ involvement in yearlong urology research programs. Here, we discuss the current relevance, benefits and risks of taking a urology RY. We then outline the challenges facing both applicants and programs as RY popularity rises, and provide recommendations to ensure their continued success.

Current State of Research Years in Urology

Urology has long valued research, and over time it has emerged as a means for students to demonstrate their committed interest in the field.² A growing number are choosing to dedicate an entire year to urology research, perhaps in response to increased competition for residency positions.⁴ Between 2019 and 2020, the number of matched applicants in urology who completed a RY rose by 55%, compared to just 17% across all specialties.¹ Continued growth is likely as the United States Medical Licensing Examination® (USMLE®) Step 1 moves to pass/fail scoring and program directors shift their attention to alternative criteria in differentiating applicants.^2,3

This year, the COVID-19 pandemic has brought additional challenges and uncertainties to the urology match. Restrictions on clinical activities, visiting student rotations and interviews have begun to accrue, upending the traditional application process.³ In response, some students have suggested taking a RY to delay their timeline and avoid the current match cycle. Those in favor express desires to complete USMLE Step 2 examinations, assess programs in person prior to ranking them and trade an unpredictable match for next year’s return to status quo.

The American Urological Association (AUA) has yet to issue an official statement; however, other specialties such as dermatology and ophthalmology advise their applicants against this strategy, arguing that a RY should only be pursued if one’s interest preceded the pandemic. These positions are challenging, and accepting one without genuine enthusiasm may lead to burnout. Insufficient productivity can reflect poorly, ultimately weakening the student’s residency application.⁴ Furthermore, each additional year of training reduces career earning potential by $200,000.

Still, fear of going unmatched may drive more students to pursue a RY despite advice against doing so.⁴ In survey data of 78 urology applicants shared publicly on a commonly used online spreadsheet, 45% indicated their interest in a RY had changed due to COVID-related academic policies and uncertainty. Of these, 86% were now more interested in completing a RY, with 60% indicating that avoiding the current application cycle was their primary motivation. Given these findings, a discussion of the risks and benefits informing a student’s decision is warranted.

Students can reap profound benefits from a RY, gaining unrivaled exposure to the field of urology above and beyond that of a typical clerkship. Both committed and contemplating students may benefit from the experience and the time it offers for specialty interests to be considered and clarified amid structured mentorship.⁴ Successful participants develop research skills, publish manuscripts and further define their career goals while obtaining strong LORs. Thus, a productive RY can significantly bolster the strength of a student’s urology residency application while demonstrating genuine commitment to the field.

Residency programs enjoy complementary benefits in offering RY positions. Motivated students can rapidly move projects from inception to completion and catalyze productivity across the urology department. Additionally, programs gain the opportunity to longitudinally assess a student’s fit with their department and urology as a whole.

However, RYs are not without their risks. Students may take on significant financial burden if a position is unpaid or underfunded. In focusing on narrow research interests, they may inadvertently neglect broader medical knowledge and skills needed on their return to clinical training. Students dedicating a year to research are expected to have substantial output, and failing to demonstrate productivity may jeopardize LORs and taint one’s residency application. Programs take on equivalent risk, potentially wasting time and resources if a student does not perform at the level expected.

As urology RYs continue to grow in popularity, current challenges for both students and programs will concurrently grow in magnitude. While many academic urology departments may be willing to take on motivated students for a RY, the number of well advertised opportunities remains small. Without a comprehensive list of available RY positions, applicants often struggle to find opportunities.⁵ This decentralized process leaves interested students without a position and willing programs without a student. Ultimately, most students apply to the same few known programs, inflating their competitiveness, while leaving the majority undiscovered.

Recommendations

Interest in RYs is already on the rise, and academic changes like pass/fail USMLE Step 1 scoring and responses to COVID-19 are set to further expand the role research plays in upcoming urology matches.³ To improve the RY experience for both students and programs, we propose several means to address current challenges and concerns.

Students interested in a urology RY can seek opportunities beyond those advertised online. Defining one’s motivations and interests is crucial; next, ask local urologists for help connecting with potential mentors nationwide. In assessing opportunities, gather information about ongoing projects, clinical opportunities and funding prior to making a decision. Due to COVID-19, inquiring about institutional policies affecting research activities is also imperative. Further, despite increased uncertainty during this application cycle, we recommend against pursuing a RY solely to delay one’s match as the risks noted previously may outweigh the benefits.⁴

Next, we encourage the development of a centralized opportunity list and application process specific to urology. Existing repositories by the Association of American Medical Colleges (AAMC) and individual schools are challenging to locate and remain outdated and incomplete for urology positions. Thus, the AUA might consider maintaining a web page with detailed information regarding all active RY opportunities, analogous to those currently available for urology vacancies and job openings. A dedicated, standardized list would improve accessibility and clarity for students seeking positions. A more involved approach could implement an application portal, akin to that of the National Institutes of Health’s postbaccalaureate Intramural Research Training Award (IRTA) program, for programs to identify candidates. Ultimately, a centralized solution would reduce redundant effort, increase efficiency and lessen applicants’ biases toward established programs. As a result, better holistic matching between RY programs and interested applicants could be achieved.

Until these challenges can be addressed, both programs and applicants will continue to struggle amid rising interest in urology RYs. These positions offer immense benefits to both parties yet also entail risks that must be carefully considered, especially during these unprecedented current academic conditions. Centralization of the urology RY application process is a promising opportunity to improve both efficiency and fairness for all those involved.