Urology is one of the most competitive medical specialties. Earning acceptance to an accredited urology program in the U.S. generally requires strong clinical performance in urology clerkships, impactful letters of recommendation from well-known urologists, good USMLE (United States Medical Licensing Examination) scores, and research experiences.^1-3 Factors like having a home urology program with an established urology research infrastructure provide benefits to prospective urology applicants, including dedicated research opportunities and curated mentorship that helps students navigate the arduous match process.⁴ The demographic breakdown of top medical schools with research institutions is unclear; however, medical schools that accept larger proportions of underrepresented in medicine (URM) students, such as international, osteopathic, and HBCU (historically black college and university) medical schools, generally do not have affiliated urology programs compared with their allopathic counterparts.⁵ And with the Accreditation Council for Graduate Medical Education merger in 2020, then the pass/fail criteria implemented with USMLE Step 1 scores, school name recognition and ranking may factor more when programs review applications.^6,7 These circumstances contribute to challenges URM candidates face at lesser-known institutions that can negatively affect applicants matching into urology residency programs.^4-6

Historically, urology residency programs and departments have had low representation of URM trainees and faculty. As recently as 2019, less than 9% of urology residents identified as Black or Hispanic.⁷ In 2019, urology had among the lowest proportion of URM trainees.⁸ This trend, as of 2021, has led to only 321 (2.4%) and 584 (4.4%) of the 13,790 total U.S. practicing urologists identifying as Black or Hispanic, respectively.⁸ In 2022, the urology match was 66%; 58% of applicants that matched ethnically identified as partially or entirely Black/African American. Similarly, 41% of applicants matched that ethnically identified as partially or entirely Hispanic/Latino/Spanish origin. This compared to 69% and 65% of matched applicants that ethnically identified as partially or entirely Asian or White, respectively. Development of research experiences for students at unranked institutions without home programs may address this gap in the urology workforce as urology research remains an important component in earning a residency position.

In response to this need, programs like the University of Washington (UW) have crafted virtual research experiences that support students from URM backgrounds or from institutions that are less resourced in urology and urology research. This program at UW consists of regular meetings to review research opportunities, sponsorship, clinical skill development, and mentorship through medical school, residency, and post-training. Beyond work on a dedicated research project, discussions focused on career development include preparation of a resume/curriculum vitae or personal statement, selection of external sub-internships, and additional research training. The Table highlights general points of emphasis that can be incorporated into meetings to facilitate productive and fruitful mentor/mentee relationships. These points help to keep each party engaged and accountable throughout the experience, while fostering lasting, genuine connections. However, formal institutional backing is a necessity for these types of programs that will provide financial support for the program mentees and the program’s infrastructure. Because this is an ad hoc program, students are required to connect with a dedicated team of mentors, often through informal connections.

Table. Points of Emphasis During Hybrid Mentorship Meetings

As a fourth-year medical student at Philadelphia College of Osteopathic Medicine, I relied heavily on making those informal connections because my institution does not have a home urology program. Those connections established my network of urology mentors across the U.S. One of my first experiences in urology came during my third-year urology clerkship, where I was the first assist for a stone case. After weeks of gaining the attending’s trust, I was permitted to help with most of the case. The independence and confidence I felt during that procedure made me immediately know this was the field of medicine I must pursue. After coming to this realization, I made considerable efforts to find urologists of color via networks like Tristate Black Men in Medicine in Philadelphia. After meeting a urologic oncology fellow at Temple University, I was introduced to urology faculty at UW that same year. Since then, those gentlemen have been instrumental in navigating the match process—providing me with research opportunities, career planning, and mentorship for the last almost 2 years. Their letters of recommendation were pivotal in my being accepted as the inaugural research fellow at SUNY Downstate in Brooklyn, New York, where I have further expanded my network of amazing urology mentors. Fortunately, urology has emerging resources that can make informal research experiences like the UW virtual mentored research experience more formal.

A few examples of such resources include Urology Unbound, which conducts annual urology bootcamps that support research and career development for URM medical students that can create connections between institutions lacking innate research resources with training programs capable to support medical student research. Urology departments within the University of California system initiated a hybrid, longitudinal research and mentorship program intended for first-year medical students interested in urology who matriculated at institutions without a home program.⁸ Finally, the Michigan Urology Academy is a 2-day workshop that similarly supports development of competitive applications, and expand on topics including research, mentorship, and professional development. Aligning these efforts with individualized mentorship plans can support extensions of these research experiences, further building the portfolio of URM students. Ultimately, this can result in presentations at scientific meetings like the AUA Annual Meeting and manuscript publications in various urological journals.

A diverse workforce is necessary to optimize patient care. Comprehensive mentorship initiatives targeting URM students can help alleviate the disparities in the urology workforce. Early urology exposure and intentional mentorship may be key to increasing URM interest and retention in urology and urology research.