Introduction

Urology is a field made up of predominantly male physicians, with women representing only about 11% of practicing urologists.¹ However, female interest in the field of urology is rapidly increasing.^2,3 A significant proportion of female urology residents choose to pursue fellowship training. However, gender disparities exist among urological subspecialties. The subspecialties most frequently pursued by female urologists include FPMRS (urogynecology/female pelvic medicine and reconstructive surgery, 26%) and pediatric urology (21%). In contrast, female pursuit of fellowship training in subspecialties like endourology (5%) and robotic surgery (4%) is much less popular.⁴

Numerous studies have concluded that lack of same-sex mentors can discourage female medical students from choosing a specialty, especially in surgery. Conversely, female students who pursue a career in surgery are more likely to have had access to female surgical role models.^5-8 A recent survey-based study showed similar findings in the field of urology, demonstrating that the percentage of female urology faculty was significantly associated with the percentage of female urology applicants from a given medical school.⁹

While these studies provide evidence to support the importance of same-gender role models for encouraging female medical students to pursue surgical fields like urology, there are no studies that examine the role that same-gender mentorship plays in promoting female urology residents to enter certain urological subspecialties. Research investigating this relationship would provide valuable insight to prospective and current urology residents, fellows, core faculty mentors, as well as urology residency and fellowship program leadership across the United States.¹⁰

Results

Demographics

Ninety-two women urologists who have graduated or are currently completing fellowship training responded to our survey. The average age of participants was 39.3 years. Most respondents had graduated from fellowship (78%). Additional demographic data are summarized in Tables 1 and 3. The most heavily represented subspecialties were FPMRS (23%), pediatric urology (22%), and endourology (17%; Figure 1).

Table 1. Participant Demographics

Table 3. Mentor Demographics

Mentorship

Eighty-seven percent of respondents reported that they had a urologist mentor during residency, where 20% had 1, 27% had 2, 17% had 3, 6% had 4, and 30% had 5 or more mentors. Sixty-eight percent of respondents reported that they had access to a female urologist mentor during residency. Of the remaining respondents who did not have a mentor, 93% wish that they had. Respondents provided data on up to 3 of their most influential mentors’ demographics and most valuable characteristics (Table 2). The most commonly selected characteristics contributing to strong mentorship were teaching skills and enthusiasm (73%), ability to give valuable career advice (72%), excellent surgical skills (64%), and enthusiasm toward being a mentor (63%; Table 2).

Table 2. Responses to “What Characteristics Make This Individual a Strong Mentor?”

In addition, respondents rated each mentor on a scale of 1-3 in terms of how influential the mentor was on respondents’ choice of subspecialty. Mean influence ratings of male and female mentors were statistically similar (2.16 vs 2.18; P = .93).

Decisional factors

We asked participants to consider 11 factors and respond with how influential each factor was in their decision to pursue their chosen subspecialty. Average ratings of importance (on a scale from 1-6) for each factor are shown in Figure 2. The top 3 most important factors influencing subspecialty choice were the types of surgical cases performed, clinical and medical problems encountered within the specialty, and exposure to the subspecialty in residency.

Pigeonholing

We asked respondents to consider whether or not they had experienced “pigeonholing” during residency, which was defined in the survey as being directed, on the basis of gender, toward areas where contact with adult male patients would be lessened (e.g., toward female or pediatric patients).³ Twenty-two percent of respondents reported they experienced pigeonholing in residency, while 61% did not characterize their experience as such. Thirteen percent responded “maybe,” and 4% reported experiencing pigeonholing in practice post-fellowship or felt after becoming an attending, they were pigeonholed into practicing a subspecialty of urology that did not make full use of their training. Interestingly, those who did not experience pigeonholing were significantly less likely to believe they would have considered a different subspecialty if they had access to female mentors in other fields (P < 0.05).

Discussion and Limitations

The results of this survey demonstrate that most fellowship-trained female urologists had access to urologists they considered career mentors, both male and female, during residency. Nearly a third of respondents did not have access to a female mentor. Seventy-two percent of participants reported current Society of Women in Urology (SWIU) membership, however, they may not have been members during residency. Raising urology trainees’ awareness of SWIU may help facilitate networking for those looking for female mentorship.

Respondents provided useful data about which characteristics they thought contributed to strong mentorship, with the top three most frequently cited attributes being skilled and enthusiastic teaching, ability to provide valuable career advice, and excellent surgical skills. This feedback may be used to inform mentorship initiatives or workshops in urology training programs. Importantly, the reported influence that a mentor had on the respondent’s choice of subspecialty did not significantly differ between male and female mentors. This suggests that invested male and female mentors had a similar effect on subspecialty choice.

A majority of participants cited exposure to their subspecialty during residency as influential on their choice. Exposure to all subspecialty areas of urology during residency is integral for trainees to identify their interests and define their career goals. The practice of pigeonholing, however, serves as a threat to this process and was experienced by 22% of our sample. Moreover, women who did not experience pigeonholing were significantly less likely to believe they may have considered another fellowship. This suggests that trainees who experienced a broad exposure during residency felt confident, informed, and unrestricted in their choice of fellowship.

This study contains several limitations related to sampling and potential bias. While the number of female fellowship-trained urologists is growing, our sample size does not capture all fellowship trained women in urology. Subjects were recruited on Twitter and Facebook, which may result in a sample comprised of the urologists who use social media, some of which are younger. Increasing the sample size and distributing the survey to a wider audience may help to obtain a sample that is more representative of the population of fellowship-trained female urologists.

Conclusion

Overall, the field of urology has diversified over the last decade, with many more women choosing to enter the field. With this comes an increased need to understand how and why female urologists choose their subspecialty, and how and what kind of mentorship plays a role. Our data show that female urologists value committed mentorship by enthusiastic teachers, skilled surgeons, and individuals willing to provide career guidance, among other attributes, which can be accomplished by mentors of any gender. In addition, appropriate breadth of urologic training during residency appears to be associated with increased confidence in subspecialty career choice. This study has enhanced our understanding of which factors influence choice of subspecialty in female urologists; however, more research is needed to elucidate the strength of these associations. Further research on this topic would provide valuable insight to prospective and current urology residents, fellows, core faculty mentors, as well as urology residency and fellowship program leadership across the United States.¹⁰

If you are a woman in urology who is fellowship-trained or are currently completing a fellowship and would like to contribute to this project, please use the link below to take the survey: https://tinyurl.com/2p9zv7uh.