In a little over a year, I will become my program’s fifth graduating resident. The unique opportunity to take part in the initial growth of a residency training program has led me to reflect on some of the positive features of this growth. In sharing my experience, I hope to contribute to conversations on resident education and promote collaboration between urology residencies for the betterment of all our training programs.

Culture Is Crucial

I cannot overstate the value of culture in a residency program. Although difficult to define, I think good culture in residency is mutual support between learners and educators, both personally and professionally. This is often thought of, and can occur, in a top-down manner. Program faculty and leadership can set a positive tone, but what I have found equally crucial in a new residency program is the power of residents to contribute to culture. Do you stay late when there is an opportunity to help? Do you take extra time to teach a junior resident or medical student? Do you support your coresidents outside of the hospital? If so, you are building a positive culture at your residency. Your coresidents and faculty will notice, and eventually follow suit.

Open to Opportunities

Throughout residency, there are many people you will work with—program coordinators, nursing staff, PhD faculty, and others—who want to contribute to your education. These supportive relationships can create opportunities that will enrich your residency experience. This became clear to me in our program by working with our many advanced practice providers (APPs). Before our residency program started, they assisted with consults, bedside assisting, weekend rounding, and call nights. As our residency has grown, we have been learning to integrate resident and APP responsibilities, and increasingly can champion APP involvement in resident education. In our experience, APPs have facilitated early opportunities in the operating room and have provided strategic call coverage for events like graduation and a resident retreat weekend. This creates space for self-directed resident education and helps tilt the scales of service vs education. Within our program, opportunities created by our APPs have been integral to both education and wellness. Your program may look quite different, but I encourage you to appreciate the unique resources available to you and engage them early to amplify their contribution to your residency experience.

Growth Mindset

Inertia develops in any organization as patterns develop. Eventually things happen because it’s “the way it’s always been done.” In the early years of the residency, we haven’t run into this inertia so much as we’ve watched it settle in. This real-time vantage point has led me to appreciate the intentionality and energy needed to pursue growth and combat inertia. Without willingness to seek feedback, embrace change, and learn from failure, meaningful growth will rarely occur. We’ve instituted biannual town halls with residents and program leadership to ensure that these growth-oriented conversations have a dedicated space. Whether rotation schedules, journal club, or buying protective lead for residents, we have seen many changes and improvements born of this initiative. If something is the way it’s always been, it may be time for a change.

As residents and fellows, we can celebrate the breadth of excellent urology training programs. Even so, we should constantly look for ways to improve our own residency experience and the experience of others. Residency works best with active participation, and I hope these reflections have encouraged you to maximize your own. I would also love to hear the positive experiences at your program that we should adopt here! Send me an email: samuel.ivan@atriumhealth.org.