Figure. Vanderbilt Urology Class of 2023. Top row, left to right: Abimbola Ayangbesan, Rohan G. Bhalla. Bottom row, left to right: George E. Koch, Jacob E. Tallman.

A lifelong commitment to medicine and surgery extends far beyond the confines of the hospital. It is an all-encompassing role as a physician, researcher, educator, coach, colleague, and family member that aims to lead us towards the discovery of purpose and fulfillment in our careers. Throughout medical training, we develop the necessary skills and emotional intelligence required to become lifelong learners. The successes and turmoil of residency refines these skills and pushes us to grow not only as physicians, but also as individuals.

At its forefront, residency is a dedication towards providing the highest level of patient care. While we acquire many attributes during training, it is the medical knowledge, bedside manner, adaptability, teamwork, and high ethical standards that propel us forward. These skills become habits that stay with us for the rest of our careers as we nurture a lifelong commitment to our patients. Residency, however, is full of highs and lows. With the minutia and endless tasks, it can be easy to lose sight of what initially inspired us to pursue medicine. Finding personal meaning and fulfillment in our work is the key to establishing lifelong success and, ultimately, preventing burnout.¹ It is because of our humbling patient encounters that we devote time towards continued improvement by integrating new medical advancements, practices, and surgical techniques.²

In addition to personal experiences, residents often learn the meaning of lifelong commitment by observing their mentors in daily practice. Mentorship is a catalyst for a lifelong devotion to excellence in medicine. A seasoned mentor is a passionate coach that provides wisdom and models integrity and ethical practices, all the while cultivating a supportive environment for residents to develop their clinical and technical skills. Over time, residents aspire to emulate the characteristics of their mentors in future clinical practice and, ultimately, develop a commitment to mentoring others. Mentorship is a mutually beneficial relationship. Mentors often gain as much as mentees from their relationship and cite satisfaction from watching their mentees succeed, follow in their footsteps, or even surpass their own achievements. Residency programs should prioritize identifying mentors for residents that align with their personal and professional goals as it helps establish an early, healthy habit of surrounding oneself with experienced support.

Mentorship is the investment of time and energy into educating future generations of physicians. A commitment to education during residency encourages residents to develop a sustainable framework to stay up to date on medical advances, to critically review primary literature, and to effectively communicate complex concepts to learners, colleagues, and patients and their families. Although residency is a time for residents to educate themselves and strengthen their own medical knowledge, it is just as important for residents to become educators themselves. Teaching fosters a culture of scholarship and lifelong commitment to trainees. It comes in various modalities, can be formal or informal, and can span all levels of training from an attending guiding a resident through a surgical dissection, a senior resident explaining the evidence behind clinical decision-making on rounds, or an intern teaching suturing technique to medical students in a simulation lab. Residency programs should encourage informal peer-to-peer education by teaching residents basic education models, such as the 1-minute preceptor, that can be incorporated into daily practice.³

A major component of growth during residency is learning from our complications. Complications, unfortunately, are an inevitable part of medicine. A lifelong commitment towards bettering ourselves often stems from our clinical outcomes, both positive and negative. Many of us can vividly recall our “morbidity and mortality” conferences in residency. It is not only how we cope with and take responsibility for these complications but, more importantly, how we learn from them to decrease the risks for our future patients. Early and frequent resident involvement in quality improvement conferences like morbidity and mortality provides opportunities for personal and professional growth that can be sustained over an entire career.

The remaining pillars that inspire a lifelong commitment are research and service to others. Scholarly activities allow residents to challenge the dogma, generate intellectual conversations, encourage critical thinking, and push the field forward by advancing how we practice medicine. Volunteering and dedicating time to serving both the local and global communities provides a unique perspective on health care disparities and the unmet needs of vulnerable populations. This experience fosters empathy, compassion, and a commitment to advocating for health equity and, more importantly, understanding and confronting inequities in daily practice. Residents can engage in global health through organizations like IVUmed (International Volunteers in Urology) or serving underresourced local communities through their residency programs, local free clinics, or sectional organizations. Residency programs should actively support and encourage these activities through dedicated health equity and global health rotations, grants to support travel and research, and faculty-led involvement in both.

Recent AUA and Accreditation Council for Graduate Medical Education census data project a significant shortage of urologists in the coming decades and an alarming rate of burnout amongst us.^4,5 These data highlight the critical importance of fostering a lifelong commitment during training now more than ever. While for many urologists their career is just a job rather than a calling, there are data to suggest that greater investment in a career in medicine is associated with decreased risk of burnout.⁶ Residency is a formative time both clinically and personally. Harnessing this time to build a foundation of lifelong commitment to patient care, mentorship, education, research, and service can propel young urologists towards a balanced and successful career (Figure).