Traditionally, urological residency training involves gradually acquiring surgical skills and clinical decision-making with increased autonomy. Additionally, research rotations and manuscript writing have been at the forefront of many residency programs to help trainees learn the skills necessary to comprehend scientific literature and practice evidence-based medicine. More recently, there has been support and recognition for the importance of resident leadership and advocacy.¹ The contemporary perspectives of trainees are essential to help guide the interests of the future urology workforce and improve patient care.

Mentorship

As underrepresented in medicine (URiM) trainees continue entering urology training programs, ongoing participation by residents and faculty in mentorship and sponsorship events is important. Mentorship can range from formal relationships to informal virtual interactions and role modeling. Based on 2019 ACGME (Accreditation Council for Graduate Medical Education) data, Black and Latinx women represented only 0.6% and 0.5% of urologists, respectively.² According to the 2021 AUA Census, 5.2% and 8.4% of residents identified as Black and Hispanic, respectively.³ In 2018, the Association of American Medical Colleges reported that 5.8% of physicians and 3.2% of medical faculty identified as Latinx.⁴ Visibility of residents, particularly URiM trainees, is important to support peers and improve the diversity in urology and academic medicine. URiM trainees taking the road less traveled by pursuing urology may not be accustomed to having mentors or sponsors.⁵ Therefore, it is important to provide resident peer support and to be intentional about seeking guidance from faculty. Mentors can also be faculty from other urology programs who can diversify trainees’ clinical, research, and academic experiences.

Although it may be more comfortable for mentees to receive guidance from gender- or race-congruent mentors due to established cultural understandings, it is important to have a growth mindset and be open to different ideas. Cross-cultural or -gender mentorship relationships may reveal more common ground between mentees and mentors than initially anticipated. Most importantly, openly discussing any assumptions or perceived stereotypes is important. A team of mentors to complement residents’ needs throughout their different stages of academic training is important.⁶ “Paying it forward” is a meaningful practice that residents can engage in by guiding other residents and medical students. Resident opportunities to provide and receive mentorship are available via Urology Unbound, Latinx In Urology, the Latino Medical Student Association, the Student National Medical Association, and UReTER (Underrepresented Trainees Entering Residency) organizations.

Research

Similar to mentorship, research collaborators can be sought at residents’ primary institutions or external organizations. Yang et al found that resident publication rates during training correlated with early faculty career publication rates.⁷ Increased scholarly output was related to pursuing fellowship training and an academic career.⁷ Washington et al previously found that 11% of URiM urologists remain in academic careers compared to 24% of non-URiM urologists.⁸ Even if trainees are unsure if they want to pursue fellowship training or establish a career in academics, participating in research allows residents to address important scientific questions and advance the field of urology. Additionally, research involvement fosters relationships with academically established mentors and younger medical students. With long resident hours and competing demands for time, research often must be completed during nights and weekends, especially with variability in the protected research time training programs offer. The benefits of completing projects and generating data are rewarding and can result in opportunities to present at national scientific meetings and network with colleagues. Van Leeuwen et al found that urology residents’ participation in patient safety and quality improvement is lower than other medical trainees.⁹ AQUA (the AUA Quality Registry) is an excellent resource for trainees interested in investigating national benchmarks and quality measures. Many subspecialty organizations offer resident research travel awards, such as SUFU (the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) and SMSNA (the Sexual Medicine Society of North America). SUFU also offers an immersive didactic-based resident preceptorship program, and SMSNA also provides opportunities for prosthetic courses. The AUA has invested efforts toward supporting investigators from diverse communities by funding research projects through the LEAD (Leadership in Education, Achievement, and Diversity) Program.

Leadership

Beyond mentorship and research, trainees can engage in various AUA committees and leadership roles designed for resident representatives. During the recent AUA2023 scientific meeting, the AUA launched the Global Residents Leadership Retreat, which included 21 domestic and 20 international residents. The Society of Women in Urology also offers 2 resident representative positions. Residency programs can also support trainees to engage in lobbying by attending the Annual Urology Advocacy Summit. Additionally, trainees can participate in the Residents and Fellows committee and within their respective regional section leadership. For residents with interests in global surgery and volunteerism, there are opportunities via the International Volunteers in Urology organization.

Although residency training is finite, the subsequent career that follows is longer lasting. It is never too early or too late to get involved in opportunities that can foster skills and growth, and improve patient care. Demonstrating passion and dedication as a resident can result in many possibilities for participation within the AUA.