I am not envious of today’s urology residency applicant. An increasingly competitive field, combined with a plethora of residency programs, lends itself to potential decisional regret on the part of both the applicant and residency program. Moreover, many applicants who go unmatched are likely excellent candidates, yet face uncertain futures. While many repeat the process the following year, there is no guarantee of matching the second time around. The ranking process is therefore critical, as it sets the foundation for the residents’ training and future professional development. For urological residency programs, the selection process should assess not only the applicants’ knowledge and skills that are germane to the field, but also their ability to apply this knowledge in practical situations. In the age of rapid-fire virtual interviews, each lasting between 10 and 12 minutes, assessing a candidate’s fit for a particular program may seem like an imperfect and sometimes arbitrary exercise.

While the vast majority of today’s applicants are excellent candidates and each residency program has its unique strengths, the top ranked candidate may not be ideally suited for the number 1 program. Rather, a paradigm shift is unfolding where preciously limited interview time is optimized so that the right candidate is matched with right program. The process should endeavor to find the best fit for both parties. This is where domain (also known as skill)-based interviews are an emerging and useful tool in the selection process of urology residency programs.

Domain-based interviews are structured and seek to assess an applicant’s knowledge and skills in a specific field of study or practice. In the context of a urology residency program, a domain-based interview evaluates the applicant’s knowledge and skills related to the demands and required skill set of a surgical field.

The interview consists of a set of questions that are designed to assess the applicant’s knowledge and abilities in areas such as anatomy, surgical procedures, patient management, and ethical considerations. At Rutgers New Jersey Medical School, we devised 5 domains that were felt to best represent the pedigree that is generally sought:

1. Academic productivity and performance
2. Urological experiences in clerkship and interaction with specific patient populations
3. Fit for the program (generally assigned to the chief residents)
4. Interpersonal skills and conflict resolution
5. Manual dexterity skills, including hobbies, sports, instruments, etc

Each interviewer is assigned a single domain and conducts each interview by asking standardized questions related to their domain. The questions are designed to elicit information about the applicant’s skill sets and their ability to apply this knowledge in practical situations. Domain-based interviews have been shown to be reliable and valid measures of knowledge and skills. The structured format of the interview, as well as the use of standardized questions, while perhaps repetitive, allows for valid response comparisons.¹ After each domain-based interview, the applicant is given a score (1.0-4.0) by the interviewer. Scores for each candidate are tallied for each domain to create a preliminary rank list.

There are several advantages of domain-based interviews. Not only do they reliably elicit an applicant’s knowledge and skills in a specific domain, they do so economically and maximize preciously limited interview time. In contrast, other selection methods such as open-ended interviews may duplicate questions among different interviewers within the same program that are not necessarily helpful to the ranking process. Open-ended interviews may not provide a comprehensive assessment of an applicant’s knowledge and skills, as they rely on the interviewer’s subjective judgment.² Furthermore, we seek to minimize the “halo effect”—as an applicant’s charm or ability to interview well compared to their peers may not necessarily predict for success in residency and beyond.³ Domain-based interviews may also compartmentalize and minimize a particular weakness in a specific domain. A candidate with a lower score in one domain may be very strong in the aggregate, and a more complete picture emerges with each domain score. The same applicant may perform poorly in an open-ended interview format, where they may be queried more narrowly and not given the opportunity to reveal their true potential as a urology trainee.

While many may find this process cold and mechanical, leaders in the field of industrial psychology have successfully utilized these methods for years. As much as we do not wish to admit, human intuition is a poor judge when compared to standardized, domain-based interview techniques.

Incredibly, research has shown that domain-based interviews are more predictive of future job performance compared to other selection methods, such as personality tests or biographical information.⁴

In addition to the reliability and validity of domain-based interviews, they are more efficient and cost-effective compared to other selection methods. The structured format of the interview allows for a more streamlined selection process, as the questions can be predetermined and easily scored. This reduces the time and resources required to assess the applicants and enables programs to efficiently make informed decisions.⁵

A secondary advantage of domain-based interviews is their ability to assess the applicant’s ability to think critically and apply their knowledge in practical situations. The questions in a domain-based interview are additionally designed to assess the applicant’s problem-solving abilities and to think on their feet. This is particularly important for a residency program in urology, as the field requires not only knowledge of the subject matter but also the ability to make decisions quickly and effectively in high-pressure situations.

Lastly, domain-based interviews rely on trust among faculty. By assigning each faculty interviewer to a particular domain, there is little to no overlap in interview questions, meaning that each faculty reports their respective domain-based findings of a given applicant to the group. Unique knowledge is then gained from each interviewer during the round table discussion with their fellow faculty members, leading to a cumulative score.

Despite the advantages of domain-based interviews, it is important to acknowledge that they should not be the sole selection method used in a urology residency program. We recommend that domain-based interviews be used in conjunction with other selection methods, such as reference letters and performance evaluations, to provide a comprehensive assessment of the applicant.

Additionally, the use of multiple ranking methods can help reduce the potential for bias in the selection process and ensure that the most suitable candidates are prioritized.¹

Since introducing domain-based interviews at Rutgers New Jersey Medical School in 2021, we have successfully matched our top-ranked candidates in both cycles (number 1 and number 2 in 2021, and number 1 and number 3 in 2022). This reflects the mutual fit that emerged from our interview process, and we are confident that these residents will thrive in our program.