The AUA Match process is one of the most selective in medicine, and urology continues to be a highly desired specialty with increasing competitiveness. Given the growing competitiveness of the AUA Match, urology applicants need to identify the factors that contribute to a successful match. While it is widely accepted that residency application selection criteria, such as United States Medical Licensing Examination board scores, research publications, and recommendations, contribute to one’s success in the Urology Match, there is limited research on the characteristics of medical schools that produce urology residents.¹

An analysis of the medical school characteristics of 1814 urology residents from the 2016 to 2021 urology resident cohort revealed that the presence of a home urology program was the single most significant factor in predicting the percentage of graduates who become urology residents.¹ Given that the presence of a home urology program confers such substantial benefits to urology applicants, this article aims to increase awareness of the barriers and obstacles faced by students without a home urology program. Additionally, we highlight the Aliabadi-Kazim Scholars Program (AKSP), which aims to provide first- and second-year medical students without a home urology program early exposure to the field and has a broader commitment to increase diversity, equity, and inclusion in urology.

Challenges Faced By Medical Students Without a Home Urology Program

Medical students who apply to urology and attend an institution without a home urology program are at a disadvantage compared to their peers attending institutions with a home urology program. They face challenges such as reduced awareness of urology as a specialty and approachability of mentors within the field. In a competitive specialty like urology, mentors are crucial in guiding students throughout research projects, endeavors to improve competitiveness and residency applications.² Moreover, students with home programs have access to their institution’s urology subinternship, which provides an opportunity for a more in-depth urology experience without the challenges of needing to travel and increased costs of away rotations. According to a survey of 64 applicants for the 2020 AUA Match, the median cost per applicant was $9725, with some costs reaching as high as $12,564.³ Applicants without a home urology program are more likely to complete 3 or more away rotations, which can cost thousands of additional dollars. However, research has shown that doing more than 3 away rotations does not necessarily increase the number of interview invitations received by applicants.⁴

Furthermore, medical students are encouraged to attend their home department’s didactic conferences or grand rounds, as familiarity with the department and academic urologists is helpful during subinternships.⁵ Consequently, medical students who do not have the advantages of a home urology program may be unable to compensate with external experiences due to lack of access, limited connections to department faculty, and cost-prohibitive away rotations. Finally, it is important to note that for some medical schools, students have the highest chance of matching at their home program.⁵

AKSP

The Urology Department at the University of Minnesota stands out among other programs for its proactive efforts to promote diversity and equal access in the field of urology. Recognizing the need to provide early exposure to medical students who lack a home urology residency program, Dr Christopher Warlick and the department established AKSP in 2022. This immersive program offers a fully funded weeklong experience, encompassing clinical and operating room observations across various subspecialties, as well as research exposure, professional development opportunities, and education on the Urology Match process (Figures 1-6). The program also establishes long-term relationships with its participants. This is achieved by emphasizing an ongoing open-door policy for guidance and advice, research opportunities, and quarterly group check-ins. Table 1 contains direct quotes of student experiences, and Table 2 shows survey results from program participants.

Table 1. Aliabadi-Kazim Scholars Program Participant Experiences

Table 2. Results From Likert-Scale Survey of Aliabadi-Kazim Scholars Program Participants

Figure 1. Ibaad Khan, MS-II, participating in surgical skills training on the da Vinci Surgical System.

Figure 2. Dr Christopher Warlick (left) guiding Bebe Eke, OMS-III (right), in the excision of a tumor on a kidney model using the da Vinci Surgical System.

Figure 3. Talmadge Gaither, MS-II, participating in a ureteroscopy simulation guided by University of Minnesota resident.

Figure 4. Jameshisa Alexander, MS-II, participating in a holmium laser enucleation of the prostate simulation.

Figure 5. Jasmin Banton, Aline Hoang, and Bebe Eke (left to right) in between observing surgical cases.

Figure 6. Aliabadi-Kazim Scholars Program 2023 cohort group photo.

Thus far, there have been 2 AKSP cohorts, and through a meticulous selection process, they select up to 10 first- and second-year medical students from across the nation with the aim of igniting their passion for urology and providing them with an in-depth understanding of the field. The program targets first- and second-year students to ensure they have time over the subsequent 1 to 2 years to take the steps required to be competitive urology applicants. Feedback from participants in the program suggest it is having a significant positive impact (Tables 1 and 2). In line with their commitment to promoting diversity and inclusivity, AKSP strongly encourages applications from women and students underrepresented in medicine. This commitment to increase diversity, equity, and inclusion efforts in urology is essential, as the 2022 AUA Census shows that only 2.2% of practicing urologists identify as African American and 4.9% as Hispanic. While female urologist representation has risen to 11.6%, there is still a clear gap between the demographics of urologists and that of the general population. Increasing diversity in the field will help ensure optimal care and comfort for all urology patients.

Another program deserving of mention is the University of California (UC)–wide Integrative Research Program, pioneered by Dr Yahir Santiago-Lastra of UC San Diego Department of Urology, which offers 1 to 2 students a year without a home urology program the opportunity to participate in clinical experiences and research for 6 to 8 weeks at a UC urology department, with a stipend. Programs like this and the AKSP are critical for students who cannot attend institutions with a home urology program, as they provide students with the resources, guidance, and support necessary to enhance their chances of matching successfully into urology.

The Necessity of Future Initiatives

For aspiring physicians without mentors or family members in medicine, selecting a medical school with an affiliated residency program may not be within their purview. For this reason, urology pipeline programs that target high school and college students are needed. Such programs can help students make informed decisions about which medical school program will best suit their potential needs.

In the meantime, it is our hope that the success of AKSP inspires other urology programs to commit to supporting students without home urology programs and to promote diversity and inclusivity in the field.