You’ve just conquered a long and grueling urology residency. Now, you’re at a crossroads: do you dive straight into your professional career or do you take the plunge into a fellowship?

Take a Breather and Investigate

Before making any decisions, engage in self-reflection. A fellowship can significantly impact your career path and long-term career satisfaction, so consider your clinical experiences and interests. What aspects of urology light your fire? Which patient populations (adult, pediatric, gender-specific) do you most enjoy?

Research the Fellowship Options

Next, create a spreadsheet highlighting available programs. Look at the curriculum, faculty expertise, research opportunities, and reputation. Think about whether you want to focus on sharpening your surgical skills in a specific fellowship with the goal of later moving into private practice. Or perhaps you’re considering a fellowship as a way to dive into academic urology and delve into research within the field. The former fellowships are typically a year in length, whereas the latter fellowship may be 2 or 3 years. Keep in mind that if you’re passionate about research, choosing an academic fellowship would pave the way for your research career. On the other hand, if research isn’t your cup of tea, opting for research-oriented fellowships might not bring you satisfaction.

Use online resources, attend conferences, and network. If you are interested in a field, get involved in a related research project during residency. This allows you to understand the literature, spot knowledge gaps, and meet the big names. Plus, you’ll get a taste of the subspecialty’s culture to see if it makes sense for you. This last point is perhaps the most important, as you want to subspecialize in an area where you and the people in that field are very much sympatico. (A caveat: be sure to “taste everything in the candy shop” before you make this momentous decision.)

Find Your Yoda

Mentorship is gold. Seek advice from senior physicians or advisors. They have insights into the day-to-day realities of subspecialties, the application process, and available opportunities. They also serve as “power advocates,” whose recommendations have added impact. When seeking a mentor, look at the individual’s track record and speak to past mentees.

Breaking Down Fellowship Programs

There’s no one-size-fits-all. When choosing a fellowship program, consider both professional and personal factors. Here’s a guide to help you make the decision:

Self-Assessment: Start by evaluating your strengths, weaknesses, and interests. Take stock of what you are passionate about. What creates within you a sense of wonder or, indeed, thrills you? Where do you see yourself in 10 years?

Curriculum and Training: Investigate the curriculum and training offered by different fellowships in your chosen subspecialty. Look for comprehensive training, diverse clinical settings, advanced procedures, and robust research opportunities. Rank the program in terms of these characteristics and rank the importance of each aspect.

Lifestyle Factors: Consider the workload, call schedules, and types of surgeries in each program. Balancing professional commitments with personal priorities is crucial for long-term happiness and career satisfaction. Remember, the 80-hour work week no longer applies. Interview current and past fellows of any program to find out details.

Subspecialty Culture and Diversity: Evaluate the culture and diversity within the subspecialty. A supportive and inclusive environment is essential for professional growth and collaboration. Speak with the Chief Residents to gain information on the subspecialty and to better understand the culture of that institution. Along with your subspecialty mentors, you also will be working with the residents.

Career Outcomes: Research the career trajectories of past fellows. Be sure to speak to several people who have finished that program. Examine their postfellowship employment opportunities, academic achievements, leadership, and their current roles to better gauge the potential career benefits of each program.

Institutional Support: Assess the resources, facilities, and support services available. Access to cutting-edge technology and a supportive academic environment significantly enhance your experience.

Research Opportunities: Look at the research prospects and mentorship offered. Engaging in scholarly activities can enhance your skills and open doors to future leadership roles. However, if you have not done research thus far in your career, an academic fellowship may not serve your purposes. If you are seeking an academic career, carefully assess the laboratory facilities. Do they have a dedicated Urology laboratory for both basic science as well as bench-top and animal studies? Do they have access to a cadaver laboratory? Is there a training robot in the laboratory? Are there PhD mentors to guide research?

Program Resources and Facilities: Consider the resources each program provides, such as mentorship, surgical options and complexity, clinical skills training, mental health support, advanced technology, and research laboratories (vide supra).

Interview and Observation: As you narrow down your options, interview with the programs, observe their operations, and speak with faculty, former fellows, current fellows, and current Urology residents. Create a spreadsheet to map out each program and include notes and observations from each person.

Family and Geographic Considerations: Discuss your options with your partner and family and consider geographic and nonfellowship factors. Will your partner and family be happy? Review the salary and the cost of living in that area, making sure the 2 are in sync. Ensuring that your personal life aligns with your professional aspirations is key.

Ranking and Application: Carefully review the spreadsheet you have created and then rank the fellowship programs based on your values and long-term goals (Figure).

Trust Your Gut

In the end, you know yourself. Prioritize personal and professional fulfillment as you navigate this crucial choice. With thorough research, mentorship, and careful evaluation, you can embark on a rewarding journey that will set the stage for a successful and satisfying career in urology.

Acknowledgment

Special thanks to Dr Ralph Clayman, Dr Jaimie Landman, Dr Akhil Das, and Dr Yi Xi Wu for reviewing and providing insight to the article.