Each year, the AUA releases its Annual Census report, highlighting data on American and international urologists, residents and fellow trainees, and advanced practice providers. These comprehensive reports provide insight into trends, including geographical distribution, demographic characteristics, and urology practice patterns.¹ Since 2019, medical students have been included in the Census. Our recent publication in Urology Practice^® is the first to examine medical students’ responses to the AUA Annual Census, and it revealed several important findings about female applicants, underrepresented in medicine (URiM) applicants, and COVID’s effects on applicants.²

Survey participants included 149 student AUA members who expressed interest in applying to urology in the future. Thirty-six participants (24%) identified as female and 19 (13%) identified as URiM. Students were asked about reasons they might apply into urology, and the most common responses included surgical procedures (93%), “good lifestyle” among surgical careers (85%), direct patient care (84%), and cutting-edge technology (81%). Compared to the pre-COVID period (2019), a greater proportion of students during the pandemic era (2020-2021) cited cutting-edge technology (90.1% vs 73.1%, P = .008) and surgical procedures (98.6% vs 87.2%, P = .008) as reasons for applying into urology. The most common reasons students noted for potentially not applying to urology included competitiveness (48%), lifestyle concerns (26%), and difficult/long residency (22%). Female and URiM students expressed concern over the combined “male dominated/gender discrimination/lack of diversity” aspect (female 33% vs male 3%, P < .001; URiM 25% vs non-URiM 7%, P = .04; Table).

Table. Factors and Their Level of Importance in Deciding to Apply Into Urology, by Gender and Underrepresented in Medicine Status

Examination of students’ reasons for potentially not applying into urology are equally important as their reasons for interest in the field. Medical students represent the core of the urology pipeline. By understanding students’ preferences, particularly their interests and concerns related to urology, mentors can strengthen their connections with mentees and equip students with better-informed insights into future career paths. Neglecting the perspectives of students who ultimately choose paths outside of urology fails to allow us to identify issues that may deter highly capable individuals from entering the field.

Consider 2 particularly insightful findings from our study: First, a notable number of students hold misconceptions about the lifestyle of practicing urologists; and second, female and URiM students express concerns related to gender discrimination and/or the lack of diversity in urology. These are real challenges that need to be recognized in order for mentors and urology programs to recruit the best and brightest students. If a female student receives support from their mentor in academic pursuits and research but harbors unaddressed concerns about gender discrimination, the field of urology risks losing a potentially outstanding candidate. Similarly, if a medical student progresses through their education with a misguided perception of urology’s lifestyle, only to discover during acting internships that their perceptions were inaccurate, they face the challenge of pivoting their career choice at a late stage. A mentor well-versed in these aspects might have provided better guidance, encouraging exploration of alternative career paths.

Our study also provided insights into the evolution of student responses between the pre-COVID period (2019) and the pandemic era (2020-2021). Surprisingly, more students cited surgical procedures and cutting-edge technology as reasons they would pursue urology. We considered possible reasons for this shift. The pandemic significantly limited medical student involvement in direct patient care, with many rotations transitioning to observational or virtual experiences, minimizing patient-facing exposure.³ We feel that these experiences may have provided less fulfillment for students in direct patient-facing care, prompting many to reconsider and place heavier emphasis on specialties with surgical components, such as urology. Additionally, the transition to virtual learning during COVID exposed students to exciting virtual sessions, providing insights into various urological procedures and technologies they might not have encountered in person.⁴ Regardless of the rationale, it is evident that emphasizing the procedural and innovative aspects of urology early in students’ medical careers is crucial to fostering early interest in the field.

Ultimately, we hope that our findings will pave the way for future studies to better understand the pipeline of medical students entering urology. In the future, we plan to delve into additional topics that remained unexplored in our current work, such as the levels of anticipated debt reported by students upon graduation and how this factor might influence their decision to pursue a career with what many would perceive to be a longer training path.

In the meantime, our hope is that our findings stimulate discussions and inspire mentors to engage in meaningful conversations with their student mentees. We feel that these discussions will not only cultivate interest in the field but also address concerns related to urology. This presents an exciting opportunity to increase the representation of nontraditional and underrepresented students in the field of urology moving forward.

Acknowledgments

We thank William Meeks from the AUA for his assistance with this paper.