Urology residency programs in Canada are all accredited by the Royal College of Physicians and Surgeons of Canada. There are a total of 14 residency training programs in Canada, with the newest program (Northern Ontario School of Medicine University) matching its inaugural residents this upcoming residency match cycle. All urology residency programs in Canada are 5 years in length. Some programs offer a clinician-investigator program, where residents choose to further train in research opportunities, thereby extending their residency training. Over the last decade, an average of 30 spots per year are offered across the country for hopeful medical students wanting to match to urology training. The number of applicants varies anywhere from 45 to 75 for these 30 urology training spots.¹

One unique aspect about matching to urology residency in Canada is the small number of programs across the country. Prior to the COVID pandemic, medical students would often go on an “elective tour” across the country, visiting the different urology residency programs for 1 to 2 weeks at a time for elective rotations. Not only did this allow students to evaluate the residency programs, but it also allowed residency programs to assess prospective students. In Canada, clinical performance during these elective rotations is heavily prioritized by residency programs when selecting and ranking applicants for the urology residency match process. In fact, between 2018 and 2019, of the 61 total successful applicants to urology, only 1 matched without completing an elective in urology in their matched school.²

As one can imagine for any competitive specialty, students often ended up doing all of their elective time in urology (often exceeding 20 weeks) in hopes of matching to urology. Due to concerns of an imbalanced medical education, the Association of Faculties of Medicine of Canada introduced a policy in 2020 to limit the number of electives that students may undertake in 1 discipline, with the aim being to ensure a well-rounded medical education, as well as to permit consideration of multiple career options.³ With this policy change, as well as the COVID pandemic which did not allow for traveling electives, students and programs were faced with new challenges.⁴

Prior to the COVID pandemic, urology was also unique in Canada due to something called the “Urology Fair.” Urology is the only specialty in Canada that offers applicants a single-site, single-day fair to conduct residency application interviews. Prospective students used to travel to 1 major city in Canada and conduct their residency interviews for all urology residency programs in 1 weekend. This day, known as the “Canadian Urology Fair,” has been ongoing since 1994, when it was created to ease the financial burden for applicants and to minimize time away from medical training.⁵ Since the COVID pandemic, this fair has since transitioned to a virtual format, with all Canadian urology residency interviews taking place using an online platform over 1 weekend.⁶

Trainees in Canada are also offered several programs by the Canadian Urological Association, such as the Basic Science Course and Canadian Senior Urology Residents Annual Scientific Retreat. These courses provide teaching and also allow for networking opportunities with your co-trainees across the country. In addition to this, there are also numerous courses for senior residents preparing for their board exams, and these courses provide more opportunities to catch up with colleagues you may have met during the elective tour.

While attending the inaugural Global Residents Leadership Retreat (GRLR) at the 2023 AUA Annual Meeting, I had the opportunity to meet and connect with other urology trainees from across the US and the world. Aside from the expected differences in training length and medical school experiences, I was surprised to learn how few urology trainees across the world ‘needed’ to pursue fellowship. I say the word needed in quotations because in Canada it seems that trainees often pursue fellowship training more due to the job market rather than needing the extra training to be competent. Unlike the job market in the US and other countries, the job market for urologists in Canada is more limited. A study from 2017 by Hosier and Touma showed that 79% of graduating Canadian urology residents were planning fellowship training, and 58% rated the job market as “poor” or “very poor.”⁷ Anecdotally, when speaking with my co-trainees at the aforementioned review courses, of the ~30 of us, only 3 to 4 were going straight out to work, with the remaining residents all pursuing fellowship training. This difference in job market and the need to pursue additional fellowship training was one remarkable difference between training in urology in Canada vs the majority of the other countries’ representatives I spoke to during the GRLR.

During the GRLR, we were fortunate to listen to leaders in urology including Dr Margaret Pearle, Dr J. Brantley Thrasher, Dr Stephen Nakada, and Dr John Denstedt on their lessons on leadership. Undoubtedly, this session of the GRLR was the most valuable for me and my 40 other colleagues attending the retreat, and their talks left us humbled and inspired. Though the whole day was filled with lessons on leadership, one key message that particularly struck me and I routinely use now as a chief resident in my program is that of Dr Thrasher. The key message was that you should praise in public, but criticize in private. When he spoke those words, I replayed several instances over in my mind, instances from both my private and professional life, where the outcomes would have been much better if I had saved my criticisms for a private setting rather than public. Using this lesson in particular, I’ve learned that my team at work (resident cohort) typically functions better when I praise residents in public, but save the criticism for a private setting. Overall, attending the GRLR was a very valuable experience for me as it allowed me to connect with colleagues from around the world, provided me with lessons on leadership, and gave me fresh ideas on how to shape the future of urology in Canada.