Prior to the participating in the Global Resident Leadership Retreat (GRLR), I had little knowledge of international urology training. Outside of a surgical mission trip to India in January 2023, I had never interacted with residents from other countries. I have always viewed the AUA Annual Meeting as an opportunity to network and gain new insight into the latest research and clinical practice developments; however, participation in the GRLR would serve as a unique forum to interact with residents from across the world and gain a new perspective on leadership as it applies to the next generation of urologists.

Of the 39 participants in the inaugural retreat, 20 (51%) were women, including 8/19 (42%) international representatives and 12/20 (60%) AUA domestic section representatives. Achieving gender equity at a leadership development forum like this is an important step, especially in the context of significant gender disparities in leadership positions across all levels from national committees to institutional roles.¹ Despite improvements in workforce diversity, women make up only 12% of the US urology workforce and 28% of trainees.^2,3

What stood out most about the program was the comprehensive leadership development through team-building exercises, shared experiences, and problem-based learning. Throughout the day, we had the opportunity to work with nearly every participant in both small-group and 1-on-1 exercises. Before the conclusion of each session, we would come together as a large group to reflect on common themes. While we all came from diverse backgrounds from both a cultural and training-specific perspective, the core leadership principles were universally applicable. Not only were we provided with a framework for modeling our own leadership style, but we were also empowered with the tools necessary for continued growth as our practices and goals evolve.

Through conversations with fellow participants, I gained an appreciation for the diversity in clinical training experience outside of the US. Each year, over 350 trainees enter urology residency programs in the US alone, and this number continues to grow.^4,5 While there is a degree of standardization of US urology training as dictated by ACGME (the Accreditation Council for Graduate Medical Education), there remains some variability among various programs. Trainees are expected to log a minimum number of cases within general urology, pediatric urology, endourology, oncology, reconstruction, and robotic surgery; however, the range of cases can vary based on the complement of teaching faculty within a training program. Additionally, while the vast majority of training programs are 5 years, there are several 6-year programs that incorporate a research year into the curriculum. Despite these discrepancies, length of training and leave policies are clearly delineated by both ACGME and the American Board of Urology.

Although international programs have similar governing bodies evaluating core competencies, there is significant variability in exposure to cases related to oncology, reconstruction, and robotic surgery. While robotic surgery has gained momentum as a core surgical skill among US training programs, it was less frequently utilized by some of the international trainees. Instead, they were gaining more experience in open and laparoscopic surgery compared to the US trainees. Although the clinical case volume varied, the training structure and models for graduated autonomy were quite similar. Additionally, each participant shared the same pride in being a part of a team throughout training with opportunities to mentor and teach more junior colleagues as we progressed through residency.

Regardless of cultural or training background, we face similar challenges related to burnout, meeting the urologic needs of an aging population, technological advances in health care delivery, and improving diversity in our respective workforces. We as future leaders will be responsible for guiding our peers in navigating these challenges such that we can continue to advance the field. Access to global collaborative experiences like GRLR should continue to be emphasized in order to provide necessary perspective and better prepare the next generation of urologists to meet the needs of an evolving practice landscape. This experience not only has been formative in how I approach leadership as a chief resident within my program, but has also inspired me to seek out international opportunities for research and clinical collaboration in my future practice.