key: cord-0050704-tjeh5trb
authors: Huang, Mitchell M.; Koo, Kevin
title: EDITORIAL COMMENT
date: 2020-09-26
journal: Urology
DOI: 10.1016/j.urology.2020.06.051
sha: e3ef136a237b2ac2012989573c82e6a2ee9c2d58
doc_id: 50704
cord_uid: tjeh5trb

nan

The Urology Residency Match Program remains a competitive resident selection process. Although match rates have increased in recent years, the average number of applications submitted per applicant has also steadily and disproportionately risen over the past 7 cycles. 1,2 Among the factors motivating excess applications is a dearth of published data on successful applicants, which may provoke anxiety among applicants about having too few publications, too few interviews, and too few programs to rank.

The appetite for numerical thresholds is not exclusive to applicants. Wading through a rising tide of applications has incentivized some program directors to use the United States Medical Licensing Examination Step 1 score as a screening cutoff to eliminate up to 70% of applicants. 3 In light of an announced change in Step 1 score reporting to a pass/fail system in 2022, both prospective applicants and residency program directors have predicted that future match cycles will place greater emphasis on other quantitative metrics, such as research publications. This study poses thoughtful questions about how a specialty with a selective residency match should approach this transition-and the answer, we suggest, is with caution and context.

By systematically searching for PubMed-indexed publications among recently matched residents, the authors provide granular data on the number and type of publications among successful applicants at a subset of training programs. Their findings may help residency candidates contextualize their research experiences relative to previous top applicants. However, we urge caution before extrapolating these data to draw conclusions about what constitutes a compelling urology residency application. As the authors note, research achievements should be evaluated holistically with consideration given to other experiences that might not be reflected solely in the number of PubMed-indexed publications. For instance, the discrepancy between the AAMC Careers in Medicine statistics-an average of 7.7 researchrelated publications, abstracts, and presentations per urology applicant-and the 2.4 PubMed-indexed articles reported in this study is less likely to be intentional misrepresentation, as some have suggested, 4,5 but instead a reflection of the broader range of research experiences that ERAS captures and that evaluators should consider. The breadth of these experiences, from designing and implementing a clinical trial, to conducting quality improvement projects, to writing and presenting conference abstracts, is worthy of inclusion during candidate review and underscores that the number of PubMed-indexed items, while a convenient metric and a tempting cutoff, is alone a limited and potentially unreliable indicator of an applicant's scholastic potential.

Furthermore, while the authors appropriately point out that additional data and transparency about the profiles of successful applicants may help alleviate applicant anxiety and facilitate advising, published data related to the match must be properly contextualized to allay the concerns that perpetuate the continued increase in the volume of submitted applications per applicant. Relying on PubMed-indexed publications as a measure of competitiveness might encourage aspiring urologists to prioritize opportunities for publications at the expense of other worthwhile academic experiences that facilitate independent thought and intellectual enrichment. As such, we applaud and support program directors who give due consideration to applicants' leadership qualities, volunteer work, academic achievements, and other personal strengths. 6 The findings of this study are most valuable if and when considered among other data that best reflect a candidate's chance of successfully matching.

In the setting of COVID-19, the recent decision by the Society of Academic Urologists to suspend visiting sub-internships and in-person interviews 7 will introduce new uncertainties about the urology match and its impact on applicant behavior. The recommendations of this study are prescient: transparency and clarity in the selection of urology applicants are more relevant and important than ever. We encourage the Society of Academic Urologists and residency program leaders to pioneer coordinated efforts to compile and communicate historical applicant data in a format that is sufficiently detailed to inform counseling and facilitate continued efforts to strengthen the diversity of the urology workforce pipeline. 

Thank you to the authors for their thoughtful comments. We certainly agree that there are many valuable research experiences in addition to PubMed-Indexed work for urology applicants. Program directors (PDs) may value research experience because it may show an applicant's intellectual curiosity and work ethic. It is likely that they examine this part of the application closely and then decide for themselves whether it brings merit to their program. For example, in the common scenario that a student decides to pursue urology late in their third year of medical school, publishing a peer reviewed manuscript would be difficult.

When more is less: the burden of increasing urology residency applications

Challenges facing program directors in the urology match

Prevalence of research publication misrepresentation among urology residency applicants and its effect on match success

Publication misrepresentation among urology residency applicants

Program directors' criteria for selection into urology residency

Urology Residency Match Policy