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Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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Bulletin Brief

Update from ACS Advisory Councils

March 15, 2022

Innovations in the Urology Match

by Simone Thavaseelan, MD, on behalf of the Society of Academic Urology and the ACS Advisory Council for Urology

As a small, competitive surgical subspeciality, urology maintains an early and independent match with the ability to innovate outside the NRMP (National Residency Match Program). The Society of Academic Urology (SAU) is the academic and program director subspeciality organization that leads and directs the Urology Match (UM), whereas the American Urologic Association (AUA), the national professional organization of urologists, executes the UM. With approximately 144 urology residency programs and around 365 residency positions, the SAU has a number of member-led taskforces that tackle challenges and opportunities in academic urology.

With regard to the UM, recent SAU led initiatives include:

  • Institution of a SAU/AUA Urology Match code of conduct in 2018
  • Development of a national standardized curriculum for virtual away rotations in 2020
  • Requirement of accountability with Council of Physician Accountability recommendation for virtual interviews in 2020
  • Implementation of a synchronized nationally coordinated interview release date in 2020
  • Addition of “Flush Day” (synchronized nationally coordinated release and rebook date) for interview adjustments in 2021
  • Completion of a SAU/AUA Preference Signaling (PS) pilot in 2021

All of these innovations were led by SAU members—key urologic academic leaders—with small group collaboration. Subsequent national implementation was supported by an engaged SAU board of directors seeking to facilitate meaningful change and organization process improvement in the complex ecosystem of the UM.

The SAU/AUA PS pilot was modeled on the ENT pilot which, through the open-source publishing of their process and content, provided remarkable blueprints to allow the SAU to scale these efforts into our subspeciality. The SAU held a pro/con debate; engaged multiple stakeholders, including program directors, coordinators, and applicants, in the process; carried out live webinars; released short how-to videos; and relied on the AUA to integrate the electronic process aspects in the UM software.

Trends across all specialties have shown an increase in the number of applications submitted per student over the year and within urology on average, with applicants sending more than 80 applications and programs receiving more than 350 applications. The sheer volume of applications is expensive and stressful for applicants and overwhelming for programs. While application limits have been discussed across multiple specialties, including the SAU, consensus to limit applicant autonomy, despite the potential to improve organizational process, has been debated and investigated. However, the theoretical risk and liability of restriction of trade or individual autonomy has limited execution of such application caps. Consequently, the SAU pursued the PS pilot to specifically provide an applicant-driven, equitable method of signaling for programs to use as one of many metrics for applicant selection. Voluntary participation in the PS pilot nearly was universal, with an average of 19 signals received by programs (range one to 62) and approximately 50% of signals going to 25% of programs. Survey data suggest a high rate of overall satisfaction with the process.

Following implementation of a synchronized nationally coordinated interview release date to have programs standardize interview offers and allow a structured format for applicants to accept and turn down interviews, we added a staged “Flush Day” to allow for releasing of undesired interviews and rebooks through waitlist offers approximately 4 days following the coordinated interview release.

The UM is a highly competitive and complex system, affected by overapplication interview selection that is a bottleneck amid a congested applicant interview market. The SAU and AUA are committed to designing member-led solutions where consensus exists to decrease the uncertainty and inefficiency that surrounds the experience and creates effective organizational improvement processes for stakeholders.

Simone Thavaseelan, MD, is a residency program director and associate professor of surgery (urology), Brown University Warren Alpert School of Medicine, Providence, RI; and chief, urology section, Providence Veterans Affairs Medical Center.