Research

Most academic physicians are drawn towards applicants who want to be like them--namely, academicians. In truth, even the most academic programs (with the notable exception of Johns Hopkins) rarely see more than 50% of their graduates pursue academic careers. But demonstrating that you are interested in academics, and, at the very least, willing to give it serious consideration, is an absolute must.

 

By far, the best way to display your interest in academic medicine is to do research. It is not a must, and for some people, it is simply not a possibility; however, there is no question that it helps substantially. High quality basic science work is great--if it has some relevance to Urology, even better. Clinical projects with Urologists (these can be done at the end of your third/beginning of the fourth year) are looked upon very favorably. These small projects can also yield very strong letters of recommendations from influential people. Bring the topic up with any Urology attending, and you will be surprised how fast you can come up with a project that you can work on during an easy stretch of clinical rotations. Even clinical projects outside Urology will significantly improve your application. See an interesting case? Write-up a case report! Just let the attending know you want to write it up, go over it with him/her, and submit it to a journal. By demonstrating your interest, initiative, and follow-through, you will get yourself noticed. In addition, taking a year off to perform research is an option, as there is no question it will help your application to some degree. Obviously, this is a major commitment, however, and is only worthwhile if you are truly interested in taking a break from your clinical training. The strongest applicants have substantial lab projects (and publications) completed in the first two years, coupled with small clinical projects performed over the latter two years. Research conducted prior to medical school is also extremely relevant to your application. It should be stressed, though, that although research is a great plus, many applicants match at top programs without any research whatsoever.

  

Advisor

By early fourth year you should start actively looking for an advisor who will help guide you through the match process. This person is often the chairman of your department, but can also be any other Urology faculty member who expresses interest in counseling you through the residency match process. People that write your letters of recommendation are usually very willing to advise you. Make sure the physician you select is intimately involved in the resident selection process, as the person who is "in the know" is most likely to give the best advice. The advisor can help judge the strength of your application and suggest where you should apply. It is especially important to get a good advisor if you think your application is not very strong--this person will give you the best assessment of whether it is worthwhile to go through with the whole process and how to make a back up plan. Towards the end of match season, some advisors will be willing to make phone calls on your behalf to your first choice residency.

Urology Sub-I

As far as your Urology application is concerned, this is the most important month of medical school. The time to shine, if ever there was one. This is where you need to show off your clinical competence, your motivation level, your work ethic, and your ability to work well with others. You will be under the microscope. Be eager to help, yet, at all costs, avoid being annoying.  Always be on time (read: early) for conferences, appointments, the OR, etc. Come early and stay late. Be reliable when you are given tasks and responsibilities. See as many patients on the service as you can possibly handle and definitely those into whose cases you scrubbed. Work your tail off on your presentation if you are asked to give one at a weekly conference. If you see an unusual case, volunteer to write a case report.

During the rotation your knowledge base will be repeatedly tested and in the minds of faculty will correlate with intelligence and motivation level. Starting to read Urology texts early is also a great way to test your interest in the field. You should begin reading well before the rotation begins and continue to read while you are on service.

Consider the books contained in the textbook guide of this website. 

In summary, during your Sub-I, be the absolute best medical student you can be, and make as many friends as possible. Every PA, nurse, resident, and attending that likes you helps your cause. In the end, you need to leave this month with two things:

    * (1) A good grade
    * (2) Letters of recommendation, with one being from your department chairman

Away Rotations

Not enough can be said about doing away rotations, especially if you have your sights set on a particular program where you would like to match. For the regular match, people will tell you that doing an away rotation is a double-edged sword, but for Urology the benefits most of the time far outweigh the risks. Urology residencies are incredibly small in size, and programs often feel it is much less risky to accept applicants who have had a month-long audition. Residency directors love nothing more than a known entity--a strong medical student whom they know personally. By forming ties with people in the department that you visit, you greatly increase your chances of matching there. Just be friendly, work your tail off, show that you know something (without showing-up the residents), give a reasonable presentation (if asked), and you will be fine. When it comes time to interview, the day will be relaxed and friendly, with few serious questions. Of course there is always the chance that you won't click with the program you visit. It can be argued that this, too, is a benefit, as it is better that you discovered this before, rather than after, you matched. Regardless of whether you liked your away rotation, it is wise to try and obtain a letter of recommendation from this department, preferably from the chairman.

Letters of Recommendation

You need at least three letters of recommendation. At times people submit four, but some chairmen will pick three at random and just reads those. One of the letters you submit must be a letter from the chairman of urology at your school. Without this letter, your application is severely weakened and every program will ask why you lack this letter. If you cannot obtain one from your home chairman, a chairman at a program where you did an away rotation will at least reduce some of the damage. Your other two recommendations need to be from people that know you well and would be willing to go to bat for you. If you have done any research, one of the letters could be from your research advisor. There is no doubt that it is of great help if the people writing your letters are well-known, but a lukewarm letter from a big-wig does not stand up to a very strong letter from a lesser known (or even unknown) clinician. Most people get all three letters from Urology faculty, while others get one or two letters from people in other specialties (surgical specialties are preferable). It probably matters little--just make sure you have the chairman letter and the other two are from people that know you well. If you do an away rotation early enough in the application process, it is advisable that you get one of your letters from this institution. A strong chairman letter from an away rotation can be a considerable addition to anyone's application.

Application and Personal Statement

The first one or two months of your fourth year (early to mid-summer) should mark the official beginning of your residency campaign. Now is the time to start thinking about the nitty-gritty of how to apply, where to apply, and what you will include in your application. If you are at this stage, you must make sure that you register for the Americal Urological Association (AUA) Match. Logistically this is painless, costs $75, and you can register right now by clicking on this link. You will get a match number a few weeks after you register. Additionally, this is a reasonable time to register for the NRMP match (the primary match for all of your non-early match friends). Nearly every Urology program requires you also go through the NRMP match (though this is merely a formality), and doing so by December 1st saves you an extra $50. You may also wait until after you have matched to find out whether your program requires you to go through the formality of the NRMP match, however, you will end up paying the extra $50 if they do. There is no longer any need to ask programs to send you brochures, as all of their information is now on the web. However, for non-ERAS programs (there are fewer and fewer of these every year), you need to contact the programs directly in order to receive an application.

 

The Urology application is a lot like medical school applications, but, for the most part, significantly easier. Urology is part of the ERAS system, which means you write only one essay, fill out your basic resume information, and your application is basically complete. The resume part of ERAS--in which you list activities, research, and other interests--is generally straightforward. List anything you think a residency might think is interesting and that you wouldn't mind talking about during your interview. Some interviewers won't read this, but some will; at one point in time or another, you will be asked about every piece of information on your application. People love to hear about interesting non-academic things, so don't forget these. Also, don't forget about any research you have done, papers you have published, or any awards or honors. There is some debate over whether to list all your posters and abstracts--if this is an issue for you, it is a good one to bring up with your advisor. In general, if the work pertains to urology it is reasonable to list everything, otherwise, a sample of your posters and abstracts may be sufficient. You don't want to seem like you are padding your application.

 

The most difficult part of your ERAS application is the personal statement. Allow yourself plenty of time to write this essay--it is not trivial to present yourself in one written page. And people will actually read this: probably only half of your interviewers at most, but certainly the program director and chairman will give it a good read. Numerous questions will come from your personal statement, and it truly is your way of introducing yourself. Set specific goals for what you want to get across. Why did I choose Urology? What do I bring to Urology? Why will I be a good Urologist? What are my career goals? Of course, you can't truly answer those questions and give an impression of who you are all in a single captivating page. In general, it's a good idea to keep it simple--remember your audience consists of busy academic urologists--and try to throw in something interesting (preferably early on) that makes it readable. As always, you can't overrate having a good introduction, and keep it under one page single-spaced. Know that some programs will rate your personal statement, which will then be factored into an overall score.

 

 The next question is how many programs to apply to. Broadly speaking, 10 is probably too few and 40 may be too many. That said, AUA statistics reveal that, over the past several years, applicants are applying to an average of 39-41 programs! This is up from five years ago, no doubt due to the adoption of ERAS among Urology residencies. And if you don't believe these numbers, take a look at this 2006-2007 UrologyMatch poll. Remember, however, that these numbers include the people who applied to all 111 programs in the country--and there are definitely those individuals out there. In general, applying to 30-35 programs (at most) that are within your competitive range should be sufficient. Obviously, a large portion of people do not match each year, however, it is questionable whether applying to 60 schools truly helps those on the bubble. Our advice: no more than 35 applications and concentrate your efforts on those! But no matter how great an applicant you are, make sure you send out some applications to programs not considered to be top-tier. You need to have "safety" programs, because you never know what is going to happen, and it is certainly an incredibly competitive process.

 

Finally, once you have your application finished, get it sent off. It is a very good idea to be on the early side of things. Early September is when you can first send off your application, and you should definitely have it in by mid-September. Many programs offer interviews on a rolling basis, and it may be somewhat easier to garner an interview early rather than late. Not to mention the fact that you will have more flexibility with scheduling if you are getting interviews earlier than other applicants. Also, several programs have a mid-September deadline for receiving applications, and nearly all are due by the end of September. These deadlines include your ERAS application and letters of recommendation, but not your Dean's letter since that does not get sent until November 1.

Interviews

Assuming that you sent in your application in early September, you may begin receiving interview offers within a few weeks. Some programs start interviews as early as the middle of October, but most occur between early November and mid-December. Plan on the interview season mainly taking place from November 1 to December 21, with the peak season lasting from mid-November to mid-December. If at all possible, you should schedule a vacation during one of these months--you will be very, very thankful.

 

You will find out about most of your offers during the month of October. Most programs will e-mail you but some will call you. Be sure to check your e-mail and voice messages often and schedule your interviews as quickly as possible (some suggest within minutes of receiving the e-mail or phone message) as interview spots fill up fast. Most Urology applicants plan on interviewing at 10-15 programs if all goes well (the average was 10 interviews per applicant in the 2006 match--remember this includes people that didn't get any interviews at all!). Be appreciative of every interview offer you receive as each program usually gives out a total of only 30-45 interviews in a match season. It is reasonable to accept all your offers initially (and schedule them quickly, since interview dates will fill up, and you need all the flexibility you can possibly manage). If you end up receiving more offers than you plan on accepting, you can always cancel interviews. Please post your cancelled interviews on the UrologyMatch discussion board for the benefit of other applicants. It is considered good form, to cancel interviews at least 2 weeks in advance--programs will be much more understanding if you cancel with enough time for them to fill your interview slot. For a chairman's perspective on interview cancellation etiquette, we recommend that you read this post on the discussion board.

 

Scheduling your interviews will turn out to be more difficult than you expect. Many programs only offer two dates, and few offer more than four. Fridays and Saturdays (thankfully) end up being popular interview days, and, as you can imagine, there are a limited number of these days during the interview season. In other words, you may not be able to interview at all the programs you would like to. This makes scheduling interviews early all the more important since it gives you more flexibility. Most programs will make an effort to help you schedule your date such that it fits your travel schedule, but that doesn't always hold. And, unfortunately, only occasionally is there coordination with regard to interview dates among programs in a given city. One thing you can do to help your scheduling is to call program administrators before you even get an interview offer and ask what their dates are going to be (some also list interview dates on their website). Additionally, applicants post their interview dates on the UrologyMatch discussion board as they find them out, which provides some help in planning your schedule. The interview day can often be excruciatingly long and painful. Here is what to expect:

 

• Typically 8-16 interviewees on a given day (though there will be some with even more, and a few that only interview a couple candidates per day).
• An introduction from the program director and/or chair of the department outlining the program and faculty (a good thing if you didn't get around to reading the program's information on their website). 
• Anywhere from five to ten interviews lasting 10-20 minutes with one or two (rarely, three) faculty members at a time. You may or may not have short breaks between interviews. Some places will have you just rotate from office to office, doing 8 interviews in less than two hours with no breaks between interviews.
• Time with residents, either between interviews or before or after the interview part of the day--take this opportunity to ask questions.
• A tour of the hospital(s)--also a good time to get info from residents.
• Lunch either at the hospital (usually catered) or at a nearby restaurant.

 

Some programs have a dinner the night before the interview day; very few have anything the night after the interview. And don't worry if you can't make it to one of these night-time activities which tend to be dinner with the residents and possible a few faculty members. They do provide a nice time to talk to residents, however. As far as talking to residents goes, 95% of the time, the residents will have no say on the admissions process and you can ask anything you would like. The caveats, however, are as follows: a) Certain schools include some of their residents in the process--they will usually let you know when this is true, but try to find out yourself if you think this is possibility; b) If you say something really stupid, word may get around.

 

The interviews themselves are 95% softball questions. The basics of why you chose urology, what you like to do, what you want to do with your life, research you have done, etc. . . The interviewers are just trying to get a sense of your personality, how articulate you are, and, as many will tell you, make sure you're not a sociopath. Other than that, most doctors aren't able to glean much information from the basic 10-20 minute interview. Every interview will include time for you to ask questions. Some interviews will, in fact, consist only of your questions. These can be hard, especially if you have already asked the same 3 or 4 questions to several other interviewers that day. Therefore, be prepared with plenty of questions .

 

The other 5% of questions you will get--the atypical ones--are still nearly always benign. Pimping almost never occurs, and these oddball questions can range from "Who was number 5 on the Yankees?" to "What do you read on the sh**ter?" Or, for example, if you say you are interested in research, you may be asked which programs you applied to have a research year. If you are female (though males will also very often get this question) you may be asked (quite illegally) your marital status, and often your intent to have children. Women should count on several of these questions at every interview. Overall, the best advice is to smile, stay composed, speak confidently and articulately, and try not to sound like you have answered every question 10 times already. There is absolutely no need to get anxious about your Urology interviews. The most difficult thing is to not tire as the day goes on, since you may be moving from room to room answering the same exact questions for several hours.

 

QUESTIONS TO ASK AT INTERVIEWS

 

 

Post-Interview Communication

Post-interview contact is an enormous issue. Ethical conduct is not always the overriding principle on either the applicant's or the program's side. An article published in The Journal of Urology (Teichman 2000) revealed that there is a considerable amount of post-interview contact. This article, by the way, is a must read. The general rules of the match state that programs can contact you by letter at any time, and vice versa (see AUA post interview contact). Many programs (though certainly not all) send out letters or e-mails after the interviews have taken place.A lot of these letters are simply to say thank you for visiting, and let you know that "you will be highly considered for one of our spots." These are meaningless unless you know for a fact that other people who interviewed at the same program received no letter or a less flattering letter (you can usually find out from the UrologyMatch discussion board). DO NOT let these letters affect your rank list. Phone calls from the programs have, thankfully, become very rare in urology (as these are indeed illegal), so you should not have to worry about what you might say to a program that is not your number one choice. Know that the Journal of Urology article by Teichman revealed that 31% of program directors (and 44% of applicants) acknowledge dishonesty, and that 82% of program directors thought applicants "lied." Additionally, 81% of program directors were "skeptical" or "did not believe" when informed they were a "high" or "number 1 selection." As far as contact from your side goes, there are many philosophies:

 

1) Thank you notes: Should you send them? Absolutely. Should they be handwritten? Typed? Sent to everyone you interviewed with? Just the chair and program director? These questions are much harder, and, truthfully, less important. Thank you notes are certainly part of your application, but probably the least important part. Sending off one or two letters to most if not all of your programs should be fine. Just let them know you enjoyed your visit, and mention some things that make it clear you aren't just writing a form letter. Click here to see some samples. Be aware that these will end up in your file.

 

2) Telling programs where you are ranking them: Should you tell your number one program where they rank? Definitely--it can only help you. Should you tell multiple programs you are ranking them number 1? Absolutely not--people do talk in the urology world, and this would be a horrible start to your career. The key question is what to do about your other programs. Do you use words in your thank you notes like "highly ranked" or "extremely highly ranked" to indicate where you are ranking a given program? Do you tell all your programs that they are "highly ranked"? Hopefully not. Overall, how you approach this issue is really up to you and what you consider ethical. Of course, programs often assume you are lying when you use these terms (see article), not to mention that using a phrase like "highly ranked" may come off simply as "not number 1." You have to go with what you think is appropriate for yourself and the programs you applied to.

 

3) Revisits: After you are done interviewing, you should strongly consider revisiting your top choices. Many programs will explicitly invite you during your interview to do so. In addition, there are several programs that will only highly rank applicants who have done a Sub-I or a revisit. These programs are very adamant about matching only the applicants that want to be in their program, and a revisit is your way of showing utmost interest. If you are very interested in a program, it is worth asking the residents how important the revisit is to the admissions committee. To arrange a revisit, contact the residency director and plan to scrub into a case or two with the chairman (it is definitely worth revisiting on the day when the chairman is in the OR). Don't sweat the details, the residents will tell you what to do. After the revisit, consider sending another thank you letter to the chairman and/or program director. If you haven't sent your original thank you letters yet, definitely be sure to mention your second trip to the department.

 

4) The final lap: This is the period in early January after you have finished your interviews, sent in your thank you notes, and you have a good idea of your rank list, but before programs have sent their lists in. It is well within reason to send a last-minute e-mail or leave a brief voice-mail message at the top 2 or 3 programs on your rank list. This may be a good time to let these programs know where they stand (particularly your number 1 program), if you didn't do it in your thank you notes. Also, it may be reasonable to have your advisor or chair of your home program make a call to your first-choice residency at this time. These calls are not typical, and are usually reserved for fellowship applications, but if it seems appropriate in your situation, it could help you significantly.

 

THANK YOU LETTER SAMPLES

 

Match List

Constructing the right match list begins with taking advantage of the interview day. Truly, the most important part of that day is to get a sense of the program. The "je ne sais quoi" of the program (justifiably or not) will turn out to be a huge factor in making up your rank list. It is difficult to pinpoint exactly what you did and didn't like about each place you visited, but your overall impression is extremely meaningful and can give you a sense of whether you would fit in. Keep in mind, however, that one day is not always an accurate representation of a program. Strongly consider revisiting programs to get a better sense of the department. In fact, the revisit is a tremendously useful way to let a program know your level of interest.

 

When making your list, it is vital to know how the match works. For good descriptions of the matching algorithm follow these links: (1)AUA Match Explanation (2) NRMP Match Explanation (same algorithm as the AUA match). The most common mistake that people make about the match process is thinking that if they rank a less-desirable, but more attainable, program higher on their rank list, they will increase their chances of matching there. This is false! Go through the examples on the NRMP site and make sure that you grasp the nuances--you have spent innumerable years in school trying to understand things that are completely irrelevant, so spend 10 minutes understanding the match! Remember, ignore how you feel the programs will rank you, and rank the programs based on your desire to match with them!!! 

In general, there are countless approaches to actually making up your match list, but most people fall into one of two camps: 1) Make a big list of qualities you are looking for and rate each program accordingly (see MyAgenda module of this site), or 2) Go with the general impression you get of each program. Each method has its own merits, and, most likely, you already know which one suits your style. No matter which approach you take, you will find yourself, in the end, going largely with your gut instincts. You may be surprised to see how many factors other than the quality and reputation of the program play into your decision. You will be signing on for a rigorous five or six years, and you need to try and place yourself in a position in which you will look forward to going to work. As far as concrete advice goes, here are some suggestions:

• Write some things down about each program after your visit. Your interview days will begin to blend together very quickly (now you can use the new MyAgenda module for this)
• As truthful as residents try to be, they inevitably are putting on the shine for interview day, and it is very difficult to get any of the real dirt on the program. A reasonable way to obtain gossip is to ask residents what they hear about other nearby programs. 
• Another great way to find out what goes on at other programs is to make friends with other students along the interview trail. They often have great insight into their home programs.
• After you make your list, make sure you don't have any regrets about ranking certain programs above others. Every spot on the list matters--you truly never know where on your list you will end up. 
• Rank all the programs you interviewed at unless you would rather not be a Urologist than attend that program. If you have made the effort to interview at a program, there is no reason not to rank it unless you truly hated it. Any program in the country will give you the training you need to become a successful Urologist.

 

You will submit your match list online to the AUA before an early January deadline. You should receive an email confirmation after you submit your list. Obviously, try to submit your list well in advance of the deadline, so you can relax after you get your email confirmation. After you submit your list, you can change it for any reason by calling the Match line at 866-746-4282 (x3913) before the actual deadline.

 

Fourth Year

After you submit your list in early January, the focus of medical school changes. Grades become unimportant (as residency programs are unlikely to see grades after July) and your priorities should be: a) gaining intern survival skills, b) increasing knowledge-base, and c) relaxing. Take electives that will enhance your ability to do and think independently. Some electives to think about in the fourth year include:

• General Surgery Sub-I: You will get to see cases that you were unlikely to see as a 3rd year and will probably not get a chance to scrub in on as an intern. This will also prepare you well to run the floor. 
• Medicine Sub-I: Every patient you will have from now on will have medical co-morbidities. Learn not to be afraid of DM, CHF, and the like.
• Nephrology: This is a hit or miss elective that gives you insight into the medical pathologies of the urinary tract.
• Radiology: Be sure to take this rotation if did not do so in the 3rd year.
• Cardiac Anesthesia: This is a great rotation to learn to do central lines (every cardiac patient gets one in the OR), to intubate, and to understand the basics of anesthesia.
• SICU: This is the place to gain ICU management know-how and learn to deal with very complicated patients.
• Infectious Disease: Thorough knowledge of infectious disease treatment is essential for any surgeon.

You will also need to take the USMLE Step 2 this year. Follow this link for advice on how to best handle this hurdle. Otherwise, be sure to enjoy your fourth year. You will not be this carefree again until retirement!