by Alan J Wein, MD
Advice for Medical Students Hoping to Enter Urology:
Applications and acceptances for urology residencies in the United States are organized and implemented through the American Urologic Association Office of Education through a match system that has worked quite well over the years. The match actually occurs in January of your senior year, and interviews generally occur in late October, November and early to mid December. This past year, there were 326 applicants registered for the match, and there were 218 first year spots filled, meaning that there were 108 applicants who went unmatched. It is therefore critically important that you apply to the proper "mix" of programs, and your urology advisor will help you choose what a proper mix consists of for you. My suggestions for optimizing your chances of a successful match at the "best" program possible are as follows.
The first meeting with your urology advisor should occur no later than June or July. For this meeting, you should try and have a realistic appraisal of what quartile of the class you are in, whether you are a reasonable candidate for Alpha Omega Alpha (or have already been elected as a junior), and you should bring a copy of your evaluations from the dean's office (available to you), your national board scores, and whatever portion of your dean's letter might already be available. You should make a copy of the urology programs from the list of accredited residencies in the ACGME book, and you should come with an idea of the individuals from whom you might expect excellent recommendations, preferably from urology, surgery, or other surgical subspecialties. You should also have a firm idea of any geographic restrictions that you would like to apply to your match list, and, if you will be matching with someone, you will need that information as well. My own personal feeling is that you should apply to no less than 20 programs, and whatever the number of programs you apply to, the percentage distribution should be as follows. Half of the programs should be programs that seem to be a reasonable match for your medical school performance and ability. One-quarter of the programs should be programs that are at or above the "upper end" of your reach, and one-quarter of the programs should be what would under ordinary circumstances be considered "fall backs" for a very good student. Fall backs can be deceptive, however, as those programs may have a favorite son (or daughter) or two that might fill their match selections for that year. It has been my observation that those who fail to match have not picked the proper mix or number of institutions for their match list.
The first step in the match is to obtain a "match number." This can be done by going to the AUA website. The initial letters of inquiry to the individual programs should go out in June/July or early August. Each program will send a reply, or perhaps a brochure, acknowledging your letter and explaining any peculiarity of the application process that might apply to them. That letter will also generally confirm what the configuration of their program is (number of years of surgery, number of years of clinical urology, number of years ((if any)) of basic research). Applications are generally made through ERAS, and these should definitely be in by late September. Although the dean's letters do not, by convention, come out until the beginning of November, many programs have already made their decisions regarding interviews by that time. Thus, it is critically important to select references who will write you the best letter of recommendation possible. Programs generally review completed applications periodically during the months of October and November and select a certain number of individuals for interview.
I think it's important for you to go to as many personal interviews as possible, recognizing that the practicality and expense of this may be somewhat inhibitory. Interviews for residency are like any new process‹they take a little getting used to. My advice is to try and schedule some of what you consider the "lower priority" interviews as first on your schedule, and save the interviews from the programs which are at the top of your list until you are a seasoned interview veteran.
Questions always arise as to the advisability of taking an elective at one of the places at the top of your list, or at the place which is at the top of your list. This can be a double-edged sword. If you make a terrific impression, of course, it's much to your advantage. If circumstances work out so that the overall impression is less than exceedingly positive (and there could be a lot of reasons for this that have nothing to do with your own ability or performance), this could work to your disadvantage.
Finally, some students ask about the advisability of doing research as an elective or as a summer project does this affect your desirability as a candidate? Overall, my answer would be that it does not affect your desirability. If you're interested in research for the intellectual joy and worth of it, then do it, but, in the majority of cases, I don't think that having your name on one or two publications, or spending a month or two in someone's laboratory, is going to materially affect your standing with a particular program. If you have spent a considerable amount of time doing research and have been productive, or are already a Ph.D., or are working towards that, the story obviously changes, and your appeal to a certain number of programs will certainly be enhanced. I hope this is helpful.
Professor and Chair
University of Pennsylvania School of Medicine.