Matching into a Urology Program: The Devil is in the Details

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by Byron D. Joyner, MD, MPA 

For at least the last five years, the field of Urology has been fortunate to be able to choose from the strongest medical students in the country. Urology remains one of the most competitive surgical subspecialties. For this reason, medical students who are interested in applying in the field of Urology need to demonstrate that they are competitive applicants. How is this best achieved?

A competitive applicant is made up of many details, including great grades, unbelievable USMLE scores, influential letters of recommendation, a stellar sub-internship, groundbreaking research, and a provocative personal statement. The value of each of these details is weighted differently depending on whom you are asking. The definition of a competitive candidate will vary depending on which Urology department you are considering and which person in the department you are asking, be it chairperson, program director, faculty or resident.

With no consensus on the exact definition of a competitive applicant, how should an applicant make him or herself as competitive as possible when trying to match in the field of Urology? Candidates will need to excel in the academic domains with great grades and unbelievable USMLE scores being the standard. Yet, there must be other critical details that further differentiate candidates.

Powerful letters of recommendation (LORs) are important to distinguish a competitive candidate. LORs are often used by a Urology department when deciding whether a candidate should be interviewed. LORs offer descriptions of an applicant's personal attributes but are often imprecise indicators of performance as they lack details of the applicant’s clinical competency and motor skills. Therefore, powerful letters of recommendation are important, but are only part of the competitive applicant’s portfolio.

What is the importance of performing a sub-internship or externship? A sub-internship at your own institution is a must. First it allows you clinical experience and exposure to the field of Urology. Second, it provides you with an opportunity to ask for letters of recommendation from your chairperson and from other faculty with whom you work closely during your rotation. 

An externship at an outside Urology department is more difficult.  It can either make or break you at that institution. If you decide to perform an externship, you should keep several goals in mind. 1) It should be performed at a program where you are very interested in being accepted. 2) It should afford you time with the current residents in order to evaluate the program’s culture and your potential for growth and success within that culture. 3) Finally, it should confirm for you, in a different setting, that Urology is truly your chosen field. 

In order to maximize your chance of a stellar sub-internship, you should carefully review the expectations of the program prior to beginning your rotation. This information can be obtained from the written curriculum and from the program director. Once you have started your sub-internship you should seek the “hidden curriculum” from the current residents. This information will help you function as a valuable member of their team. This involves establishing a good relationship with the residents through being available and prepared, professional and personable, and, most of all, hardworking and reliable. Do not assume that you will automatically be a member of the team; you’ll have to work at it. And, you should. The residents will respect you more that way.

Is groundbreaking research the key to a competitive application? Demonstrating an interest in research is important in a competitive field like Urology and does have a higher association with matching in competitive programs, even though there is no definitive correlation between published research and resident performance. Putting time into research during medical school can enrich you academically and will be well-received on your application. However, you must be able to clearly articulate the design and rational behind the research at the time of an interview, as a poor understanding or misrepresentation of research and scholarly activities is far worse than a simple lack of research experience. 

At this point you must be thinking that, competitive, must be determined by your "provocative personal statement". In part, it is. The personal statement need not be as provocative though, as it is honest and authentic. Write about something you love. Write about something that distinguishes you from everyone else. Write about something that will make you memorable. Try to refrain from invoking common themes involving a dramatic epiphany about the anatomy and physiology of the urinary tract. Your personal statement should be personal. Describe something important to you, and dig deep into what you learned from the experience and how it made you a better individual. The personal statement should be a representation of you in your most genuine form - concise, punctuated and spell-checked, of course.

Once you gain an interview, you have gained a lot. The interview should be easy, as long as you’re confident (but not arrogant), comfortable (but not dull) and classy (but not obnoxious). During the interview, a process of duality is at work. The program will attempt to determine a “best fit.” The program will look for poise, maturity, motivation, personality, strength, communication and interpersonal skills. You should do the same to determine your own “best fit.”  You should look for happy residents, a challenging but collegial environment and pride in the program. The program should not only articulate this but live its vision.

So, what is the secret to being a competitive applicant and matching in the perfect Urology program? The devil, of course! He’s in the details. Crossing the “T’s” and dotting the “I’s” is essential because this type of attention to detail precedes you. Attention to detail is rewarded by the world in general, and your reputation for being careful and thoughtful, is a cherished characteristic of a great physician. Even the grandest project depends on the success of the smallest details: great grades, unbelievable USMLE scores, influential letters of recommendation, a stellar sub-internship, groundbreaking research, and a provocative personal statement. When all the details finally come together and you get the coveted interview, show up in your Sunday best. Be charming. Be honest. Be authentic. But, leave the horns at home.

Laura Leddy, MD, contributed to this article

Dr. Leddy is a Urology resident at the University of Washington. She gave the devil his due, and didn't even have to go down to Georgia (or the deep blue sea). . .