I decided on urology fairly late in my med school
career, during the year I took off for an MPH between third and fourth
years. I started med school expecting to go into medical oncology, then
loved surgery when I started my rotations third year. I almost settled
on surgical oncology, but felt there wasn't enough clinical continuity,
and wasn't thrilled with the overall atmosphere in general surgery. At
Yale, as at many schools, the surgical subspecialties clerkship comprises
a few short rotations over which the students have relatively little
choice. Urology was not among my three specialty blocks, so, like ENT,
ortho, neurosurgery, etc., I had had almost no exposure to it. I became
interested basically from talking to classmates who had enjoyed the clerkship--it
seemed to offer a combination of fascinating surgery, long-term clinical
contact with patients, and research opportunities. Also, and very importantly,
I liked the urologists and urology residents I met: I have yet to meet
a urologist who wishes s/he were doing something else or were not in
did you prepare yourself for application to your chosen specialty?
a sub-I in urology at Yale at the start of my fourth year, then
an externship at UCLA a few months later. I spent some time in
a urology lab at ale, and wrote a case report with one of the faculty
wrote your letters of recommendation for your application?
letters from the urology faculty at Yale, and one from my summer
research PI in medical oncology. Obviously, a letter from the dept
chair is extremely important, esp. in a relatively small field
like urology where enior faculty at different institutions tend
to know each other personally s well as professionally. One program,
UCSF, requires no less than five letters.
programs did you apply to and why?
to 29 programs across the country. I got advise from the faculty
and residents, as well as other word-of-mouth sources on which
offered the est surgical and academic training. I concentrated
for the most part on big cities, though there were a few exceptions.
kinds of questions did programs tend to ask you?
predictable: why urology, what are you looking for in a program.
Almost every program wanted to hear about my research experience--be
prepared to explain any publications in detail. They always ask
what questions I had about their programs. They ask if I'm planning
to do a fellowship. At one program, Mass General, there was actually
a pimp session: he interviewer showed me an X-ray (KUB) and asked
me a series of questions bout a renal stone case.
would you have done differently in applying?
have written more letters after the interviews and perhaps done
a bit more research specifically in Urology.
was the most difficult part of the application process?
interviews tend to be mid-week, and rarely group together vis-a-vis
dates (except Boston), so it meant a lot of non-Saturday night
stay flying. Also, Urology was one of the few non-ERAS fields,
so it meant actually finding a bona fide typewriter and banging
out 29 separate applications.
should I look for on my interview and tour day?
schedule (often home call after the general sugery year/s); number
of general sugery years. Is there a dedicated research year? Is
Urology a division of surgery or a stand-alone department at the
hospital? Do urology residents have equal footing with general
surgery categoricals during the prelim years, or are they stuck
with four months of vascular?
questions should I ask of residents, faculty, and program directors?
and depth of surgical experience? What sort of research opportunities?
Do most go onto private practice or academics? Most importantly:
how happy are the residents? How are their relationships with the
faculty? And with each other? Some programs (UPenn, Cleveland Clinic
come to mind) expect you to come back for a "second look" if you're
did you form your rank list?
of geography and an overall gestalt of the program's academic,
clinical, and surgical strength. And again, how happy do the residents
seem? Definitely rank all programs at which you think you'd be
happy, and rank in order of _your_ preference. Consider writing
a letter to your top-choice program telling them they'll be first
on your list, but don't lie! It's a small field, and writing five "first-choice" letters
will come back to haunt you.
other advice can you give seniors applying in your specialty?
is a pretty political process, and it's not unusual for programs
to get the two or three applicants at the top of their list. Try
to pick an top choice program and do a sub-I away, but don't go overboard
and do three like some people do. Good luck! It's a tough match,
but definitely worthwhile: urology's a rich field with broad exposure
to surgical and medical issues. There are a lot of quality-of-life
interventions, and there's great potential to make a significant,
and lasting, difference in patients' lives. And again, urologists
make happy doctors!