Elsevier

Journal of Surgical Education

Volume 70, Issue 1, January–February 2013, Pages 138-143
Journal of Surgical Education

Original report
Predictors of Success in a Urology Residency Program

https://doi.org/10.1016/j.jsurg.2012.06.015Get rights and content

Objectives

In selecting a medical student for a urology residency, a set of preconceived criteria as to what will predict a successful resident are generally applied. To determine what factors predict an “excellent” clinical resident and a successful in-service test taker, we analyzed 10 years of urology resident files.

Participants and Study Design

Retrospective chart review of 29 urology residents at Washington University graduating from July 2000 to July 2009. Medical student applications and interview evaluations were compared with future performance as a general surgical intern and then as a urology resident, in terms of clinical performance and in-service examination scores.

Results

Of 29 residents, based on clinical evaluations over 4 years of urology residency, 12 were “excellent,” 17 “average and needing improvement.” “Excellent” residents had higher applicant rank submitted to the “match” (7.2 vs. 12.1, p = 0.04) and better letters of recommendation (3.0 vs. 2.5, 0.018). “Excellent” residents also had better evaluations as an intern (3.9 vs 2.7, p < 0.001). “Good” urology in-service examination test takers compared with “below average” test takers noted higher rank on the match list (7.8 vs 12.1, p = 0.04), better quality med school (2.6 vs 2.0; p = 0.002), higher USMLE scores (92.5 vs 86.6% tile, p = 0.02), American Board of Surgery in-training examination (ABSITE) score (58.6 vs 37.2% tile, p = 0.04), and were more likely to pass the board examination (100% vs 76.9%, p = 0.03). Residents with higher clinical evaluations were also more likely to go into fellowships (83.3% vs 16.2%, OR = 23.3) and academic careers (41.6 vs 11.1%, OR = 5.71).

Conclusions

Performance as a surgery intern predicts future performance as a GU Resident. “Good” test takers as medical students and as interns continue to test well as GU residents. Early identification, intervention, and mentoring while still an intern are essential. Selection criteria we currently use to select GU residents are surprisingly predictive.

Introduction

In 1985, the Urology Program Directors, under the direction of the Society of University Urologists, established a matching system for first year residents. The Urology Residency Matching program assigns match numbers to applications and programs that register online. Applicants register with the Electronic Residency Application Service (ERAS) and contact programs to set up interviews. All applicants and programs complete the preference list forms online and submit them to the Urology Matching Program by January of each year. The Urology Residency Matching Program performs the match and sends out results to applicants, medical schools, and training programs.

With the competitive nature of surgical subspecialties such as urology, residency programs are faced with the difficult task of forming rank lists from a growing pool of applicants. While most programs use the same objective criteria to assess applicants, there have been few studies that evaluate which factors are actually predictive of a successful resident. Several studies have demonstrated a correlation between USMLE scores and performance on in-service examinations in various specialties,1, 2, 3, 4, 5, 6 however, this represents only one small aspect of the residency application. To ensure the training of the highest quality clinicians and surgeons, it is crucial to assess whether our current selection criteria are predictive of subsequent resident performance. Furthermore, program directors must identify factors that are associated with poor performance early in the training process to allow for possible proactive intervention, if needed. Our study seeks to evaluate the factors associated with clinical and objective performance as a urology resident.

Section snippets

Participants and Study Design

A retrospective review of 29 resident files from the Division of Urology at Washington University in St Louis between July 2000 and July 2009 was performed. The study was exempt from institutional review board (IRB) because of the lack of patient identifiers or protected health information. Medical student applications and resident files were reviewed. Data extracted from the medical student application included applicant rank, USMLE part I scores, medical school quality, undergraduate quality,

Results

During the course of training, residents were evaluated every 6 months based on a Likert scale (see Figure 1) by their supervising academic urology faculty as to their clinical and technical performance. The data were subsequently stratified into 2 groups, “excellent” and “average and needing improvement.” Outcomes of this analysis are shown in Table 1. Significant differences were noted between the 2 groups with respect to rank order, quality of the LOR, and evaluations as an intern. Those

Discussion

The goal of our study was to further define the factors which are predictive of success in a urology residency program. Resident success can be defined in terms of clinical performance or objective measures of knowledge (i.e., standardized tests). We sought to address both of these domains by stratifying residents based on in-service scores and clinical evaluations.

With regards to objective measures of performance, our study has several significant findings. As would be expected, performance on

Conclusions

The applicant selection process at our institution is surprisingly predictive of future success as a urology resident. Faculty interviews and letters of recommendation appear to correlate directly with clinical performance during residency. Furthermore, performance on USMLE part I and in-service examination is correlated with successful passage of the board examinations. Larger scale studies are warranted to further define the factors predictive of urology resident success. Early identification

Acknowledgments

Previous Presentations: Grewal S, Yeung L, Brandes, B. “Separating the Wheat from the Chaff: What Criteria Predict a ‘Good’ Urology Resident?” Presented at the 96th Annual Clinical Congress of the American College of Surgeons, 2010.

The authors have no conflicts of interest to report relative to the preparation or publication of this study.

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