FROM THE RESIDENTS AND FELLOWS COMMITTEE Growing Diverse Leaders: Diversity, Equity and Inclusion Efforts from the Residents and Fellows Committee

By: Michael Ernst, MD; Ruchika Talwar, MD | Posted on: 01 Apr 2022

The Residents and Fellows Committee of the American Urological Association has represented the voices of trainee members since its inception in 2002. Over the past 20 years, our committee has grown to include not just members from each geographical AUA section, but also representatives from Canada and Mexico, as well as liasons from the American College of Surgeons, Residency Review Committee and the American Medical Association. Our aim is to advance the needs and concerns of all residents and fellows. As such, over the past year our committee has been involved with multiple efforts to increase diversity, accessibility and inclusion in urological training.

Although the current cohort of urology trainees is increasingly becoming more diverse, progress is still lagging behind many other fields. In 2021, women made up 34% (120/357) of all matched applicants, 16% of full time faculty and 10.3% of practicing urologists.1,2 It is predicted that female urologists will make up a significant proportion of the workforce growth over the next 4 decades.3 Despite the increasing number of women entering urology, they continue to be underrepresented in leadership positions across urology organizations.4,5 Similar trends are seen for racial/ethnic minorities in urology. Based on the most recent AUA census data, 2.1% of practicing urologists were Black and 3.8% Hispanic, while for residents 3.1% were Black and 5.7% Hispanic.2 A 2019 study showed that trainees underrepresented in medicine (UIM) made up 30.8% of current residents in urology, 33.6% in surgery and 42.3% in all medical fields overall.6

One mechanism to increase diversity within medical fields and access to leadership positions is the development of mentorship programs. These programs have been associated with facilitating specialty choice, career satisfaction and increased productivity.7 Often, trainees UIM feel isolated and experience reduced mentorship opportunities due to smaller numbers of underrepresented physicians at academic centers.8 Faculty who are UIM may be in junior roles themselves, overburdened and are frequently asked to serve in these mentorship roles with little to no preparation. Therefore, all leaders must become culturally informed in understanding the unique challenges faced by those underrepresented within urology and be able to provide “cross-cultural” mentoring.9

Mentorship for urology residents has been one of the key themes of the AUA Residents and Fellows Committee for 2021–2022. While all residents would benefit from more robust mentorship, this is especially true of those who are underrepresented in our field and leadership. The 2021 AUA May Kick-off Weekend featured a virtual panel, moderated by our committee, with experts from across the country discussing the benefits of mentorship, how to find a mentor and best practices for being a mentee. This was attended by 75 trainees and is available now for streaming on the AUA website. Additionally, our committee has been investigating the development of a national mentorship program that could be accessible to urology residents. The first step in this program is a needs assessment of current urology residents. We hope this program can add to the excellent mentorship work already being done by the R. Frank Jones Urological Society, Society of Women in Urology, Urology Unbound and Urologists for Equity.

Over the past few years our committee has also been actively advocating for changes to the parental leave policies established by the American Board of Urology (ABU). With the assistance of the AUA, our committee developed a survey that was included in the Annual AUA Resident Census. This found that 24.8% of residents have children, and 80% of them had a child during their residency training. At that time, 78% of residents took fewer than 2 weeks off after the birth of their child and there was no national ABU policy for trainees. In 2021 the ABU, along with numerous stakeholders, developed and implemented a standardized parental leave policy. This policy now allows 6 weeks of parental leave without affecting vacation or sick leave and without an extension of training. Additionally, residents are allowed an additional 2–4 weeks of leave depending on their year of training.10 Our committee offered full support for the ABU’s policy and has worked hard to make all residents aware of this positive step forward towards equity and inclusion.

Furthermore, the AUA Residents and Fellows Committee will be hosting a series of podcasts through the AUA Inside Tract Series. These will tackle topics such as navigating residency in a dual physician household, the challenges of having a child during residency, seeking leadership as a female in urology and an introduction to the subspecialties available through urology. These podcasts will be of general interest to urology trainees, but will also serve to increase knowledge of some common “hidden curriculum” items. In addition, the Residents’ Forum at the AUA 2022 Annual Meeting will focus on several of these “hidden curriculum” topics and intentionally features several panels that consist of a diverse set of accomplished urologists from various genders, races and ethnicities.

The Residents and Fellows Committee firmly believes that a diverse and inclusive training environment is critical to the best educational, clinical and research outcomes. The April 2021 Diversity Issue of AUANews outlined many of the current gaps in inclusivity and diversity that are present within urology. The suggested next steps often required not just increasing access to resources for underrepresented groups, but an intentional commitment to increasing diversity in all its forms. Our committee members serve just 1-year terms, significantly shorter than that of many other AUA committees. This should allow our committee to quickly become representative of the current diversity of trainees within urology. It is incumbent on the AUA member sections to consider this diversity when selecting resident representatives to the Residents and Fellows Committee. We strive to represent the diversity of urology trainees that helps to elevate and advance our field.

  1. Findlay BL, Manka MG, Bole R et al: Defining the current landscape of women in urology: an analysis of female applicants, residents, and faculty at AUA-accredited residency programs. Urology 2021; 148: 59.
  2. American Urological Association: The State of the Urology Workforce and Practice in the United States, 2020. Linthicum, Maryland: American Urological Association 2020. Available at https://www.auanet.org/research/research-resources/aua-census/census-results.
  3. Nam CS, Daignault-Newton S, Herrel LA et al: The future is female: urology workforce projection from 2020 to 2060. Urology 2021; 150: 30.
  4. Cancian M, Aguiar L and Thavaseelan S: The representation of women in urological leadership. Urol Pract 2018; 5: 228.
  5. Wenzel J, Dudley A, Agnor R et al: Women are underrepresented in prestigious recognition awards in the American Urological Association. Urology 2021; https://doi.org/10.1016/j.urology.2021.03.058.
  6. Shantharam G, Tran TY, McGee H et al: Examining Trends in underrepresented minorities in urology residency. Urology 2019; 127: 36.
  7. Khan NR, Rialon KL, Buretta KJ et al: Residents as mentors: the development of resident mentorship milestones. J Grad Med Educ 2017; 9: 551.
  8. Moreno NA, Dimick JB and Newman EA: Mentorship strategies to foster inclusivity in surgery during a virtual era. Am J Surg 2020; 220: 1536.
  9. Roberts SE, Nehemiah A, Butler PD et al: Mentoring residents underrepresented in medicine: strategies to ensure success. J Surg Educ 2021; 78: 361.
  10. American Board of Urology: Leaves of Absence. Available at https://www.abu.org/residency-requirements/.
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