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How I Matched into a Top Urology Program in the United States as an International Medical Graduate

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How I Matched into a Top Urology Program in the United States as an International Medical Graduate

In this blog, I will share with you my urology match® experience as an international medical graduate (IMG) and what I did to match at a top Urology Residency Program.

How does the urology Match® process work?

The path to becoming a urologist in the US includes applying to a different match® than organized by the American Urological Association and the Society of Academic Urologists, which is different from the National Residency Matching Program® (NRMP®). Therefore, when you peruse through NRMP documents such as Charting the Outcomes of the Match®, urology doesn’t show up. It uses the same platform to apply, ERAS. However, the matchday is a month and a half earlier, usually around the first week of February.

Year-to-year logistics change, but in the most current format, applicants send their applications through ERAS on/earlier than September 28 and ALL programs are forced to respond with either an acceptance, rejection, or waitlist on a specific day, called common release day. All applicants have 2 days to think about acceptances and rejections and must confirm the following Monday. Programs “flush” remaining spots Monday and Tuesday and after that, no further cancellations can be made by applicants.

Additionally, applicants get 5 preference signals to show interest in their 5 favorite programs. Each program uses them differently, some don’t care about them, some only interview applicants who signal them and there’s no easy way to know.

Research Course

The research course will teach you how to take a research project from idea to publication and in which I will share my 3-year experience of clinical research in which I had over 100 publications and 80 presentations.

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How many years is urology training in the US?

Urology programs in the US are either 5-year programs or 6-year programs. 6-year programs have a total of 12 months of research built into them, while 5-year programs have ~3 months of research built into them.

Urology Match Statistics? How hard is it to match into urology?

The urology match is a very challenging undertaking, even for American graduates. The average true match rate is somewhere around 60%. For IMGs, this number is drastically lower. According to ERAS, 69, 62 and 70 IMGs have registered for the AUA match in the last 3 cycles. Of these, only 33, 20 and 40 have gotten at least 1 interview. Additionally, each year has seen 5, 5 and 11 IMGs (both Caribbean and not) matched, for an estimated match rate of ~8%, ~7% and 15% respectively. IMGs usually take up less than 5% of the 380 available positions. Currently, IMGs make up less than 2% of the total urology residency workforce in the entire US.

Step Scores! How high should I score to match into urology residency?

Being such a competitive specialty high scores are essential. In the advent of a Pass/Fail Step 1, increased importance is given to Step 2 and Research. Urology is VERY ACADEMIC AND RESEARCH ORIENTED. Since the AUA/SAU provide no data on step scores, applicants can look at prior publications and the urology spreadsheet for some sort of insight. Matched American graduates typically score a mean of 255 on Step 2, however, this number is probably underestimating the current landscape where after the content change of December 2020, 270s have been more frequent. I personally know unmatched American grads with 270s. Without data, it’s hard to back up any claim, but I’d feel comfortable applying again with a 265+, but ideally a 270+. Given the sheer amount of competition, you need to stand out head and shoulders above the competition. I personally applied with a 265+.

You can read more about how to perform highly on STEP 2CK here.

United States Clinical Experience (USCE)

Like most surgical specialties, USCE proving that you’re a capable team player within a surgical team is a big plus. I personally did not have any hands-on USCE per se, however, had long periods of observerships and procedures in animal labs that helped me make up for my lack of USCE. Securing hands-on USCE as a graduate is very difficult, so, if possible, try to get some electives or sub-internships while you’re a medical student. You can read more about USCE and related opportunities here.

U.S. Clinical Experience

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Research

Research is one of the most important components of your application as an IMG. As previously mentioned, Urology is highly academic and expects applicants to be somewhat academically inclined. There’s no Charting the Outcomes of the match; however, I personally worked on sorting this out and presented this information at the AUA meeting of 2022. IMGs typically have AT LEAST 8 high-quality urology publications done while performing research fellowships in the US. Case reports and case series, as well as unrelated studies from other fields, are not very helpful to the overall strength of your application. These are not hard rules, and I know of people who have matched with less; however, the better prepared you are and the clearer it is for your application to stand out, the better your chances of doing well in the match. I personally applied with ~45 PubMed-indexed publications of which ~15 were urology-related and I was the first author in most. When combined with posters and presentations, this number grew to ~100.

While research overall is great, you should seek to land a research position within the US where you can work with a mentor.

To learn more about how to do research and research methodology check out our courses.

Match into your dream residency!

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Letters of Recommendation and Networking

Letters of Recommendation are by FAR the MOST important aspect of your application. A strong letter from a well-known urologist is the entire difference between getting and not getting interviews. In fact, a recent survey by the Mayo Clinic found that by far, LoRs are the single most important factor PDs consider when deciding who to extend interviews to. A letter this strong is unlikely to be obtained from a month or two of observership and instead needs to be cultivated over years. This is the reason why pretty much all matched IMGs spend years as Research Fellows prior to applying, as not only is research per se important, but the relation and trust built during this period are crucial for your letter. Since you need 3-4 letters to apply, you should branch out and seek to collaborate.

Attend as many conferences as you can, most notably, AUA, WCET and SUO are great places to network as these are typically frequented by most urologists.

ERAS and Experience

Your experiences should ideally demonstrate that you can grow within a project (i.e ascending from volunteer to coordinator), work well with a team, be able to finish tasks and demonstrate scientific curiosity. I applied with around 20 experiences; however new ERAS will limit this to only 10. It’s important to portray yourself as a well-rounded applicant. In my case, hobbies were a big part of my application, as I am a musician and included recordings of my songs which demonstrated dexterity.

Your experiences should not be repeated in your personal statement, but both should paint a congruent picture of your strengths as an applicant.

Application Packages

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Urology Match Experience

I applied to 135 programs, virtually every single program that did not explicitly state that it did not take IMGs. I received 9 interview offers and 15 waitlist offers, of which I ended up getting one additional interview offer. I attended 10 interviews and ranked all 10 programs. Preparing for interviews is KEY. Some of the interviews overlap with what interviewers will answer and being able to confidently answer these questions eloquently may become the difference between matching and not matching. If you’re offered an interview most likely you’re good enough to be there and it comes down to fit and matching their values.

Interview Preparation

The best way to learn something is to do it. That’s why we divide our one-hour interview preparation sessions into two parts. The first half of the session would be a mock interview as if you are interviewing with a program while the second half would provide you with feedback on your performance.

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While you don’t have to follow my experience exactly to a tee, and you may find success depending on your goals and luck (which is a very big part of matching) with effort, I wholeheartedly wish you all the success. The match is an arduous journey which I hope has a positive resolution for all of those who apply to the Match. I don’t consider myself the smartest person but I am a very hard worker and hopefully this will help you believe that you too, can DO it.

Written By: David Hinojosa-Gonzalez

David Hinojosa-Gonzalez is an incoming intern to the Urology Residency at Baylor College of Medicine in Houston, Texas. He graduated in 2020 from Tecnologico de Monterrey’s medical school in Mexico, where he served as a research fellow for a year prior to transition to Massachusetts General Hospital/Harvard Medical School for a 2-year research fellowship. He’s an avid researcher with over 100 publications and presentations, which helped him carve his way into the field where only <2% of the resident workforce are IMGs.06:45 PM