COVID-19 adjustments impact Urology Residency training

Nov. 20, 2020

The COVID-19 pandemic has put incalculable strains on the health care system and its providers. The practice of medicine has been forced to change to keep patients and health care staff as safe as possible.

For some hospitals and practices, health care is delivered in great part by residents, under the supervision of their attending physicians. Undoubtedly, their education, service and daily lives have been impacted. Likewise, medical students preparing for matriculation into residency programs have to negotiate an environment that is unlike the experience of residency application and interviewing in the past.

Boyd R. Viers, M.D., the associate program director of the Urology Residency program at Mayo Clinic in Rochester, Minnesota, discusses some of the recent changes in the program.

What are some of the changes that you have seen in residency training in your department, both prior to and during the pandemic?

Changes in residency training will extend beyond the 2020 pandemic. Some of the pursuits we have been making in simulation have really helped during the pandemic. There has been a paradigm shift in urologic surgery education. The traditional mantra of "see one, do one, teach one" just doesn't apply anymore. We are now in an era with an emphasis on "see some, practice many, and only operate once proficient."

Endoscopic and robotic surgery has a large footprint in urologic care. We can now provide many training tools to enable our residents to practice and build surgical skill before they ever operate on patients. For robotic surgery, we have implemented a well-defined competence-based curriculum and a pathway to live patient cases. It starts with didactics and surgical video review followed by a basic and advanced virtual robotic simulation course, and finally culminates in a faculty-led robotic cadaver lab. Each one of these components is applicable to trainees at any surgical skill level and enables them to continually build on their current level of proficiency. Such a process has been well received and allows for the trainees to transition safely and effectively to live patient care.

As for changes related to the pandemic, I do not know where to start. I do feel that limiting our ability to gather in person in groups to discuss interesting cases, review journal articles, or go over morbidity and mortality has been detrimental to all training programs. In an effort to mitigate the side effects imposed by the pandemic, we have gone to every effort possible to move all educational events to a virtual platform. While we hope this situation is short-lived, we now have an efficient process in place that would allow for us to continue virtual education well into the future.

It's a very stressful time for everyone, including residents. What sorts of measures have you pursued to check in with residents and address any concerns?

Pandemic-related stress and distractions have greatly impacted our residents' ability to focus on becoming great urologic surgeons. To create a healthy learning environment, one needs to have stability, predictability and a sense of well-being. In an effort to reduce trainee stress and enhance physical and emotional well-being, we are currently remodeling the resident workroom to create a dedicated for space for fitness, meditation and emotional recovery for our trainees. This outcome is the result of monthly virtual town hall meetings between the program directors and trainees to address any concerns that they may have.

Urology is a competitive and early match. How has your application and interview process changed?

The application process has changed dramatically. COVID-19 has forced us to get creative in how we personalize the interview experience.

First, this year it was not possible for trainees to do subinternship rotations; there was no way for us to evaluate them, or for them to evaluate us. Any exposure to our program has been through pre-interview-season applicant town halls and by upping our game with social media content. The residents have started an Instagram page!

Second, the time between application review and invitation to interview has been condensed. In addition, all interviews will be done in a virtual manner, and therefore we anticipate a much larger applicant pool this year. Due to the virtual nature of this interview season, applicants will be able to participate in a much larger number of institution interviews. As a result, there is concern that this could lead to a very top-heavy interview pool. In an effort to mitigate this effect at our institution we have added interview days, will perform a comprehensive review of each applicant who applies to Mayo Clinic, and will employ several additional checks and balances to ensure that we have a diverse and well-represented pool of interviewees.

Third, a large part of the interview experience is the ability to get a personal sense of the institution and its culture, and the ability to interact with current trainees. We intend to have a virtual dinner with breakout sessions for prospective applicants and current residents the evening before each interview day and will continue with a live virtual tour of all facilities for each group of applicants.

What advice would you offer to a potential resident or to the mentor of a medical student pursuing a Urology Residency?

Do not close any doors. Medical students who go on to excel in Urology Residency are those who do well in their core clerkships. Away rotations can be helpful to build relationships and get to see an institution that you are seriously interested in. Unfortunately, this year away rotations were not possible for many of applicants, if any at all. We understand this, and also understand that residents' ability to get outside letters of recommendation is limited. In spring 2020, core clerkship grades were tossed out the window in some medical schools. Many institutions went from a grading system that included honors to a pass-fail-only system.

Given the competitive nature of urology, I understand that this situation can be quite stressful. First impressions will be critical this year as we rely on virtual interaction. I would strongly urge mentors to tell their mentees to reach out to institutions that they are seriously interested in.

For more information

Urology Residency (Arizona). Mayo Clinic.

Urology Residency (Florida). Mayo Clinic.

Urology Residency (Minnesota). Mayo Clinic.