Assessing the Female and Underrepresented Minority Medical Student Experience in the Urology Match: Where Do We Fall Short?

Published:October 13, 2020DOI:



      To better understand the experiences of female and underrepresented minority (URM) medical students pursuing urology and determine if discrimination was perceived at any point during the application process.


      After the rank list submission deadline (January 2, 2020), we emailed an anonymous survey to all 353 applicants to our institution for the 2020 AUA Residency Match (80.0% of applicants nationally). The survey inquired about their experiences pursuing urology and the residency match process. Ordinal regression models were used to identify any significant predictors of survey responses.


      One hundred ninety applicants (136 male [72%], 54 female [28%]) completed the survey. A significantly higher percentage of females vs males noted discrimination (odds ratio: 2.53; confidence interval: 1.37-4.74, Fig. 1). URM students also reported higher frequencies of discrimination than non-URM students (odds ratio: 2.27; confidence interval: 1.07-4.83). Thirty-two percent of respondents tested positive on the Maslach Burnout Inventory; we did not identify any predictors of burnout. Higher proportions of female residents, faculty and leadership at a particular program had a more favorable impact on the rank lists of female applicants compared with males. Higher proportions of URM residents, faculty and leadership at a particular program had a more favorable impact on the rank lists of URM applicants compared with non-URM.


      Our collective findings suggest that URM and female medical students have less favorable experiences interacting with urology trainees and faculty than do their nonminority and male counterparts. Higher percentages of female and URM urology residents and faculty promote effective recruitment of female and URM applicants.
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      1. Vespa J, Medina L, Armstrong D. Demographic Turning Points for the United States: Population Projections; 2020. Available at:

        • Alsan M
        • Garrick O
        • Graziani G
        Does diversity matter for health? Experimental evidence from Oakland.
        Am Econ Rev. 2019; 109: 4071-4111
        • Greenwood BN
        • Carnahan S
        • Huang L
        Patient-physician gender concordance and increased mortality among female heart attack patients.
        Proc Natl Acad Sci U S A. 2018; 115: 8569-8574
        • Roter DL
        • Hall JA
        • Aoki Y
        Physician gender effects in medical communication: a meta-analytic review.
        JAMA. 2002; 288: 756-764
        • Komaromy M
        • Grumbach K
        • Drake M
        • et al.
        The role of black and Hispanic physicians in providing health care for underserved populations.
        N Engl J Med. 1996; 334: 1305-1310
        • Lucas FL
        • Stukel TA
        • Morris AM
        • Siewers AE
        • Birkmeyer JD
        Race and surgical mortality in the United States.
        Ann Surg. 2006; 243: 281-286
        • Cooper-Patrick L
        • Gallo JJ
        • Gonzales JJ
        • et al.
        Race, gender, and partnership in the patient-physician relationship.
        JAMA. 1999; 282: 583-589
        • Association of American Medical Colleges
        Diversity in Medicine: Facts and Figures.
        2019 (Available at:)
        • American Urological Association
        The State of the Urology Workforce and Practice in the United States.
        2018 (Available at:)
      2. Association of American Medical Colleges. 2019 Fall Applicant, Matriculant, and Enrollment Data Tables. Available at:

        • American Urological Association
        Urology Residents in the United States and Across the Globe.
        2018 (Available at:)
        • Shantharam G
        • Tran TY
        • McGee H
        • Thavaseelan S
        Examining trends in underrepresented minorities in urology residency.
        Urology. 2019; 127: 36-41
        • American Urological Association
        Urology Residency Match Statistics.
        2020 (Available at:)
        • Halpern JA
        • Lee UJ
        • Wolff EM
        • et al.
        Women in urology residency, 1978-2013: a critical look at gender representation in our specialty.
        Urology. 2016; 92: 20-25
        • Mészáros V
        • Adám S
        • Szabó M
        • Szigeti R
        • Urbán R
        The bifactor model of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS)—an alternative measurement model of burnout.
        Stress Health. 2014; 30: 82-88
        • Hill KA
        • Samuels EA
        • Gross CP
        • et al.
        Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation.
        JAMA Intern Med. 2020;
        • Cook AF
        • Arora VM
        • Rasinski KA
        • Curlin FA
        • Yoon JD
        The prevalence of medical student mistreatment and its association with burnout.
        Acad Med. 2014; 89: 749-754
        • Dyrbye LN
        • Burke SE
        • Hardeman RR
        • et al.
        Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians.
        JAMA. 2018; 320: 1114-1130
        • Hu Y-Y
        • Ellis RJ
        • Hewitt DB
        • et al.
        Discrimination, abuse, harassment, and burnout in surgical residency training.
        N Engl J Med. 2019; 381: 1741-1752
        • Wong D
        • Ganesan V
        • Kuprasertkul I
        • Khouri RK
        • Lemack GE
        Reversing the decline in urology residency applications: an analysis of medical school factors critical to maintaining student interest.
        Urology. 2019;
        • Hewitt DB
        • Ellis RJ
        • Chung JW
        • et al.
        Association of surgical resident wellness with medical errors and patient outcomes.
        Ann Surg. 2020;
        • Dyrbye LN
        • Thomas MR
        • Massie FS
        • et al.
        Burnout and suicidal ideation among US medical students.
        Ann Intern Med. 2008; 149: 334-341
        • Kane L.
        Medscape National Physician Burnout & Suicide Report.
        • Marchalik D
        • Catomeris A
        • Krasnow R
        The impact of burnout on professional and academic goals and career regret in urology trainees.
        J Urol. 2019; 202: 45-46
        • Filippou P
        • Mahajan S
        • Deal A
        • et al.
        The presence of gender bias in letters of recommendations written for urology residency applicants.
        Urology. 2019; 134: 56-61
        • Washington SL
        • Baradaran N
        • Gaither TW
        • et al.
        Racial distribution of urology workforce in United States in comparison to general population.
        Transl Androl Urol. 2018; 7: 526-534
        • Dai JC
        • Agochukwu-Mmonu N
        • Hittelman AB
        Strategies for attracting women and underrepresented minorities in urology.
        Curr Urol Rep. 2019; 20: 61