A Survey of Pediatric Urology Fellowship Applicants: Past Priorities to Guide Future Possibilities
Michael Ernst, MD1, Kristin Ebert, MD1, Alexandra Rehfuss, MD2, Daryl McLeod, MD1, Seth Alpert, MD1.
1Nationwide Children's Hospital, Columbus, OH, USA, 2Albany Medical College, Albany, NY, USA.
Background: The number of applicants to pediatric urology fellowships is often lower than the available positions, giving applicants significant influence over where they ultimately match. Historically, interviews were conducted at individual hospitals, in-person, during the penultimate year of residency training, with residents bearing the cost of flights and hotels at interviews. The objective of this study was to understand the factors associated with where applicants decide to apply, interview, and match for fellowship, as well as barriers within this process. Methods: A 24-question survey was sent to all applicants who successfully matched into pediatric urology fellowship from 2013 to 2019. Questions included: demographics; factors associated with where they applied, interviewed, and ranked; and burdens of application process. Results: A total of 126 recent and current fellows were contacted, and 73 (60%) completed the full survey (51% male and 49% female). Responses were received from every match year surveyed, with 53% having matched 2017-2019 and 47% 2013-2016. On average respondents applied to 10 programs, interviewed at 9, and ranked 8. The most important factors in selecting where to apply were: #1 Recommendations from mentor, #2 Reputation of program, and #3 Structure of training program. “Geographic location” as a factor was significantly correlated with female gender (0.293, p=0.019) and was 4th most important factor overall, but 2nd most important for female respondents. Overall, 34% (25) of respondents had children at time of application and this was significantly correlated with ranking “Family or personal reasons” as important when choosing where to apply (0.395, p=0.002). In fact, this was the most important factor overall for applicants with children. Rating important factors for their rank list on a scale of 1-5, respondents reported top factors as: #1 Clinical autonomy (4.2), #2 Reputation of program (3.8), and #3 Structure of program (3.7). Hospital facilities were only rated “important” by 12% (9) of respondents and were the #8 most important factor for applicants when making a rank list. 82% (60) faced at least one personal or professional barrier during the application process. The most common barrier was “cost of interviewing” (59%, 43 respondents), followed by “time off from work” (55%, 40) and “time away from family” (27%, 20). Personal vacation time was used by 61% (45) of applicants during interviews, with 37% (27) using more than 5 days. Open ended comments from respondents stated “cost is prohibitive”, “multiday interview process is likely unnecessary”, and “majority of this financial burden is on the applicants”. Conclusions: This study has shown that most pediatric urology fellowship applicants apply to programs primarily based on recommendations and the reputation of a training program. The most important factors when ranking programs are clinical autonomy and program reputation. Many applicants faced personal or professional barriers during the application process, largely due to costs and time away from work and family. While recent interviews have transitioned to a virtual format by necessity, prior applicants did not rate hospital facilities as important to them. Overall, there is room to improve this process based on such feedback.
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