Investigators assess applicants’ considerations in preference signaling for urology residency

The diversity of current residents at a urology program was found to positively influence the diversity of applicants to that program for residency, according to findings from a recent study published in Urology.¹

Among all respondents, 81.8% were in favor of a continuation of preference signaling, with 4.1% indicating that they were against it.

The study was conducted by investigators at Cleveland Clinic in Cleveland, Ohio.

"Promoting gender and ethnic diversity in the urology workforce is vital, considering the diverse patient population requiring care. One important step to enhance provider diversity is increasing the diversity among residents,” said lead author Juan Sebastian Rodriguez-Alvarez, MD, in correspondence with Urology Times. Rodriguez-Alvarez is a research fellow at the Glickman Urological and Kidney Institute at Cleveland Clinic.

For the study, 403 candidates who applied to Cleveland Clinic during the 2023 American Urological Association Urology Residency Match were emailed a multiple-choice survey the day after Match Day. In total, 121 (30%) responded to the survey, and all recorded responses were anonymous.

Among all respondents, 81.8% were in favor of a continuation of preference signaling, with 4.1% indicating that they were against it. In regard to applicant interviews, 52.1% of respondents indicated that interviews should remain virtual, whereas 24.8% disagreed.

The investigators also found that when respondents indicated a preference signal for a program, they were 2.74 times more likely to obtain an interview with that program compared with programs they did not preference signal. Among all matched applicants, 47.5% matched at a program where they completed their sub-internship, and 25.7% matched at a program that they preference signaled.

In regard to the rationale behind preference signaling, geographic location and perceived quality of clinical training were the highest ranked factors in respondents’ choice of where to preference signal or sub-internship. The lowest ranked criteria was a program’s research reputation on Doximity.

Further, 77.8% of Black respondents, 72.7% of Asian respondents, 57.1% of Latino respondents, and 46.5% of White respondents indicated that the racial and ethnic diversity of residents at a program influenced their decision to preference signal or sub-internship with that program. This difference was found to be significant when comparing Black and Asian respondents to White respondents (P < .05).

Similarly, 88.9% of Black respondents, 55% of Asian respondents, 64.3% of Latino respondents, and 25.4% of White respondents indicated that a program’s institutional statement on diversity influenced their decision to preference signal or sub-internship. This difference was found to be significant when comparing Black, Asian, and Latino participants with White participants (P < .05).

Among all female respondents, 81.6% were more likely to preference signal or choose a sub-internship with programs that had gender diversity among residents, compared with only 33.8% of male respondents (P = .002). Similarly, 73.5% of female respondents indicated that their decision to preference signal or sub-internship was at least slightly influenced by the ethnic diversity of residents, compared with 39.7% of male respondents (P < .001).

Senior author of the study and reconstructive urologist at Cleveland Clinic, Molly E. DeWitt-Foy, MD, stated in correspondence with Urology Times, “Our survey-based study exploring criteria behind preference signaling or sub-internship applications highlights the importance of ethnic diversity among residents and faculty in attracting female applicants. Notably, diverse residents, but not faculty, had a positive influence on ethnically diverse applicants. We advocate for programs to prioritize enhancing both resident and faculty diversity, ultimately cultivating a more gender and ethnically diverse resident pool.”

Reference

1. Rodriguez-Alvarez JS, Munoz-Lopez C, Khouri Jr. RK, Emrich Accioly JP, Harwood S, Campbell SC, DeWitt-Foy ME. Diversity attracts diversity: 2023 AUA Match results. Urology. 2023 Jul 19;S0090-4295(23)00596-4. doi:10.1016/j.urology.2023.07.008