How do you land a uro spot?

[Cremaster]

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Hey,
I'm a 3rd year urologist wannabe, but the more I try to learn about the field, the more confused I get. I apologize for starting another GU thread, but I didn't want to jack the one 4th years were using to discuss this year's match. So, if anybody can help me out with these questions, I'd appreciate it.

How do you figure out where you should do away rotations? Do you place more weight in high profile programs in an attempt to get a good LOR from a well-known doc, or is it more important to spend a month somewhere where you will be likely to match (assuming that the two are different)?

What 4th year electives do you think are beneficial for an applicant?

What's the story with research? How critical is it? I don't know how I'll be able to fit any in, but if it's important, I'd like to know.

I've heard differing opinions on the necessity of taking step II in time for the PDs to see the scores. I asked one PD who wanted it. To the 4th years, what has your experience been? If it's not a must, what do you think the step I score should be before an applicant decides to hold off on taking step II until later in the year (when I took step I, the mean was 216 with an SD of 24)?

And finally (for now, at least)...what are your opinions on the different types of programs (5 vs. 6 years, 1 vs. 2 years of general surgery, programs with required research). I'd be happy to land a spot anywhere, but I'm interested in hearing your thoughts.

Thanks for helping me out...and I hope you will all be happy with the match results.

 

[Cremaster]

Umm...I don't mean to sound desperate, but I am. So, if somebody out there doesn't mind helping me out, I'd be grateful. Even if you don't have responses to all of my many questions...I'd appreciate any input you can offer.

Thanks again...congrats with the match.

 

[jt999]

well now that I matched, I guess I can offer some advice...

1) For away rotations, there are probably 2 strategies you can use. Either you can goto a high profile place and get letters from prominent urologists or you can goto a lesser place and get to know them real well. I elected to do the first and ended up getting 2 letters from well known docs that I believe helped me out tremendously. At many of the interviews, I would see the interviewers flip through my LOR and look at the name first. If it was someone they had heard of or knew perosnally, they would read them. Otherwise it was quite common that they just flipped ot the next letter. Don't know where you're form cremaster, but if you need, I can recommend places in the new york metro area for away rotations.

2)I don't think any 4th year electives are necessary other than a month of urology at your home institution and at least one away rotation. By the time you finish these up, you will probably be interviewing and your other electives will not matter.

3)I'm not sure if research is completely necessary, but I believe this is what helped me get all my interviews. I have about 4 papers from before med school and about 5-6 abstracts/papers during med school. I managed to get some posters accepted at the SUO and AUA meetings. An added bonus of going to these meetings was being able to run into your interviewers and get a second chance to talk to them. It seems like most programs want people who are capable of performing research in some way.

4) There are some programs that require you to complete step II before interviewing, but the vats majority don't seem to care. I personally took them in Sept. and kept them blocked until I got my results. After receiving the results, I unblocked the scores. I;m sure you;ve heard things like there are really high cutoffs for screening purposes, but trust me this is not necessarily true. I know people who got below average step one scores and still were getting alot of interviews. I'm sure some programs do have high cutoffs, but I think many don't.

5) My philosophy on 5vs6 years was that i didn't care. I was going to go to the program that I felt would best fit me. I ended up matching at a 6 year program, which was my #2 choice. Unless your an ultra competitive candidate, I don't think you should limit yourself to programs based on number of years of training. Urology is already very competitive... DOn't make it anymore so by narrowing your possibilities.

 

[FireAway]

1) I wouldn't recommend doing an away rotation at all unless you are at a medical school without a urology residency, or has a urology program that is "in transition" (i.e. a lousy program). If you really want to go to the expense of doing one, I would get a high profile place and work really hard. The problem with rotating at a place you really want to end up is that there are always random incidents that happen on any service which may reflect badly on you through no fault of your own. All it takes is one attending to wake up one the wrong side of the bed and you're toast. I matched at my #1, and I didn't do one at all. Is saw that happen with an away student at my med school.

Trauma surg, vascular surg, SICU. I'm sort of +/- on nephrology. I didn't do one, but my matchmate did and it was a difficult rotation with reportedly little benefit/applicability. Sure its the same organ, but how much dialysis do you really need to know? Anyway, they just treat it all with steroids anyway.

3) Research. This is an excellent question. The best advice I have for you before you go thru the process is to figure out what you want to be doing in 10 years. If you don't see yourself in academic medicine, I would not even bother with the expense of visiting UCLA or U of Washington. I mention those programs in particular b/c they weight that part of your app very heavily. In fact, at UCLA on the cover of your file they have a continuum of private practice (worst) to chairman of dept. (best) to keep track of your career goals. Interviewing is expensive, so if you're not a big research person (I'm not) then I would avoid the heavily-academic programs altogether. That is the single biggest mistake I made in the interviewing process, tho I'm thrilled with my end result.

4) No one at 16 programs asked me about my Step II scores, when I was gonna take it, etc. It never came up even once. I cleared 260 on my Step 1, so I wasn't about to take Step 2 and risk a bad result, or have questions about why I didn't release scores. In fact I still haven't taken it! Honestly I don't see any reason to take it in advance of your interviews, its really a nonissue unless you have a mediocre Step 1 score, in which case I would study my butt off and smoke it just to help that aspect of your app. As far as cutoffs, I wouldn't take Step 2 unless you got less than 220 or 230, but that's just an absolute stab in the dark, based on nothing at all.

5) I ended up putting all 6 year programs at the top of my list, but that's not because I had any preference. I just wanted to find a program that I liked, paying little attention to overall length. Some people say that with a 5 year program, you miss out on critical care management that you would get in a 6 year program, but of course that's controversial, and anyway part of the whole idea of going into urology in the first place is to avoid critical care, right? LOL The length of research committment is a personal thing too. As I said, I don't particularly like research (come on if I wanted to start a lab I wouldn't have gone to med school), so I wanted a program with only 6 mo of research. Frankly I'd rather do an extra year of gen surg than a wasted year in the lab.

The best advice I wish I could go back and give myself six months ago would be to avoid programs that are heavy on academics/research, and not to be tempted to interview at those places based on name value/prestige alone. I'm happy to name specific programs, but would prefer to do so via private email/IM if you're interested. Anyway, best wishes on the urology match.

 

[Cremaster]

JT and FireAway...I appreciate the input. Thanks for taking the time out to share your experiences and lend some advice. I hope to be in your shoes at this time next year.

Best of luck,
Cremaster

 

[PPdoc]

Hey Cremaster,

First of all, good luck -- it?s a long and sometimes frustrating process to get the residency you want.

I echo what has already been said, though I disagree with FireAway -- I did 2 away rotations plus one at my home program. Though some disagree with 3 mos of uro, it was good for me to evaluate the type of program that I was looking for (big academic vs. community-based). As it turned out, I really liked one of the programs, and really did not mesh with the other program -- something i would not have known unless i did a month there. also, doing a 3rd month allowed me to do a more specialized month (renal transplant in my case), though you could also do peds, onc, whatever.

Also, I do think that you need research, even if you are focused on smaller, community programs. It?s just one for factor working for you -- even if it?s just a case report, abstract, whatever. I think that some interviewers (even at community programs) have a checklist in their mind (sometimes literally in the file!) that includes research experience.

I did so-so on step 1, so I started studying for step 2 at the end of 3rd year and took it in july of 4th year -- my score jumped ~20pts. honestly, the earlier you take it, the better you will do (for most people), plus it is nice not to have to worry about it -- i?m almost done with med school and can?t remember the first thing about peds, ob/gyn, etc. That being said, if you smoked step 1 like FireAway, then you should probably wait.

5 vs. 6 -- i agree with what?s been said -- I had both types in my top 5 and ended up in a 5yr.

re LOR -- I had a letter from an internal medicine staff who is not that well-known (at least to urologists outside of my state) and the vast majority of my interviewers commented on it (one even read a section aloud). It generated much more of a positive response than the perfuctory, formula letter from my chairman. So, if you know someone well, and feel that they would write you a great letter, then use it -- even if they aren?t world-reknowned or even a urologist.

most important advice -- have fun your senior year!! take advantage of the fact it?s an early match -- I am writing this post from a hospital in Brasil, where I am on an elective surgery rotation.

good luck!