Tips for optimizing productivity and collaboration for trainees who go unmatched in urology

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"Going into the upcoming application cycle, I am now a bit more excited and a little less terrified," writes Leah Ashton, MD.

Leah Ashton, MD

The fourth year of medical school is equally exciting and terrifying. This final year of training is, in so many ways, the culmination of a lifetime of volunteering, working, studying, and researching for the very sake of learning and for being considered a competitive applicant for the residency specialty of our choosing. This final year does a great job of preparing us for the next chapter in our training. It provides much less direction for those of us who go unmatched. Neither programs nor applicants want to prepare for this circumstance. So, when I read the words “no match” on February 1, I felt unprepared for how best to proceed. After coping with the initial wave of disappointment, I asked myself ever so quietly, “What steps do I need to take, now, to become a urologist?”

Step 1: I needed to decide whether to apply for a surgical preliminary position or for a research-intensive fellowship to enhance my application.

I reached out to every preliminary general surgery program with a urology department and asked if they were still interviewing applicants. I applied to every research opportunity I could find.

Without knowing which type of opportunity to pursue, I turned to the Twitterverse, as I didn’t personally know anyone who had gone through a similar experience. I went on a particular “social media search” for physicians who might be open to providing personalized mentorship. After a very discouraging preliminary surgery interview, I reached out to Amy M. Pearlman, MD, via direct message. She immediately responded and arranged a time to meet over Zoom. During our discussion, I made it clear that I was willing to move anywhere for an opportunity to be productive and have good mentorship. She created a position for me, on the spot, to work with her in Iowa.

My new mentor’s sentiment was clear. She acknowledged my value as an applicant, saw potential in me to contribute to her research initiatives, and, therefore, offered me an opportunity to join her team.

This brings me to my first piece of advice for unmatched applicants: Identify all types of opportunities. Interview broadly. Seek out personalized mentorship. (And consider using social media as a means to connect.)

Step 2: I needed to figure out the logistics of this research year. Dr. Pearlman informed me during our initial conversation that she currently did not have funding to support a research fellow. This meant I needed to assess my current financial situation and figure out if I could pursue an unfunded opportunity. I also needed to discuss relocating with my fiancé (as we were in the midst of preparing for our summer wedding).

Dr. Pearlman acknowledged the importance of financial support, nonetheless, and offered to look for potential funding mechanisms.

This brings me to my second piece of advice: Engage in honest conversations with potential mentors regarding funding opportunities. If the mentor currently doesn’t have funding, discuss opportunities for applying for funding well in advance of deadlines.

Step 3: I needed to figure out how to be productive even prior to graduating medical school.

I found out in February I didn’t match and had plans to reapply the following cycle. This meant I needed to spend my remaining months of medical school, which most students spend winding down and traveling, being as productive as possible to strengthen my application. I was able to join an existing research project with Dr. Pearlman that was at the manuscript-preparation stage. I met with my institution’s librarian and was able to complete the first manuscript draft prior to graduating medical school. As a result, I was able to submit the manuscript to a peer-reviewed journal well in advance of the residency application deadline.

This brings me to my third piece of advice: Start before actually starting. If you are able to begin working on research projects early, this could be the difference between having nearly 8 months of productive time before the next application deadline vs 4 (if I had started in June).

As I prepare to reapply this fall, I can’t say with certainty that these 3 steps are enough to be successful in matching the second time around, but they are something tangible that have allowed me to grow as a person and applicant. Going into the upcoming application cycle, I am now a bit more excited and a little less terrified.

Amy M. Pearlman, MD

I initially met Leah in the Twitterverse in February 2022. She briefly introduced herself via a direct Twitter message and asked if I might be available to provide guidance as she tried to navigate the waters of an applicant who had just gone unmatched into urology residency. We hopped on a Zoom call that Saturday. I asked about what she perceived to be strengths and weaknesses of her application and what her options were for the upcoming year. For Leah and others in similar situations, there is no guidebook as to whether to pursue a 1-year general surgery preliminary or research experience. There is also no right answer. Conversations like these in times like these necessitate thoughtful reflection—a very vulnerable thing to ask of oneself and of someone with whom I had just met.

I asked her questions like,

• “Where are you willing to live for a year?” to which she responded, “Anywhere.”

• “What do you hope to gain from the year?” to which she responded, “Meet as many people as possible and be productive.”

• “Do you want to be my research fellow for a year in Iowa?” to which she responded “Absolutely.”

This conversation necessitated we address critical logistics, including that I had no funding to support her position for the year, but that I would look for funding mechanisms and email some of my colleagues regarding additional opportunities.

I also had to acknowledge that, although her move to Iowa and contribution to our research enterprise would be a productive experience, it would not secure her a spot in our residency program.

It was important for the future of our mentor-mentee relationship that we have this type of real-talk conversation—even during our very first conversation on a Saturday morning over Zoom. It was important that I communicate what I could and could not guarantee her should she decide to relocate over 700 miles with her husband and puppy. It came down to the one and only thing I could guarantee—mentorship.

My role as a mentor, particularly for a residency reapplicant, can be broken down into 6 tangible responsibilities:

Monitor what type of guidance is needed from my mentee, allowing for these needs to change. Intentionally asking the simplest of questions, “What else?” at regular intervals.

Educate my mentee on various aspects of urology, not just those related to research projects. The research year is an incredible time for an applicant to build their foundation of urologic knowledge prior to even starting residency. Rather than being considered behind, this time allows the applicant to actually get ahead.

Network. Introducing my mentee to faculty, staff, and trainees. Everyone I know, I want my mentee to know. Encourage my mentee to develop additional mentorship relationships with my colleagues. Doing so also opens up additional funding opportunities.

Train my mentee on a variety of communication skills and provide constructive feedback on responses, with a particular focus on common interview questions. Interview performance for reapplicants is even more important the second time around and can become a space for the well-prepared applicant to excel.

Observe for any and all opportunities, separate from research, to involve my mentee in meaningful initiatives, from urology-related community outreach to attendance at society meetings. This provides the applicant with additional opportunities to contribute, as well as additional experiences for the applicant to add to their application and interview responses.

Respond in a timely fashion, particularly to publication drafts and application material edits. There is no time to waste as the mentee is preparing to reapply.

I strive to be an intentional mentor. One that allows for flexibility in needs and time constraints of my mentee and me. These responsibilities allow for curiosity, growth, and a genuine appreciation for the contributions of the mentee and mentor.