J. Whitley2, B. D. Joyner1,2, K. Kieran1,2 1University Of Washington,Seattle, WA, USA 2Seattle Children’s Hospital,Seattle, WA, USA
Introduction: Increasing diversity remains a goal of many urology training programs. Failure to recruit and retain underrepresented minority (URM) applicants has been attributed to a “pipeline” issue, although it is unclear where in the “pipeline” this discrepancy is most pronounced. Since the cost of residency interviews has been previosuly identified as a potential barrier to some applicants, we wondered whether differential cost might be a factor for URM students applying to urology. We undertook this study to determine whether the structure of residency interviews at selected top residency programs is associated with differential cost to students at medical schools with high and low URM populations.
Methods: We identified 22 theoretical applicants: 11 "students" at medical schools with the student body >20% URM ("high-URM"), and 11 "students" at randomly selected medical schools with the student body <15% URM ("low-URM"). We contacted each of 17 "top" urology residency programs to identify interview dates for the 2017-2018 match, created a theoretical interview schedule for each "student," and calculated the cost of travel (by car for <3 hours drive, otherwise by air) and lodging from each of the 22 medical schools to the 17 residency programs on one of the planned interview dates. The aggregate costs to "students" at high-URM and low-URM medical schools were compared.
Results: The median aggregate costs of travel and lodging for "students" attending all 17 interviews was $9189 (range: $7202-13,703) for applicants from high-URM schools and $9035 (range: $6698-$11967) for applicants from low-URM institutions (p=0.81).
Conclusion: In the 2017-2018 urology interview season, costs to applicants from high-URM and low-URM institutions are statistically similar. Absolute cost considerations are unlikely to account for differences in URM representation in top-tier residency programs. Program directors and undergraduate medical education leadership must continue to investigate real and postulated barriers to URM engagement and retention along the pipeline to urology graduate medical education.