To the Editor
The COVID-19 pandemic has led to significant disruptions in undergraduate and postgraduate Urology education and training. In this letter, we examine the wide-ranging impact of the COVID-19 pandemic on the Urology Residency Match in Singapore, and share strategies to proactively mitigate these consequences.
BACKGROUND TO SINGAPORE'S UROLOGY RESIDENCY MATCH
Urology Residency in Singapore is a 6-year program accredited by the Accreditation Council for Graduate Medical Education-International. Nationwide, there are 3 Sponsoring Institutions (SI) as training sites. Applicants are required to submit their Curriculum Vitae, Referee letters, and participate in Multiple Mini Interviews, conducted by the Ministry of Health.1 Successful applicants are asked to rank their preference for a SI, and the 3 SIs will similarly rank the applicants. Potential residents are only allowed to apply in their second year after graduation, and have typically completed at least one formal postgraduate Urology clerkship.
IMPACT OF THE COVID-19 PANDEMIC ON POTENTIAL RESIDENTS
Due to social distancing measures, medical student education has relied primarily on remote-teaching via video-conferencing platforms. Medical student electives have been cancelled. Valuable hands-on exposure to diverse Urologic procedures, known to significantly influence decisions to enter Urology residency,2 have been lost. Due to manpower redistribution, doctors have been redeployed from Urology departments to frontline departments. Potential residents have faced difficulties securing clinical clerkships and electives in Urology. Even within Urology clerkships, potential residents have been confronted with reduced surgical exposure due to deferment of non-urgent surgeries. Local and international conferences and workshops, typically keenly attended by potential residents, have been cancelled. In Singapore, experiences during clinical clerkship, positive working environments, quality of education, and quality of mentorship have been found to be the most important factors influencing residency choices among applicants.3 These factors are fundamentally related to the experiences of working and learning in the speciality of interest, and interacting with faculty and residents. These have been significantly disrupted and restricted by the pandemic. The feared eventual impact would be declining interests in Urology residency, and less-informed choices on preferred training sites. From the Program's perspective, the pandemic has undoubtedly limited first-hand opportunities to evaluate potential residents.
STRATEGIES TO MITIGATE CONSEQUENCES
To guard against the detrimental effects of reduced Urology exposure,4 core Urology curriculum for medical students was maintained via video-conferencing. Didactic teaching was deliberately modified to include more case-based learning, and a variety of Urology procedures was intentionally introduced to students, leveraging on online resources. Interns rotating through the Urology department were also actively engaged through hands-on exposure to various procedures. Potential residents and students who were unable to secure clerkships or electives were engaged in scholarly activities through research participation. Moving forward, we would strongly consider forming Urology Interest Groups, which have been shown to be a significant positive predictor of Urology residency application.5
CONCLUSION
With no clear end in sight for the COVID-19 pandemic, it is timely for Residency Programs worldwide to examine the impact on their respective Urology Residency Match Exercises, and proactively implement measures to mitigate these consequences for the foreseeable future.
AUTHORS’ CONTRIBUTIONS
Yi Quan Tan: Conceptualization, Writing - original draft. Gregory Pek: Conceptualization, Writing - review & editing. Ziting Wang: Conceptualization, Writing - review & editing. Ho Yee Tiong: Conceptualization, Writing - review & editing. Edmund Chiong: Conceptualization, Writing - review & editing, Supervision.
References
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