Malshy Kamil, Hunt Trevor C, Cheng Zijing, Li Ashley, Steidle Matthew, Campbell Timothy D, Doersch Karen M, Joseph Jean V, Bandari Jathin
Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
Department of Health Services Research and Policy, University of Rochester Medical Center, Rochester, NY, USA.
Transl Androl Urol. 2025 Aug 30;14(8):2365-2374. doi: 10.21037/tau-2025-367. Epub 2025 Aug 26.
Diversity enhances quality, innovation, and cultural competence; however, international medical graduates (IMGs) may face disparities in matching into American residency and fellowship programs. This study aimed to examine the influence of medical education [US/Canada (US/CA) . IMGs] on match outcomes in urology over time.
We analyzed the American Urological Association residency and subspecialty fellowship match data (2014-2024), examining trends in total match slots and those filled by US/CA . IMG applicants across residency and fellowship programs. Secondary analyses assessed residency and fellowship trends separately, compared match rates, and evaluated unmatched applicants. Spearman's correlation assessed trend monotonicity, and chi-squared tests compared match outcomes by applicant group.
7,273 applicants [6,061 (83.3%) US/CA; 1,212 (16.7%) IMG] participated in urology matches from 2014-2024, with 4,995 (68.7%) applying to residency and 2,278 (31.3%) to fellowship programs. Total residency and fellowship slots significantly increased from 385 in 2014 to 586 in 2024 (ρ=1.00; P<0.001). Matched US/CA applicants rose significantly from 342 to 499 (ρ=0.99; P<0.001), while matched IMGs showed no significant change (ρ=0.51; P=0.10). US/CA applicants primarily drove the increase in filled slots. Secondary analyses showed US/CA applicants had significantly higher match rates overall [odds ratio (OR) =10.5, 95% confidence interval (CI): 9.1-12.1, P<0.001], in residency (OR =6.7, 95% CI: 5.3-8.5, P<0.001), and fellowship (OR =17.8, 95% CI: 14.4-22.5, P<0.001).
Over the past decade, urology residency and fellowship slots have increased, predominantly filled by more US/CA applicants. In contrast, IMG participation and match rates have remained stagnant, with significantly lower outcomes overall and within both matches.
多样性可提高质量、促进创新并增强文化能力；然而，国际医学毕业生（IMGs）在匹配进入美国住院医师培训和专科 fellowship 项目时可能面临差异。本研究旨在探讨医学教育背景[美国/加拿大（US/CA）. IMGs]对泌尿外科匹配结果随时间的影响。
我们分析了美国泌尿外科协会住院医师培训和亚专科 fellowship 匹配数据（2014 - 2024 年），研究住院医师培训和 fellowship 项目中总匹配名额以及由 US/CA. IMG 申请人填补的名额趋势。二次分析分别评估住院医师培训和 fellowship 的趋势，比较匹配率，并评估未匹配的申请人。Spearman 相关性评估趋势单调性，卡方检验按申请人组比较匹配结果。
2014 - 2024 年期间，7273 名申请人[6061 名（83.3%）US/CA；1212 名（16.7%）IMG]参与了泌尿外科匹配，其中 4995 名（68.7%）申请住院医师培训，2278 名（31.3%）申请 fellowship 项目。住院医师培训和 fellowship 的总名额从 2014 年的 385 个显著增加到 2024 年的 586 个（ρ = 1.00；P < 0.001）。匹配的 US/CA 申请人从 342 名显著增加到 499 名（ρ = 0.99；P < 0.001），而匹配的 IMGs 没有显著变化（ρ = 0.51；P = 0.10）。US/CA 申请人是填补名额增加的主要驱动力。二次分析显示，US/CA 申请人总体匹配率显著更高[优势比（OR）= 10.5，95%置信区间（CI）：9.1 - 12.1，P < 0.001]，在住院医师培训中（OR = 6.7，95%CI：5.3 - 8.5，P < 0.001），以及在 fellowship 中（OR = 17.8，95%CI：14.4 - 22.5，P < 0.001）。
在过去十年中，泌尿外科住院医师培训和 fellowship 名额增加，主要由更多的 US/CA 申请人填补。相比之下，IMG 的参与度和匹配率一直停滞不前，总体以及在两种匹配中的结果都显著更低。
