Introduction: Urology residency training encompasses a broad spectrum of subspecialty training. There is an expectation of competency in all aspects of practice upon certification. However, there is variability in exposure to subspecialty care, as well as heterogeneity in teaching sessions offered by different training programs. The objective of this study is to assess whether knowledge gaps exist among graduating Canadian urology residents.

Methods: A retrospective review of graduating residents’ performance on an annual mock exam (QUEST) held a few months before the Royal College exam was conducted for three graduating years: 2020, 2021, and 2022. The written exam, consisting of multiple-choice questions, was itemized under eight separate topics: oncology, andrology/benign prostatic hyperplasia (BPH), physiology/anatomy, female/neurourology, pediatrics, infections, nephrolithiasis, and trauma/reconstruction. A one-way ANOVA, a posthoc Tukey, and non-parametric Kruskal-Wallis tests were conducted.

Results: The exams of 115 participants from all three years were reviewed. The distribution of questions was as follows: oncology (n=60), andrology/BPH (n=39), physiology/anatomy (n=54), female/neurourology (n=39), pediatrics (n=48), infections (n=23), nephrolithiasis (n=21), and trauma/reconstruction (n=16). Overall, there was a statistically significant difference in performance on the various topics (p<0.001). On posthoc Tukey, residents performed better on female/neurourology compared to andrology/BPH (p=0.004), and female/neurourology compared to pediatrics (p=0.001).

Conclusions: Graduating Canadian urology residents appear to have knowledge gaps in andrology/BPH and pediatrics. Future Canadian Urological Association courses in these topics should be considered to address these gaps.