In the world of surgical training, the debate over the optimal duration of fellowship programs is ongoing and multifaceted. As the landscape of urologic oncology continues to evolve with advancements in research, diagnostics, treatments, and surgical techniques, the demand for highly specialized and skilled urologic oncologists has become more pronounced than ever before. Fellowship training plays a pivotal role in shaping the future of this field, providing urologists with the necessary expertise to deliver comprehensive care to patients battling urologic cancers. However, before one can identify a length of time for a defined training program, they must first outline the goals of the educational platform. It is within this context to determine the adequate training duration.

The Society of Urologic Oncology (SUO) formalized its self-accredited fellowship structure in 2001, later creating an oversight committee in 2009 to certify compliance and quality with the training goals. Since that time, programs are required to fulfill strict criteria, ensuring high-quality training environments that facilitate a comprehensive approach to understanding not only multidisciplinary treatment approaches to genitourinary cancers, but also their underlying biologic differences that allow for a refined approach to directing future scientific explorations and treatments. During these deliberations, the SUO identified the necessary requirements for graduates of SUO-sponsored fellowship programs:

1. Advanced expertise in the multidisciplinary management of patients with urologic cancer
2. Knowledge and the ability to apply the critical principles of:
   a) Medical oncology
   b) Radiation oncology
   c) Uropathology
   d) Urologic imaging techniques
3. Ability to perform complex tumor resections with a clear understanding of the benefits and the technical limitations of surgical procedures
4. Ability to perform minimally invasive approaches for diagnostic and therapeutic treatment of urologic malignancies
5. Extensive knowledge of and technical experience in urinary tract diversion and reconstruction
6. Knowledge of the biology of urologic malignancies
7. Comprehension of and facility with scientific methodology, study design, biostatistics, clinical trials, and data analysis
8. Ability to manage academic or tertiary referral clinical practice, participate in continuing education
9. Skills for self-education, and collaboration in translational research

It is within these parameters that a 24-month training program was established, including dedicated 12-month research and clinical periods. It was felt that this 2-year fellowship program would allow for a more comprehensive and in-depth immersion into the intricacies of urologic oncology. Urologic cancers encompass a broad spectrum of diseases, each presenting unique challenges and complexities. From the more prevalent prostate, kidney, and bladder cancers to the less common connective tissue, penile, and testicular cancers, a thorough understanding of disease pathology, staging, treatment modalities, and posttreatment care is paramount. A 2-year fellowship enables fellows to delve deeper into each disease process, honing their diagnostic skills, refining surgical techniques, and gaining exposure to a wider array of complex cases under the guidance of seasoned mentors.

Moreover, a 2-year fellowship program fosters the development of research acumen and scholarly pursuits among fellows. Research plays an integral role in advancing the field of urologic oncology, driving innovation, and improving patient outcomes. With a dedicated research year, fellows have ample time to conceptualize, execute, and disseminate meaningful research projects. Whether it involves clinical trials, translational research, or outcomes studies, the SUO fellowship structure allows for a more robust exploration of research questions, fostering critical thinking and scientific inquiry. Furthermore, fellows can establish valuable collaborations with interdisciplinary teams and contribute to the burgeoning body of knowledge in urologic oncology. The SUO strongly believes that one of its core missions is to continue to produce surgeon-scientists, and our fellowships are designed to do this.

In addition to clinical and research training, a 2-year fellowship program affords fellows the opportunity for enhanced mentorship and professional development. Mentorship plays a pivotal role in shaping the career trajectory of aspiring urologic oncologists, providing guidance, support, and invaluable insights gleaned from years of experience. A 2-year fellowship allows for more meaningful mentor-mentee relationships to flourish, facilitating personalized career guidance, networking opportunities, and exposure to leadership roles within the field. Moreover, fellows can partake in specialized educational initiatives, such as multidisciplinary tumor boards, national conferences, and advanced degrees (master of public health, master of clinical research, master of biomedical sciences, etc), further augmenting their skill set and professional competencies.

A 2-year fellowship program better prepares fellows for the rigors of independent practice upon completion of training. Urologic oncology is a dynamic and fast-paced field, requiring adept clinical decision-making, technical proficiency, and the ability to navigate complex patient scenarios. The additional year of hands-on experience and mentorship equips fellows with the confidence, competence, and resilience needed to excel in their future roles as urologic oncologists. Whether it involves managing challenging cases, collaborating with multidisciplinary teams, or spearheading quality improvement initiatives, the comprehensive training provided by a 2-year fellowship program ensures that fellows are well prepared to deliver high-quality, patient-centered care.

In preparation for the 2023 SUO winter meeting held in Washington, District of Columbia, the SUO executive board circulated separate questionnaires to current residents interested in advanced fellowship training beyond residency and those having completed the current SUO-structured fellowship training during the last 15 years. Unsurprisingly, residents are interested in the shortest duration of training possible, with 73% favoring a 1-year over a 2-year program. However, when polling prior SUO graduates regarding the benefits of an additional research year, 82% stated the mandated time enhanced their knowledge/understanding of urologic cancers beyond what the clinical year could provide (Figure 1). Additionally, the overwhelming majority of trainees felt prepared to independently manage their clinical (94%), research (including clinical trials; 97% and 88%, respectively), and teaching components of their future positions (Figure 2).

It is imperative for those in positions of leadership to instill our perspectives on what is necessary for understanding the biology behind the disease and what is required for the person receiving that training. More importantly, our responsibilities lie on doing what is best for the patients we care for by offering a product of surgical training and research that ensures future generations will receive even better care going forward as a result of advancing our knowledge. By establishing a 2-year duration of training, the SUO cultivates a cadre of highly skilled, well-rounded urologic oncologists poised to tackle the complex challenges of this evolving field and make enduring scientific contributions to the care of patients with urologic cancers. As ambassadors of urologic oncology fellowship programs, it is incumbent upon us to prioritize excellence in training and embrace the benefits afforded by a 2-year fellowship program for the betterment of urology and the patients we serve.