Objective <p>To create a pathway-based, vertically integrated teaching program on hematuria management that encourages competency development, and to analyze its effect in competency transfer among urology clerkship students.</p> Methods <p>Eighty clerkship students were recruited (intervention group, <i>n</i> = 40; control group, <i>n</i> = 40) in a single-center, quasi-experimental controlled study. Data on weekly tests, case presentation score, end-of-rotation comprehensive score, and a modified OSCE were collected. Between-group comparisons were performed using Welch-corrected independent-samples t tests for continuous outcomes, Fisher’s exact test or χ² test for categorical baseline variables, and covariate-adjusted linear regression with HC3 robust standard errors for the OSCE total score.</p> Results <p>The two groups had similar age, sex, and major composition. The intervention group obtained a relatively higher formative assessment performance with a higher mean weekly test score than the control group (94.09 ± 2.58 vs. 86.50 ± 8.10, <i>P</i> &lt; 0.001), and a slightly higher case score (7.39 ± 0.60 vs. 7.14 ± 0.46, <i>P</i> = 0.045), while the end-of-rotation comprehensive score did not meet the significance level (<i>P</i> = 0.771). The simulation-based OSCE showed a significantly higher OSCE total score in the intervention group (85.39 ± 4.02 vs. 80.00 ± 5.16, <i>P</i> &lt; 0.001), with main differences in domains related to management and communication; the group effect remained significant after covariate adjustment (beta = 5.56, <i>P</i> &lt; 0.001).</p> Conclusion <p>The hematuria-focused, vertically integrated teaching program was associated with improved formative assessment performance and case presentation quality, and with better performance in a simulation-based modified OSCE assessing competency transfer. Future larger-scale randomized controlled studies are needed to further validate these findings.</p>