In 2015, a major transition to a single graduate medical education (GME) accreditation system for both US allopathic and osteopathic programs began.¹ Initial steps included the creation of Osteopathic Recognition designation for programs that train learners in the integration of osteopathic medicine into patient care.² The Accreditation Council for Graduate Medical Education (ACGME) Osteopathic Principles Committee confers Osteopathic Recognition upon ACGME-accredited programs that demonstrate through a formal application process a commitment to education in osteopathic principles and practice (OPP).

The Osteopathic Recognition Milestones were developed soon after the Osteopathic Recognition requirements were established. In 2015, osteopathic

ABSTRACT

Background

While the overall percentage of residents who withdraw (2.7%) or take extended leave (1.0%) are low, subgroup analysis has found that minority physicians are approximately 30% more likely to withdraw from residency than their white counterparts and 8 times more likely to take extended leave of absence. With ongoing national efforts to support diversity in medical education through increased recruitment of underrepresented in medicine (UiM) students to residency programs, there is paucity of data identifying specific experiences challenging or contributing to their overall resiliency. Better understanding of the lived experience of UiM residents will allow residency programs to create successful curricular programing and support structures for residents to thrive.

Objective

We sought to understand UiM internal medicine residents' experiences during residency training.

Methods

We used a retrospective review of focus group transcripts of UiM internal medicine residents from 5 academic institutions in 2017 (4 in North Carolina and 1 in Georgia).

Results

Of 100 self-identified UiM residents from 5 institutions, 59 participated in the focus groups. Using a consensus-based review of transcripts, 25 distinct codes in 8 parent code categories were determined. Two primary themes emerged: resilience and isolation. Three secondary themes—social support, mentorship, and external expectations and/or biases—served as mediators for the primary themes.

Conclusions

UiM residents who became or were already resilient commonly experienced isolation at some time in their medical career, specifically during residency. Moreover, they could be influenced and positively or negatively affected by social support, mentorship, and external expectations and biases.

ABSTRACT

Background

Unconscious or implicit biases are universal and detrimental to health care and the learning environment but can be corrected. Historical interventions used the Implicit Association Test (IAT), which may have limitations.

Objective

We determined the efficacy of an implicit bias training without using the IAT.

Methods

From April 2019 to June 2020, a 90-minute educational workshop was attended by students, residents, and faculty. The curriculum included an interactive unconscious biases presentation, videoclips using vignettes to demonstrate workplace impact of unconscious biases with strategies to counter, and reflective group discussions. The evaluation included pre- and postintervention surveys. Participants were shown images of 5 individuals and recorded first impressions regarding trustworthiness and presumed profession to unmask implicit bias.

Results

Of approximately 273 participants, 181 were given the survey, of which 103 (57%) completed it with significant increases from pre- to postintervention assessments for perception scores (28.87 [SEM 0.585] vs 32.73 [0.576], P < .001) and knowledge scores (5.68 [0.191] vs 7.22 [0.157], P < .001). For a White male physician covered in tattoos, only 2% correctly identified him as a physician, and 60% felt he was untrustworthy. For a smiling Black female astronaut, only 13% correctly identified her as an astronaut. For a brooding White male serial killer, 50% found him trustworthy.

Conclusions

An interactive unconscious bias workshop, performed without the use of an IAT, was associated with increases in perceptions and knowledge regarding implicit biases. The findings also confirmed inaccurate first impression stereotypical assumptions based on ethnicity, outward appearances, couture, and media influences.

ABSTRACT

Background

Many programs struggle to recruit, select, and match a diverse class of residents, and the most effective strategies for holistic review of applications to enhance diversity are not clear.

Objective

We determined if holistic pediatric residency application review guided by frameworks that assess for bias along structural, interpersonal, and individual levels would increase the number of matched residents from racial and ethnic groups that are underrepresented in medicine (UiM).

Methods

Between 2017 and 2020, University of California San Francisco Pediatrics Department identified structural, interpersonal, and individual biases in existing selection processes and developed mitigation strategies in each area. Interventions included creating a shared mental model of desirable qualities in residents, employing a new scoring rubric, intentional inclusion of UiM faculty and trainees in the selection process, and requiring anti-bias training for everyone involved with recruitment and selection.

Results

Since implementing these changes, the percentage of entering interns who self-identify as UIM increased from 11% in 2015 to 45% (OR 6.8, P = .008) in 2019 and to 35% (OR 4.6, P = .035) in 2020.

Conclusions

Using an equity framework to guide implementation of a pediatric residency program's holistic review of applications increased the numbers of matched UiM residents over a 3-year period.

The Challenge

By 2001, the Accreditation Council for Graduate Medical Education (ACGME) 6 core competencies were established, which introduced graduate medical education's (GME's) transition to competency-based medical education (CBME).¹ Competencies are teachable attributes that residents and fellows must develop in order to carry out professional roles. Milestones describe the developmental pathway for achieving each competency in more than 150 GME specialtes and subspecialties. Yet confusion remains about their optimal use as well as misuse, which may produce adverse consequences for all stakeholders (eg, residents, faculty, programs, sponsoring institutions [SIs]).