ABSTRACT

Background

While program director (PD) letters of recommendation (LOR) are subject to bias, especially against those underrepresented in medicine, these letters are one of the most important factors in fellowship selection. Bias manifests in LOR in a number of ways, including biased use of agentic and communal terms, doubt raising language, and description of career trajectory. To reduce bias, specialty organizations have recommended standardized PD LOR.

Objective

This study examined PD LOR for applicants to a cardiology fellowship program to determine the mechanism of how bias is expressed and whether the 2017 Alliance for Academic Internal Medicine (AAIM) guidelines reduce bias.

Methods

Fifty-six LOR from applicants selected to interview at a cardiology fellowship during the 2019 and 2020 application cycles were selected using convenience sampling. LOR for underrepresented (Black, Latinx, women) and non-underrepresented applicants were analyzed using directed qualitative content analysis. Two coders used an iteratively refined codebook to code the transcripts. Data were analyzed using outputs from these codes, analytical memos were maintained, and themes summarized.

Results

With AAIM guidelines, there appeared to be reduced use of communal language for underrepresented applicants, which may represent less bias. However, in both LOR adherent and not adherent to the guidelines, underrepresented applicants were still more likely to be described using communal language, doubt raising language, and career trajectory bias.

Conclusions

PDs used language in a biased way to describe underrepresented applicants in LOR. The AAIM guidelines reduced but did not eliminate this bias. We provide recommendations to PDs and the AAIM on how to continue to work to reduce this bias.

ABSTRACT

Background

Increasing diversity in medicine is receiving more attention, yet underrepresented in medicine (UiM) surgeons remain a small fraction of all surgeons. Whether surgical training programs attempt to attract UiM applicants to their programs, and therefore their specialties, through program website information is unclear.

Objective

To analyze the scope of diversity and inclusion (D&I) related information on US allopathic and osteopathic general surgery, integrated thoracic surgery, and integrated vascular surgery residency program websites.

Methods

Residency programs were identified through the Electronic Residency Application Service (ERAS) in July 2020. We searched surgical program websites and collected data on the presence or absence of variables labeled “diversity & inclusion” or “underrepresented in medicine.” Variables found on program websites as well as sites linked to the program website were included. We excluded programs identified in ERAS as fellowship training programs. Programs without webpages were also excluded.

Results

We identified 425 residency programs and excluded 22 from data analysis. Only 75 of the 403 included programs (18.6%) contained D&I-related information. The presence of individual variables was also low, ranging from 4.5% for opportunities related to early exposure to the specialty to 11.1% for a written or video statement of commitment to D&I.

Conclusions

In 2020, as recruitment and interviews moved entirely online, few US allopathic and osteopathic general surgery, integrated thoracic surgery, and integrated vascular surgery residency programs provided D&I-related information for residency applicants on their program websites.

ABSTRACT

Background

Calls to reform the US resident selection process are growing, given increasing competition and inefficiencies of the current system. Though numerous reforms have been proposed, they have not been comprehensively cataloged.

Objective

This scoping review was conducted to characterize and categorize literature proposing systems-level reforms to the resident selection process.

Methods

Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, searches of Embase, MEDLINE, Scopus, and Web of Science databases were performed for references published from January 2005 to February 2020. Articles were included if they proposed reforms that were applicable or generalizable to all applicants, medical schools, or residency programs. An inductive approach to qualitative content analysis was used to generate codes and higher-order categories.

Results

Of 10 407 unique references screened, 116 met our inclusion criteria. Qualitative analysis generated 34 codes that were grouped into 14 categories according to the broad stages of resident selection: application submission, application review, interviews, and the Match. The most commonly proposed reforms were implementation of an application cap (n = 28), creation of a standardized program database (n = 21), utilization of standardized letters of evaluation (n = 20), and pre-interview screening (n = 13).

Conclusions

This scoping review collated and categorized proposed reforms to the resident selection process, developing a common language and framework to facilitate national conversations and change.

He was younger than my shift had been,

making his world debut a block from Lake Michigan

on the eighth floor

of the second tower

of the women's hospital.

Shortly after his first feeding,

his nurse spotted something that won him an instant one-way ticket,

with lights and sirens,

down Michigan Avenue,

to the children's hospital,

where I'd just arrived for my first day in the NICU.

I had yet to transfer my ID badge from the strap of my bag where it typically spent the night,

to the pocket of the scrubs I'd just changed into,

when my attending

The John C. Gienapp Distinguished Service Award

Henry J. Schultz, MD, MACP, Mayo Clinic, Rochester, Minnesota

The Diversity and Inclusion Award

▪
Emory University School of Medicine, Emergency Medicine Residency
▪
Morehouse School of Medicine

The Parker J. Palmer Courage to Lead Award (honors designated institutional officials)

▪
Deborah M. DeMarco, MD, FACP, University of Massachusetts Medical School, Worcester, Massachusetts, Rheumatology
▪
Meghan Walsh, MD, MPH, Hennepin Health System, Minneapolis, Minnesota, Internal Medicine

The Parker J. Palmer Courage to Teach Award (recognizes program directors)

▪
David K. Barnes, MD, FACEP, UC Davis Health, Sacramento, California, Emergency Medicine
▪
Wilma F.