Introduction

Prior to the COVID-19 pandemic, postgraduate medical education trainee selection for North American residency and fellowship programs relied on in-person interviews. This process could involve candidates traveling and staying overnight near the program; attendance at informal social receptions with faculty, trainees, and other applicants; experiencing the program's educational culture; and exploring the area. Program faculty were able to meet with candidates in-person, in formal as well as informal settings.

Social distancing and travel restrictions during the pandemic resulted in a pivotal transition to virtual interviews, a relatively novel concept in postgraduate recruitment. Potential benefits from this change include decreased

ABSTRACT

Background

Microaggressions are one form of gender bias contributing to gender disparities and mistreatment, but their prevalence during virtual residency interviews has not been explored.

Objective

To explore applicants' recall of experiencing gender microaggressions during virtual residency interviews and whether these experiences affected programs' rank position on applicants' rank lists.

Methods

Fourth-year medical students at a single institution who participated in the 2021 Match were surveyed after submitting their rank lists. Students were surveyed categorically on (1) their recall of the frequency they experienced 17 gender microaggressions during interviews, and (2) how these affected reported ranking of programs on their rank lists.

Results

Sixty-one percent (103 of 170) of eligible students responded to the survey. Seventy-two percent (36 of 50) of women experienced at least one microaggression compared to 30% (9 of 30) of men. The largest difference was in the experience of environmental microaggressions, which are demeaning cues communicated individually or institutionally, delivered visually, or that refer to climate (P<.001). Women experienced more microaggressions than men in nonsurgical (P=.003) and surgical specialties excluding obstetrics and gynecology (P=.009). When microaggressions were experienced at 1 to 2 programs, 36% of applicants (26 of 73) reported significantly lowering program ranking, compared to 5% (1 of 19) when microaggressions occurred at more than 5 programs (P=.038).

Conclusions

Women applicants experience more microaggressions than men do during nonsurgical and male-dominated surgical specialty residency interviews. Respondents who recalled experiencing microaggressions at fewer programs were more likely to report significantly lowering the rank of those programs compared to those who experienced them at more programs.

ABSTRACT

Background

Racism is a longstanding driver of health inequities. Although medical education is a potential solution to address racism in health care, best practices remain unknown.

Objective

We sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy.

Methods

A pre-post survey study was conducted in 2 urban, university-based, midsized pediatric residency programs between July 2019 and June 2020. The curriculum sessions included Self-Reflection on Implicit Bias, Historical Trauma, and Structural Racism. All sessions were paired with empathy and perspective-taking exercises and were conducted in small groups to facilitate reflective discussion. Wilcoxon signed rank tests were used to assess changes in racial bias and empathy. Linear regression was used to assess the effect of resident characteristics on racial bias and empathy.

Results

Ninety of 111 residents receiving the curriculum completed pre-surveys (81.1%), and among those, 65 completed post-surveys (72.2%). Among participants with baseline pro-White bias, there was a statistically significant shift (0.46 to 0.36, P=.02) toward no preference. Among participants with a baseline pro-Black bias, there was a statistically significant shift (-0.38 to -0.21, P=.02), toward no preference. Among participants with baseline pro-White explicit bias, there was a statistically significant shift (0.54 to 0.30, P<.001) toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy (22.95 to 22.42, P=.03).

Conclusions

Participation in a longitudinal discussion-based curriculum addressing racism modestly reduced pediatric residents' racial preferences with minimal effects on empathy scales.

ABSTRACT

Background

Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care.

Objective

To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work.

Methods

A PubMed literature search was conducted through August 30, 2021, using the terms “resident” and “sleep” in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions.

Results

Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited.

Conclusions

Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.

“Dr. Young, Dr. Deborah Young,” a voice called overhead. It was my first night on call as a neurology resident. I dialed the Neuro-ICU, and my chest began to thrum.

“This neurosurgery patient, do you know about him?”

“No.”

“He had a meningioma resected today. He was awake post-op, but he just went unresponsive.”

“How are his vitals?”

“He's a little tachy.”

“Ok, be right there.”

I headed down an airless corridor of the Jamaica Plain VA Medical Center. I had never treated a post-op neurosurgery patient. The differential swam through my head. Edema. Crap, he's herniating. No, too