Chief Residency Selection in Internal Medicine: Who Is Left Out?

Abstract

Little progress has been made in improving racial, gender, or intersectional diversity within academic internal medicine (IM). Chief Residency fulfills a unique opportunity to target diversity efforts; Chief Residents (CR) are integral in creating an inclusive environment and support system for IM trainees, and the position serves as a steppingstone for future leadership positions within academia. However, the CR selection process often lacks transparency and includes steps that are fraught with bias, thereby disadvantaging underrepresented minority groups from gaining important experience needed to climb the academic ladder. We describe a more standardized selection process that will improve recruitment and selection of more diverse CRs and ultimately improve the recruitment, retention, and promotion of more diverse faculty within academic internal medicine. Key recommendations include an open call for applications, the use of standardized and structured interviews, and the formation of a diverse selection committee to conduct a transparent selection process based on explicitly defined criteria.

Performance on Patient Experience Measures of Former Chief Medical Residents as Physician Exemplars Chosen by the Profession

“…5,6,8,9,[11][12][13][14]22,27,[44][45][46][47][48] This study's findings additionally suggest potential quality gains from harnessing the profession's "hive mind" more regularly in the practice of medicine, at least for the increasing proportion of physicians practicing in groups. 5,6,20,49 For example, the repurposing of exemplar physicians to disseminate best practices could be done beyond chief residency using fairer processes than those used to select chiefs 50 and encompassing a targeted range of desired skills (eg, masters of the evidence). Our subgroup analyses further suggest that having exemplars disseminate practices to others or matching patients with exemplars according to potential benefit may have especially sizeable benefits for historically disadvantaged groups.…”

“…However, we found qualitatively similar results for overall care ratings, which should be less subject to this concern. Finally, biases and opaqueness in the chief selection process have motivated calls for reforms with which we agree . We examined former chiefs in this study but would expect that promoting equity in selecting chiefs, or exemplars more generally, would enhance the potential for reducing disparities by identifying and redirecting physician excellence.…”

Time to Reengineer the Internal Medicine Chief Residency

“…Strategic selection of chief residents with an intent to populate the academic workforce of the future could include attention to the habits of mind of inquiry, social justice, continuous improvement, and well-being in addition to demonstrated prowess at morning report and in clinical team leadership and teaching. 5 Each chief resident should be assigned a mentorship committee to maximize the key elements for their desired future career as a researcher, educator, clinician, or other contributor to the profession of medicine. They should engage in leadership development activities and courses, meet and interview existing institutional leaders for advice and insight, participate in scholarly work to advance their academic portfolios, and receive ongoing feedback about their development.…”

“…Realizing the potential of the chief resident year to launch leadership careers in academia and beyond requires transparent selection as well as specific engineering of the role, the responsibilities, the training opportunities and the mentorship of the chiefs. Strategic selection of chief residents with an intent to populate the academic workforce of the future could include attention to the habits of mind of inquiry, social justice, continuous improvement, and well-being in addition to demonstrated prowess at morning report and in clinical team leadership and teaching …”

Intersectionality of Race, Ethnicity, and Gender in the Otolaryngology Match From 2013 to 2019

“…Other medical specialties have begun to incorporate an intersectional approach to evaluating the associations between sociocultural factors and workforce diversity; 10,11 however, there is a paucity of this analysis in the OHNS literature. This study aimed to analyze racial, ethnic, and gender disparities in the OHNS match using an intersectional approach.…”