Interventions Associated With Racial and Ethnic Diversity in US Graduate Medical Education

Mabeza, Russyan Mark; Christophers, Briana; Ederaine, Sophia A.; Glenn, Emily; Benton-Slocum, Zachary P; Marcelin, Jasmine R.

doi:10.1001/jamanetworkopen.2022.49335

Cited by 17 publications

(20 citation statements)

References 67 publications

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“…Although the proportion of interviewees who were URiM increased significantly in the SHARP period, the proportion of matched residents who were URiM increased even more significantly. This finding is consistent with earlier findings that suggest that nonholistic reviews undervalue applicants from URiM backgrounds 1,2 . It also suggests that when URiM candidates previously excluded from interviews are more thoroughly evaluated, they are disproportionately highly ranked, even though the rubric was used exclusively for interview selection and not final ranking.…”

Section: Discussionsupporting

confidence: 90%

SHARPening Residency Selection: Implementing a Systematic Holistic Application Review Process

Igarabuza,

Gusoff,

Maharaj-Best

et al. 2023

Acad Med

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Problem Traditional metrics used in residency application review processes are systematically biased against applicants from minoritized communities that are underrepresented in medicine (URiM). These biases harm not just URiM applicants but also residency programs and patients. Although several residency programs have implemented holistic reviews to mitigate these biases, few tested tools exist that can be adapted and implemented in a wide variety of settings within academic medicine. Approach This article describes advances made in the third year of a longitudinal, ongoing quality improvement project that used the A3 framework to improve recruitment of URiM residents to a family medicine residency program. The authors devised a systematic holistic application review process (SHARP) to determine which applicants to invite to interview with the program. SHARP’s development began in August 2019, and after significant discussion with program leadership and iterations of rubric refinement, the program adopted SHARP in September 2020 to review applications for the 2021 application cycle. Outcomes Compared with the 2016 to 2020 period before SHARP implementation, data from the 2021 and 2022 residency application cycles after SHARP implementation showed a significant increase in the proportion of interviewed candidates who identify as URiM (from 23% to 38%, P < .001) and matched candidates who identify as URiM (from 27% to 62%, P = .004). There was also a notable increase in the number and diversity of reviewers who evaluated applicants to the program. Next Steps SHARP is a promising tool to mitigate the effects of racism and other biases against URiM applicants to residency programs. Residency programs across specialties may benefit from adopting SHARP and adapting it based on their own goals and priorities.

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Section: Discussionsupporting

confidence: 90%

SHARPening Residency Selection: Implementing a Systematic Holistic Application Review Process

Igarabuza,

Gusoff,

Maharaj-Best

et al. 2023

Acad Med

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“…The need to diversify the health professions has been evident for decades. Persistent low representation of students and graduates from URM groups reflects structural and economic factors that also play a major role in affecting URM representation in health care programs . Recruitment strategies, holistic admissions, and pipeline programs aimed to address URM underrepresentation and have led to increasing applications, matriculations, and degree completions .…”

Section: Discussionmentioning

confidence: 99%

“…14,16,17,51,52,[56][57][58][59][60][61] Financial burden is a perceived barrier by students. 35,36 Health care programs vary in number of schools, acceptance rate, length of the program, competitiveness and cost, which may affect the choice and preference for a health care major by learners from URM groups. 23 A large number of schools, higher acceptance rates, and lower costs may attract such learners to certain professions.…”

Section: Jama Network Open | Medical Educationmentioning

confidence: 99%

Racial, Ethnic, and Sex Diversity Trends in Health Professions Programs From Applicants to Graduates

Majerczyk,

Behnen,

Weldon

et al. 2023

JAMA Netw Open

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ImportanceDiversity is an essential element of an effective health care system. A key to developing a diverse workforce is establishing a diverse student population in health professions programs.ObjectiveTo examine the diversity of students in Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), and Doctor of Pharmacy (PharmD) programs with emphasis on the trends of underrepresented minoritized groups (American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander) and sex relative to the overall age-adjusted US population.Design, Setting, and ParticipantsThis cross-sectional study used deidentified, self-reported data from 2003 to 2019 from the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, American Dental Education Association, American Dental Association, and American Association of Colleges of Pharmacy. Data analysis was performed from 2003 to 2004 and from 2018 to 2019.ExposuresData on the race, ethnicity, and sex of applicants, matriculants, and degrees conferred by health professions programs were collected and compared with the age-adjusted population in the US Census (aged 20-34 years) over time.Main Outcomes and MeasuresThe main outcomes were trends in the proportions of underrepresented minoritized groups and sex diversity among applicants, matriculants, and degrees conferred relative to the overall age-adjusted US population. Trends were measured using the representation quotient, which is defined as the ratio of the proportion of each subgroup to the total population of applicants, matriculants, or graduates relative to the proportion for that subgroup within the US Census population of similar age. Regression analysis was used to evaluate the trend over time.ResultsA total of 594 352 applicants were analyzed across the examined programs. From 2003 to 2019, the proportions of individuals from underrepresented groups increased for DDS and DMD (applicants, from 1003 of 8176 to 1962 of 11 298 [5.1%]; matriculants, from 510 of 4528 to 966 of 6163 [4.2%]; degrees awarded, from 484 of 4350 to 878 of 6340 [2.7%]), PharmD (applicants, from 9045 of 71 966 to 11 653 of 50 482 [9.0%]; matriculants, from 5979 of 42 627 to 10 129 to 62 504 [6.3%]; degrees awarded, from 922 of 7770 to 2190 of 14 800 [3.0%]), and DO (applicants, from 740 of 6814 to 3478 of 21 090 [5.4%]; degrees awarded, 199 of 2713 to 582 of 6703 [1.4%]) programs, but decreased for MD programs (applicants, from 6066 of 34 791 to 7889 of 52 777 [−2.3%]; matriculants, 2506 of 16 541 to 2952 of 21 622 [−2.4%]; degrees awarded, from 2167 of 15 829 to 2349 of 19 937 [−0.1%]). Compared with age-adjusted US Census data, all programs had more Asian students and fewer male, American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander students (representation quotient &lt;1).Conclusions and RelevanceIn this cross-sectional study, most of the health professions in the study saw increases in underrepresented minority applicants, matriculants, and degrees conferred from 2003 to 2019; however, all programs were below the age-adjusted US Census data. The increased racial, ethnic, and sex diversity in the programs illustrates progress, but additional strategies are needed to achieve a more representative health care workforce.

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“…Holistic review has gained momentum as an evidence‐supported method that more evenly balances the experiences, attributes, and metrics of residency applicants 20,21 . Although holistic review, implicit bias training, and diverse selection committees have demonstrated success in combating biased selection practices, the expansion of this body of literature is crucial to ensuring an equitable pathway to EM so that our workforce reflects this country's diverse communities 22 …”

mentioning

confidence: 99%

“…20,21 Although holistic review, implicit bias training, and diverse selection committees have demonstrated success in combating biased selection practices, the expansion of this body of literature is crucial to ensuring an equitable pathway to EM so that our workforce reflects this country's diverse communities. 22 In addition to frameshifting recruitment practices, the consensus questions guide future educational research toward the creation of an antiracist learning environment. URiM trainees disproportionately suffer from discrimination, racial harassment, and microaggressions in the clinical environment and are more likely to withdraw from residency training and take extended leaves of absence.…”

mentioning

confidence: 99%

A systematic approach to tackling racism in emergency medicine: A commentary on the executive summary of the SAEM 2022 consensus conference

Carter

Ahn

2023

Academic Emergency Medicine

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Interventions Associated With Racial and Ethnic Diversity in US Graduate Medical Education

Cited by 17 publications

References 67 publications

SHARPening Residency Selection: Implementing a Systematic Holistic Application Review Process

SHARPening Residency Selection: Implementing a Systematic Holistic Application Review Process

Racial, Ethnic, and Sex Diversity Trends in Health Professions Programs From Applicants to Graduates

A systematic approach to tackling racism in emergency medicine: A commentary on the executive summary of the SAEM 2022 consensus conference

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