Unraveling the medical residency selection game

Abstract

The diversity of modern society is often not represented in the medical workforce. This might be partly due to selection practices. We need to better understand decision-making processes by selection committees in order to improve selection procedures with regard to diversity. This paper reports on a qualitative study with a socio-constructivist perspective conducted in 2015 that explored how residency selection decision-making occurred within four specialties in two regions in the Netherlands. Data included transcripts of the decision-making meetings and of one-on-one interviews with committee members before and after the group decision-making meetings. Candidates struggled to portray themselves favorably as they had to balance playing by the rules and being authentic; between fitting in and standing out. Although admissions committees had a welcoming stance to diversity, their practices were unintentionally preventing them from hiring underrepresented minority (URM) candidates. While negotiating admissions is difficult for all candidates, it is presumably even more complicated for URM candidates. This seems to be having a negative influence on attaining workforce diversity. Current beliefs, which make committees mistakenly feel they are acting fairly, might actually justify biased practices. Awareness of the role of committee members in these processes is an essential first step.

Can veterinary medicine improve diversity in post-graduate training programs? Current state of academic veterinary medicine and recommendations on best practices

“…One study showed that even when committees had a welcoming stance to diversity, their practices unintentionally prevented them from hiring URM candidates. 18 This same group concluded that simultaneous interventions towards inclusivity in medical school and postgraduate medical education are crucial to enable the desired change. 18 A commentary in the New England Journal of Medicine Catalyst noted that the predominantly white male leaders of many medical schools and health systems must recognize that their perceptions of what leadership is, or should be, may impede progress towards a diverse and inclusive environment, despite good intentions.…”

“…18 This same group concluded that simultaneous interventions towards inclusivity in medical school and postgraduate medical education are crucial to enable the desired change. 18 A commentary in the New England Journal of Medicine Catalyst noted that the predominantly white male leaders of many medical schools and health systems must recognize that their perceptions of what leadership is, or should be, may impede progress towards a diverse and inclusive environment, despite good intentions. 19 There are strategies and programs that improve the racial and ethnic diversity of other health care professions.…”

Recommendations for Improving Canadian Radiology Equity, Diversity and Inclusion

“…Broadened scoring system parameters for review might include objective evaluation with standardized review metrics of application criteria such as letters of reference, research productivity, extracurricular activities, and life experiences. 28,29 This could minimize potential personal biases of members of the committee. Ongoing review of the evolving literature that evaluates selection tools is required to avoid using a tool that may limit diversity.6.…”

Selecting trainees: Too much focus on predictive metrics, not enough on holistic review

“…And there have been so few empirical studies of how residency selection committees make decisions that we have little basis on which to assess the meaningfulness of the rankings they give candidates. The studies that do exist suggest that committees are vulnerable to numerous biases when they determine rankings 6,9 …”