Unraveling the medical residency selection game

Does Masked Interviewing Encourage Holistic Review in Residency Selection? A Mixed-Methods Study

Problem: Medical educators increasingly champion holistic review. However, in U.S. residency selection, holistic review has been difficult to implement, hindered by a reliance on standardized academic criteria such as board scores. Masking faculty interviewers to applicants' academic files is a potential means of promoting holistic residency selection by increasing the interview's ability to make a discrete contribution to evaluation. However, little research has directly analyzed the effects of masking on how residency selection committees evaluate applicants. This mixed-methods study examined how masking interviews altered residency selection in an anesthesiology program at a large U.S. academic medical center. Intervention: During the 2019-2020 residency selection season in the University of Pennsylvania's Department of Anesthesiology & Critical Care, we masked interviewers to the major academic components of candidates' application files (board scores, transcripts, letters) on approximately half of interview days. The intent of the masking intervention was to mitigate the tendency of interviewers to form predispositions about candidates based on standardized academic criteria and thereby allow the interview to make a more independent contribution to candidate evaluation. Context: Our examination of the masking intervention used a concurrent, partially mixed, equal-status mixed-methods design guided by a pragmatist approach. We audio-recorded selection committee meetings and qualitatively analyzed them to explore how masking affected the process of candidate evaluation. We also collected independent candidate ratings from interviewers and consensus committee ratings and statistically compared ratings of candidates interviewed on masked days to ratings from conventional days. Impact: In conventional committee meetings, interviewers focused on how to reconcile academic metrics and interviews, and their evaluations of interviews were framed according to predispositions about candidates formed through perusal of application files. In masked meetings, members instead spent considerable effort evaluating candidates' "fit" and whether they came off as tactful. Masked interviewers gave halting opinions of candidates and sometimes pushed for committee leaders to reveal academic information, leading to masking breaches. Higher USMLE Step 1 score and higher medical school ranking were statistically associated with more favorable consensus rating. We found no significant differences in rating outcomes between masked and conventional interview days. Lessons learned: Elimination of academic metrics during the residency interview phase does not straightforwardly promote holistic review. While critical reflection among medical educators about the fairness and utility of such metrics has been productive, research and intervention should focus on the more proximate topic of how programs apply academic and other criteria to evaluate applicants.

Patterns of Medical Residents' Preferences for Organizational Socialization Strategies to Facilitate Their Transitions: A Q-study

Introduction

To facilitate various transitions of medical residents, healthcare team members and departments may employ various organizational socialization strategies, including formal and informal onboarding methods. However, residents' preferences for these organizational socialization strategies to ease their transition can vary. This study identifies patterns (viewpoints) in these preferences.

Methods

Using Q-methodology, we asked a purposeful sample of early-career residents to rank a set of statements into a quasi-normal distributed grid. Statements were based on previous qualitative interviews and organizational socialization theory. Participants responded to the question, 'What are your preferences regarding strategies other health care professionals, departments, or hospitals should use to optimize your next transition?' Participants then explained their sorting choices in a post-sort questionnaire. We identified different viewpoints based on by-person (inverted) factor analysis and Varimax rotation. We interpreted the viewpoints using distinguishing and consensus statements, enriched by residents' comments.

Results

Fifty-one residents ranked 42 statements, among whom 36 residents displayed four distinct viewpoints: Dependent residents (n = 10) favored a task-oriented approach, clear guidance, and formal colleague relationships; Social Capitalizing residents (n = 9) preferred structure in the onboarding period and informal workplace social interactions; Autonomous residents (n = 12) prioritized a loosely structured onboarding period, independence, responsibility, and informal social interactions; and Development-oriented residents (n = 5) desired a balanced onboarding period that allowed independence, exploration, and development.

Discussion

This identification of four viewpoints highlights the inadequacy of one-size-fits-all approaches to resident transition. Healthcare professionals and departments should tailor their socialization strategies to residents' preferences for support, structure, and formal/informal social interaction.

The impact of interviewer characteristics on residency candidate scores in Emergency Medicine: a brief report

Background

At the conclusion of residency candidate interview days, faculty interviewers commonly meet as a group to reach conclusions about candidate evaluations based on shared information. These conclusions ultimately translate into rank list position for The Residency Match. The primary objective is to determine if the post-interview discussion influences the final scores assigned by each interviewer, and to investigate whether interviewer characteristics are significantly associated with the likelihood of changing their score. Based on Foucault's 'theory of discourse' and Bourdieu's 'social capital theory,' we hypothesized that interviewer characteristics, and the discourse itself, would contribute to score changes after a post-interview discussion regarding emergency medicine residency candidates.

Methods

We conducted a cross-sectional observational study of candidate scores for all candidates to a four-year emergency medicine residency program affiliated with Yale University School of Medicine during a single application cycle. The magnitude and direction of score changes, if any, after group discussion were plotted and grouped by interviewer academic rank. We created a logistic regression model to determine the odds that candidate scores changed from pre- and post-discussion ratings related to specific interviewer factors.

Results

A total of 24 interviewers and 211 candidates created 471 unique interviewer-candidate scoring interactions, with 216 (45.8%) changing post-discussion. All interviewers ranked junior to professor were significantly more likely to change their score compared to professors. Interviewers who were women had significantly lower odds of changing their individual scores following group discussion (p=0.020; OR 0.49, 95% CI 0.26-0.89).

Conclusions

Interviewers with lower academic rank had higher odds of changing their post-discussion scores of residency candidates compared to professors. Future work is needed to further characterize the influencing factors and could help create more equitable decision processes during the residency candidate ranking process.

'Selection into training will always be an inexact process': A survey of Directors of Physician Education on selection into Basic Physician Training in Australia and New Zealand

BACKGROUND

Despite being one of the largest medical specialty training programmes in Australasia, there is no standardised method for selection into Basic Physician Training (BPT), and limited data exist regarding current practices.

AIMS

To address existing knowledge gaps, we aimed to create a 'snapshot' of current BPT selection practices and explore the perspectives of Directors of Physician Education (DPEs) regarding trainee selection.

METHODS

An electronic survey of DPEs from adult and paediatric medicine BPT sites in Australia and New Zealand was undertaken in January-February 2022. A combination of free text, multiple-choice and yes/no answers were analysed using descriptive statistics and qualitative content analysis.

RESULTS

A total of 70 responses were received, achieving a response rate of 35% (70/198). Selection practices were found to be heterogenous across BPT sites. Respondents had varying opinions regarding the utility of selection tools and desirable candidate attributes. A heavy reliance upon interviews and the reported use of subjective assessments raise concerns for selection process bias.

CONCLUSION

BPT sites should critically evaluate their selection methods, and more research in this field is needed to establish best practice.

Diversity in the pathway from medical student to specialist in the Netherlands: a retrospective cohort study

Background

Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce.

Methods

We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory.

Findings

Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist.

Interpretation

In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce.

Funding

ODISSEI.

Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection

OBJECTIVES

This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs.

METHODS

A diverse panel of EM residency program directors, attending and resident physicians, medical students, and community representatives met monthly from September 2021 to May 2022 via videoconference to coordinate a scoping literature review, two surveys, and structured interviews. This work informed the development of recommendations for incorporating EDI into Canadian EM resident physician selection. At the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, these recommendations were presented to symposium attendees composed of national EM community leaders, members, and learners. Attendees were divided into small working groups to discuss the recommendations and address three conversation-facilitating questions.

RESULTS

Symposium feedback informed a final set of eight recommendations to promote EDI practices during the resident selection process that address recruitment, retention, mitigating inequities and biases, and education. Each recommendation is accompanied by specific, actionable sub-items to guide programs toward a more equitable selection process. The small working groups also described perceived barriers to the implementation of these recommendations and outlined strategies for success that are incorporated into the recommendations.

CONCLUSION

We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).

Recommendations for Improving Canadian Radiology Equity, Diversity and Inclusion

Improving equity, diversity, and inclusion (EDI) within Canadian radiology is critical for optimal patient care and to reduce health disparities. Although there are increasing national EDI initiatives, there is a paucity of resources available to assist radiology departments as the culture of EDI evolves and faculty and institutions are expected to incorporate EDI in their practice. We present practical recommendations for radiology departments, radiology training programs, and individual radiologists wishing or mandated to improve EDI in the workplace. Actionable strategies for creating an environment that promotes EDI, attracting and supporting diverse trainees, and for how individual radiologists can be allies are presented. These EDI strategies are imperative to provide the best patient care and to strengthen the future of Canadian radiology.