Characterizing Standardized Letters of Recommendation in Urology Residency Applications

Increasing Diversity, Equity, and Inclusion in Urology Residency Recruitment: Recommendations From the Society of Women in Urology

OBJECTIVE

To provide a framework for diversifying the urologic workforce through residency recruitment by integrating principles of diversity, equity, and inclusion (DEI) into program mission and values, application review, and interview process.

MATERIALS AND METHODS

For this narrative review, the Society of Women in Urology Advancing DEI in Urology Residency Recruitment Task Force identified 4 areas for incorporating DEI into residency recruitment: defining a residency program's mission and values, holistic application review, an objective interview process, and implementing DEI principles into a program. Using PubMed and Google Scholar, we performed a non-systematic literature search of articles from January 2014 to January 2024. Search terms included combinations of "diversity", "equity", "inclusion", "residency", "holistic review", "applications", "interviews", and "initiatives". Additional resources were identified through citations of selected articles. Based on findings from these articles, Task Force members made recommendations for best practices.

RESULTS

The diversity of practicing urologists is disproportionate to that of the United States population. Emerging evidence demonstrates that DEI efforts in healthcare are associated with better outcomes and reduction in healthcare inequities. We offer strategies for residency programs to integrate DEI initiatives into their recruitment, application review, and interview process. Furthermore, we address extending DEI principles into a program's mission and culture to create an inclusive environment conducive to training and supporting individuals from unique backgrounds.

CONCLUSION

It is critical to recruit and retain diverse talent in urology to improve patient care. We urge residency programs and their supporting institutions to adopt DEI principles into their recruitment efforts.

Perceived Barriers Among Underrepresented and Historically Marginalized Medical Students Pursuing a Career in Urology

OBJECTIVE

To assess perceived barriers to pursuing urology among medical students and to determine if marginalized groups identified greater challenges to entry.

METHODS

The Deans of all New York medical schools were asked to disseminate a survey to their students. The survey collected demographic information to identify underrepresented minorities, students of low socioeconomic background, and lesbian, gay, bisexual, transgender, queer, intersex, and asexual individuals. Students were asked to rate various survey items on a five-point Likert scale to determine which factors were perceived as barriers to applying to urology residency. Student t tests and ANOVA were used to compare mean Likert ratings between groups.

RESULTS

A total of 256 students responded to the survey from 47% of medical institutions. Underrepresented minorities students cited lack of evident diversity within the field as a more significant barrier than counterparts (3.2 vs 2.7, P= .025). Lesbian, gay, bisexual, transgender, queer, intersex, and asexual students perceived the lack of evident diversity within urology (3.1 vs 2.65, P = .01), exclusivity of the field (3.73 vs 3.29, P = .04), and fear that residency programs would have negative perceptions of them as students (3.0 vs 2.1, P < .0001) as substantial obstacles compared to peers. Students with childhood household incomes less than $40,000 cited socioeconomic concerns as a higher barrier compared to students with household incomes greater than $40,000 (3.2 vs 2.3, P = .001).

CONCLUSION

Underrepresented and historically marginalized students perceive more significant barriers to pursuing urology than their peers. Urology training programs must continue to foster an inclusive environment to recruit prospective students from already marginalized groups.

Effect of Holistic Review, Interview Blinding, and Structured Questions in Resident Selection: Can we Predict Who Will Do Well in a Residency Interview?

OBJECTIVE

To examine the Urology residency application process, particularly the interview. Historically, the residency interview has been vulnerable to bias and not determined to be a predictor of future residency performance. Our goal is to determine the relationship between pre-interview metrics and post-interview ranking using best practices for Urology resident selection including holistic review, blinded interviews, and structured behaviorally anchored questions.

METHODS

Applications were assessed on cognitive (Alpha Omega Alpha, class rank, junior year clinical clerkship grades) and non-cognitive attributes (letters of recommendation [LOR], personal statement [PS], demographics, research, personal characteristics) by reviewers blinded to USMLE scores and photograph. Interviewers were blinded to the application other than PS and LORs. Interviews consisted of a structured behaviorally anchored question (SBI) and an unstructured interview (UI). Odds ratios were determined comparing pre-interview and interview impressions.

RESULTS

Fifty-one applicants were included in the analysis. USMLE step 1 score (average 245) was associated with Alpha Omega Alpha, class rank, junior year clinical clerkship, and PS. The UI score was associated with the LOR (P = .04) whereas SBI scores were not (P = .5). Faculty rank was associated with SBI, UI, and overall interview (OI) scores (P < .001). Faculty rank was also associated with LOR. Resident impression of interviewees were associated with faculty interview scores (P = .001) and faculty rank (P < .001).

CONCLUSION

Traditional interviews may be biased toward application materials and may be balanced with behavioral questions. While Step 1 score does not offer additional information over other PI metrics, blinded interviews may offer discriminant validity over a PI rubric.