Improving the recruitment, retention, and leadership advancement of faculty who are under-represented in medicine is a priority at many academic institutions to ensure excellence in patient care, research, and health equity. Here we provide a critical review of the literature and offer evidence-based guidelines for faculty recruitment, retention, and representation in leadership. Recommendations for recruitment include targeted recruitment to expand the candidate pool with diverse candidates, holistic review of applications, and incentivizing stakeholders for success with diversity efforts. Retention efforts should establish a culture of inclusivity, promote faculty develop-ment, and evaluate for biases in the promotion and tenure process. We believe this guide will be valuable for all leaders and faculty members seeking to advance diversity, equity, and inclusion in their institutions.

Advancement of diversity, equity, and inclusion (DEI) in emergency medicine can only occur with intentional recruitment of residency applicants underrepresented in medicine (UIM). Shared experiences from undergraduate and graduate medical education highlight considerations and practices that can contribute to improved diversity in the resident pool, such as holistic review and mitigating bias in the recruitment process. This review, written by members of the Council of Residency Directors in Emergency Medicine (CORD) Best Practices Subcommittee, offers best practice recommendations for the recruitment of UIM applicants. Recommendations address pre-interview readiness, interview approach, and post-interview strategies that residency leadership may use to implement holistic review and mitigate bias for recruitment of a diverse class.

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Objectives:The standardized letter of evaluation (SLOE) in emergency medicine (EM) is a widely used metric for determining interview invitations and ranking of candidates. Previous research has questioned the validity of certain sections of the SLOE.However, there remains a paucity of literature on the qualifications for EM section, which evaluates seven attributes of applicants. The aim of this study was to determine the correlation between the qualifications questions and grades, global assessment, and anticipated rank list position for EM applicants.Methods: A multi-institutional cross-sectional study was performed using SLOEs from applicants to three geographically distinct U.S. EM residency programs during the 2019-2020 application cycle. We abstracted EM rotation grade, qualifications scores, global assessment, and anticipated rank list position from the SLOEs. A Spearman correlation was calculated between each of the qualifications scores and the applicant's grades, global assessment, and anticipated rank list position in a pairwise fashion.

Background The Standardized Letter of Evaluation (SLOE) stratifies the assessment of emergency medicine (EM) bound medical applicants. However, bias in SLOE, particularly regarding race and ethnicity, is an underexplored area. Objective This study aims to assess whether underrepresented in medicine (UIM) and non-UIM applicants are rated differently in SLOE components. Methods This was a cross-section study of EM-bound applicants across 3 geographically distinct US training programs during the 2019-2020 application cycle. Using descriptive and regression analyses, we examine the differences between UIM applicants and non-UIM applicants for each of the SLOE components: 7 qualifications of an EM physician (7QEM), global assessment (GA) rating, and projected rank list (RL) position. Results Out of a combined total of 3759, 2002 (53.3%) unique EM-bound applicants were included. UIM applicants had lower ratings for each of the 7QEM questions, GA, and RL positions. Compared to non-UIM applicants, only some of the 7QEM components: “Work ethic and ability to assume responsibility,” “Ability to work in a team, and “Ability to communicate a caring nature,” were associated with their SLOE. “Commitment to EM” correlated more with GA for UIM than for non-UIM applicants. Conclusions This study shows a difference in SLOE rating, with UIM applicants receiving lower ratings than non-UIM applicants.

Improving the diversity and representation in the medical workforce requires intentional and deliberate efforts to improve the pipeline and pathway for underrepresented in medicine (UIM) applicants. Diversity enhances educational experiences and improves patient care and outcomes. Through a critical review of the literature, in this article we offer evidence-based guidelines for physician pipeline and pathway programs (PP). Recommendations are provided regarding considerations on the types of programs and surrounding implementation to ensure a sound infrastructure and framework. We believe this guide will be valuable for all leaders and faculty members seeking to grow the UIM applicant pool in our efforts to advance diversity, equity, and inclusion within medicine.

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