Holistic Review, Mitigating Bias, and Other Strategies in Residency Recruitment for Diversity, Equity, and Inclusion: An Evidence-based Guide to Best Practices from the Council of Residency Directors in Emergency Medicine

Abstract

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.

Physician Pipeline and Pathway Programs: An Evidence-based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine

“…The Council of Residency Directors in Emergency Medicine (CORD) Best Practices Subcommittee publishes a series of articles entitled CORD Best Practice reviews; this manuscript is ninth in the series. [10][11][12][13][14][15][16][17] With the assistance of a medical librarian, we conducted a literature review from inception until January 2021 through MEDLINE via PubMed using the terms and Medical Subject Headings focused on DEI (Appendix). Additionally, a bibliography review was conducted for additional articles.…”

Creating a high‐quality personal statement for residency application: A guide for medical students and mentors

“…It is an individual choice how to tell your perspective through your personal lens and whether to disclose your preferences. Incorporating personal identifiers, such as your gender, race, age, ability, sexual orientation, parenting status, religion, or political affiliation, informs the reader on aspects of your life that you feel have influenced your journey 6,7 . Revealing these can run the risk of unfair or discriminatory judgment but can also demonstrate your comfort with yourself and positively support the reasons you will shine as a resident physician 12 .…”

“…Incorporating personal identifiers, such as your gender, race, age, ability, sexual orientation, parenting status, religion, or political affiliation, informs the reader on aspects of your life that you feel have influenced your journey. 6,7 Revealing these can run the risk of unfair or discriminatory judgment but can also demonstrate your comfort with yourself and positively support the reasons you will shine as a resident physician. 12 Depending on your passion and involvement in a particular topic, this can be an opportune segue to explain your interest and future ambitions.…”

“…Prior research reveals that the personal statement has not always been valued universally 2,3 . However, the personal statement may be gaining importance with the recently increased focus on holistic review as well as the transition of USMLE Step 1 to pass/fail and the increasing prevalence of pass/fail grading in U.S. medical schools 4–7 . This is relevant as objective metrics inconsistently predict a student's ability to practice medicine and succeed in residency 8,9 and may present a potential for racial and other forms of bias in applicant selection 10 …”

“…2,3 However, the personal statement may be gaining importance with the recently increased focus on holistic review as well as the transition of USMLE Step 1 to pass/fail and the increasing prevalence of pass/fail grading in U.S. medical schools. [4][5][6][7] This is relevant as objective metrics inconsistently predict a student's ability to practice medicine and succeed in residency 8,9 and may present a potential for racial and other forms of bias in applicant selection. 10 While the objective aspects of the application emphasize comparison based on standard measures, the subjective narrative is curated and individualized by the applicant.…”