Responding to Recommended Changes to the 2020–2021 Residency Recruitment Process From a Diversity, Equity, and Inclusion Perspective

Abstract

In May 2020, the Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released its final report and recommendations. These recommendations pertain to away rotations, virtual interviews, Electronic Residency Application Service opening for programs and the overall residency timeline, and general communications and attempt to provide clarity and level the playing field during the 2020–2021 residency application cycle. The WG’s aims include promoting professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The authors argue the first 3 WG recommendations may disproportionately impact candidates from historically excluded and underrepresented groups in medicine (HEURGMs) and may affect an institution’s ability to ensure equity in the selection of residency applicants and, thus, warrant further consideration. The authors examine these recommendations from a diversity, equity, and inclusion (DEI) perspective. For each of the first 3 WG recommendations, the authors highlight new opportunities created by the recommendations and detail challenges that programs must carefully navigate to ensure equity for all candidates. The authors also recommend solutions to guide programs as they address these challenges, meet new common program requirements, and attempt to promote equity for HEURGMs. Finally, the authors recommend that after the 2020–2021 recruitment cycle, the medical education community evaluate DEI-related outcomes of both the WG’s and the authors’ recommendations and incorporate the findings into future application cycles.

The Impact of Virtual Interviewing During the COVID-19 Pandemic on the Residency Application Process: One Institution’s Experience

“…Personal interactions and opportunities to assess a program’s culture and that of its wider environment are important for all applicants, particularly those from groups historically underrepresented in medicine. 40…”

“…Personal interactions and opportunities to assess a program's culture and that of its wider environment are important for all applicants, particularly those from groups historically underrepresented in medicine. 40 A potential interview model could include an initial triage of application materials by the program, followed by a video interview of potential recruits, from whom the program could then select a smaller number of "highly probable" applicants who would be invited for an in-person interview and related activities. While evidence is accumulating to support the validity of virtual interviewing and to show applicant and reviewer confidence and comfort with this format, many issues remain to be addressed regarding both the interview process itself and other elements of the application process overall, such as those assessments provided by medical schools and the role of "audition electives" in a redesigned system.…”

Impact of Virtual Interviewing on Time and Financial Costs for NRMP© Applicants: Did Regional Campus Students Save More?

“…While modest compared to the total debt of graduating medical students, estimated at a median of $200,000, 24 these savings are especially welcome for those with limited resources considering nonprimary care specialties, and may contribute to improving diversity in some specialties. [25][26][27] The time consumed by the residency interviewing process has received relatively little attention in the literature but is a major source of stress and impediment to leaning in the senior year of medical school. [28][29][30][31] Our results indicate savings of up to 16 days by replacing in-person interviewing with virtual interviews.…”

Strategic surgery recruitment programs can enhance diversity and reinforce pipelines

“…1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Yet, structural barriers remain pervasive for women and historically excluded and underrepresented groups in medicine (URiM), which includes Black/African American, Hispanic/Latinx (i.e., mainland Puerto Rican and Mexican American), Native American (i.e., American Indian, Alaska Native, Native Hawaiian), Pacific Islander, and ‘Other’ populations. 2 , 3 , 4 , 5 , 6 Although Black and Hispanic groups comprise 12.5% and 18.3% (totaling 30.8%) of the US population, representation in medical schools, surgical training programs, and surgical faculty is disproportionately low according to Aggarwal et al using the AAMC (American Association of Medical Colleges) data reports. 4 For example, Black and Hispanic men represent 2.9% and 3.2% of matriculating medical students, respectively, but an even lower proportion of surgical trainees and faculty.…”

“…Therefore, surgical departments must prioritize DEI by establishing innovative recruitment (pipeline) and retention strategies to improve the proportion of surgical URiMs, specifically from male students to surgical trainees and female trainees to surgical faculty and leaders. 2 , 5 , 6 , 7 , 8 …”