Swipe right for surgical residency: Exploring the unconscious bias in resident selection

Abstract

Background: Applicants provide a photo with their application through the Electronic Residency Application Service, which may introduce appearance-based bias. We evaluated whether an unconscious appearance bias exists in surgical resident selection. Methods: After the match, applicant data from the 2018 to 2019 and 2019 to 2020 application cycles were examined. Reviewers were not provided the applicant photo or self-identified race during the second cycle. Photos provided by candidates were then rated by 4 surgical subspecialty residents who had no prior exposure to applications or interview status. Photos were rated on perceived fitness level, visual appearance, and photo professionalism. An overall photo score was then calculated. Results: In the study, 422 applications were reviewed and 164 received interview invitations during the 2018 to 2019 cycle. Alpha Omega Alpha membership (odds ratio, 2.31; 95% confidence interval, 1.18 e4.51), overall photo score (odds ratio, 2.29, 95% confidence interval, 1.43e3.66), research (odds ratio, 5.61, 95% confidence interval, 2.84e11.20), age (odds ratio, 0.86, 95% confidence interval, 0.76e0.99), and step 2 (odds ratio, 1.06, 95% confidence interval, 1.03e1.09) were predictors for receiving an interview. For the 2019 to 2020 cycle, 398 applications were reviewed, and 75 applicants received an invitation.Step 2 (odds ratio, 1.07, 95% confidence interval, 1.02e1.12), research (odds ratio, 2.78, 95% confidence interval, 1.40e5.55), age (odds ratio, 0.82, 95% confidence interval, 0.71e0.95), and overall photo score (odds ratio, 2.27; 95% confidence interval, 1.14e4.52) remained predictors despite reviewers being blinded to the photo during this cycle. Conclusion: Although objective metrics remain critical in determining interview invitations, overall perceived applicant appearance may influence the selection process. Although visual appearance was associated with receiving an interview, the Electronic Residency Application Service photo does not ultimately affect selection. This may suggest that appearance may influence other objective and subjective aspects of the application.

Implicit bias in healthcare: clinical practice, research and decision making

“…63 However, blinding may be beneficial when recruiting people to jobs from job applications given that application photos may influence the selection process at resident or registrar level. 64 It may be difficult to anonymise citations or publication data during academic selection processes.…”

Improving Diversity in Pediatric Residency Selection: Using an Equity Framework to Implement Holistic Review

“…These metrics may amplify existing biases 12 and reinforce structural inequities, benefiting those who are White and/or from more affluent backgrounds with higher parental education. 5,8,13 We recognized using such markers might systematically benefit already advantaged applicants, and that by relying on them, we might be missing other valuable personal attributes in applicants. To broaden our approach, we held a retreat for program leadership to create a shared mental model of attributes of successful residents.…”

“…2 Multiple studies demonstrate that bias influences residency selection. [3][4][5][6][7][8][9] To ensure an equitable recruitment and selection process, the Association of American Medical Colleges (AAMC) suggests the use of holistic review, defined as ''a flexible, individualized way of assessing an applicant's capabilities by which balanced consideration is given to experiences, attributes, and academic metrics.'' 10 Because holistic review is mission driven, its implementation varies at each institution.…”

Implementation of holistic review into emergency medicine residency application screening to improve recruitment of underrepresented in medicine applicants

“…Such a grading system with a defined scoring system may also help eliminate implicit bias compared to scores that rely more on reviewer gestalt, which have been shown to be affected by implicit bias. 13 The residency recruitment process is composed of three main phases: screening, interviewing, and selection. In practice, screening is the process of reviewing applicants' folders for consideration of an interview, interviewing offers more personal insight into applicants' character and goals, and selection is the process by which applicants are prioritized for the rank match list.…”