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Catalanotti JS, Abraham R, Choe JH, Corning KA, Fick L, Finn KM, Higgins S, Mechaber HF, Mohr T, Raj J, Swails J. Rethinking the Internal Medicine Residency Application Process to Prioritize the Public Good: A Consensus Statement of the Alliance for Academic Internal Medicine. Am J Med 2024; 137:284-289. [PMID: 38042242 DOI: 10.1016/j.amjmed.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Jillian S Catalanotti
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Reeni Abraham
- Department of Internal Medicine, University of Texas Southwestern, Dallas
| | - John H Choe
- Internal Medicine Residency Program, University of Washington, Seattle
| | - Kelli A Corning
- Internal Medicine Residency Program, University of Washington, Seattle
| | - Laurel Fick
- Internal Medicine Residency Program, Ascension St. Vincent Hospital, Indianapolis, Ind
| | - Kathleen M Finn
- Internal Medicine Residency Program, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
| | - Stacy Higgins
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Hilit F Mechaber
- Clinical Medicine, University of Miami Miller School of Medicine, Fla
| | - Thomas Mohr
- Department of Internal Medicine, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas
| | - Jaya Raj
- Department of Medicine, Creighton University School of Medicine Phoenix Regional Campus, Ariz
| | - Jennifer Swails
- Internal Medicine Residency Program, Department of Internal Medicine, University of Texas Houston
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Morgan HK, Baecher-Lind L, Bhargava R, Cox S, Everett E, Fleming A, Graziano S, Morosky C, Royce C, Sonn T, Sutton J, Sims SM. Obstetrics and gynecology clerkship directors' experiences advising residency applicants. AJOG GLOBAL REPORTS 2023; 3:100268. [PMID: 37868823 PMCID: PMC10585629 DOI: 10.1016/j.xagr.2023.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The evolving landscape of application processes for obstetrics and gynecology residency applicants poses many challenges for applicants and advisors. The lack of data coordination among national groups creates crucial gaps in information for stakeholder groups. OBJECTIVE This study aimed to identify the current state of the advising milieu for obstetrics and gynecology residency applicants and their career advisors, the annual Association of Professors of Gynecology and Obstetrics survey focused on US clerkship directors' experiences advising students through these processes. STUDY DESIGN A 23-item anonymous survey was developed that asked respondents about demographics and outcomes for the students that they advised through the 2021 application process and their experiences with dual applicants and students not matching. The survey was sent electronically to all obstetrics and gynecology clerkship directors with active Association of Professors of Gynecology and Obstetrics memberships in April 2021. RESULTS Of 224 total clerkship directors, 143 (63.8%) responded to the survey, Of the 143 respondents, almost all (136 [95.1%]) served as career advisors, and 50 (35.0%) were aware of students dual applying. Furthermore, obstetrics and gynecology was rarely the backup to a more competitive specialty. For the 2021 application cycle, 79 of 143 respondents (55.2%) reported having students not successfully match into obstetrics and gynecology, with "academic concerns" followed by "poor communication skills" as the primary reasons cited for students not matching. CONCLUSION This snapshot of clerkship directors' experiences advising students in the residency application process reveals notably high rates of dual applicants and students not matching into obstetrics and gynecology. This work fills key gaps in our knowledge of current processes and highlights the importance of career advising at multiple points during the application process.
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Affiliation(s)
- Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Morgan)
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA (Dr Baecher-Lind)
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, Regina College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (Dr Bhargava)
| | - Susan Cox
- School of Medicine, University of Texas Health Science Center at Tyler, Smith County, TX (Dr Cox)
| | - Elise Everett
- Department of Obstetrics and Gynecology, Larner College of Medicine, University of Vermont, Burlington, VT (Dr Everett)
| | - Angela Fleming
- Michigan State University College of Osteopathic Medicine, East Lansing, MI (Dr Fleming)
| | - Scott Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL (Dr Graziano)
| | - Chris Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT (Dr Morosky)
| | - Celeste Royce
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Dr Royce)
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Dr Sonn)
| | - Jill Sutton
- Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, NC (Dr Sutton)
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL (Dr Sims)
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Edje L, Casillas C, O'Toole JK. Strategies to Counteract Impact of Harmful Bias in Selection of Medical Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S75-S85. [PMID: 37099404 DOI: 10.1097/acm.0000000000005258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Human biases impact medical care in ways that perpetuate health disparities. Research has demonstrated that biases negatively affect patient outcomes and stifle diversity across the physician workforce, further compounding health disparities by worsening patient-physician concordance. Taken as one, the application, interview, recruitment, and selection processes employed by residency programs has been one of the critical junctures where bias has exacerbated inequities among future physicians. In this article, the authors define diversity and bias, review the history of bias in residency programs' processes for selecting residents, explore the impact of this history on workforce demographics, and discuss ways to optimize and work toward equity in the practices used by residency programs to select residents.
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Affiliation(s)
- Louito Edje
- L. Edje is associate dean of graduate medical education, designated institutional official, and professor of medical education and family and community medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-9125-7180
| | - Carlos Casillas
- C. Casillas is a fellow in pediatric hospital medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5789-0620
| | - Jennifer K O'Toole
- J.K. O'Toole is program director, internal medicine-pediatrics residency program and professor of pediatrics and internal medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6277-1113
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Dacre M, Branzetti J, Hopson LR, Regan L, Gisondi MA. Rejecting Reforms, Yet Calling for Change: A Qualitative Analysis of Proposed Reforms to the Residency Application Process. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:219-227. [PMID: 36512846 DOI: 10.1097/acm.0000000000005100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Annual increases in the number of residency applications burden students and challenge programs. Several reforms to the application process have been proposed; however, stakeholder input is often overlooked. The authors examined key stakeholders' opinions about several proposed reforms to the residency application process and identified important factors to guide future reforms. METHOD Using semistructured interviews, the authors asked educational administrators and trainees to consider 5 commonly proposed reforms to the residency application process: Match to obtain residency interviews, preference signaling, application limits, geographic preference disclosure, and abolishing the Match. The authors conducted a modified content analysis of interview transcripts using qualitative and quantitative analytic techniques. Frequency analysis regarding the acceptability of the 5 proposed reforms and thematic analysis of important factors to guide reform were performed. Fifteen-minute interviews were conducted between July and October 2019, with data analysis completed during a 6-month period in 2020 and 2021. RESULTS Participants included 30 stakeholders from 9 medical specialties and 15 institutions. Most participants wanted to keep the Match process intact; however, they noted several important flaws in the system that disadvantage students and warrant change. Participants did not broadly support any of the 5 proposed reforms. Two themes were identified: principles to guide reform (fairness, transparency, equity, reducing costs to students, reducing total applications, reducing work for program directors, and avoiding unintended consequences) and unpopular reform proposals (concern that application limits threaten less competitive students and signaling adds bias to the system). CONCLUSIONS Key stakeholders in the residency application process believe the system has important flaws that demand reform. Despite this, the most commonly proposed reforms are unacceptable to these stakeholders because they threaten fairness to students and program workload. These findings call for a larger investigation of proposed reforms with a more nationally representative stakeholder cohort.
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Affiliation(s)
- Michael Dacre
- M. Dacre is a fourth-year medical student, Stanford School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-5561-1656
| | - Jeremy Branzetti
- J. Branzetti was assistant professor, Department of Emergency Medicine, New York University Langone School of Medicine, New York, New York, at the time of this work. He is now affiliated with Geisinger Health System, Danville, Pennsylvania. ORCID: https://orcid.org/0000-0002-2397-0566
| | - Laura R Hopson
- L.R. Hopson is professor and associate chair for education, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-1183-4751
| | - Linda Regan
- L. Regan is associate professor and vice chair of education, Department of Emergency Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0390-4243
| | - Michael A Gisondi
- M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Stanford School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-6800-3932
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Grauer R, Ranti D, Greene K, Gorin MA, Menon M, Zorc S. Characterization of Applicant Preference Signals, Invitations for Interviews, and Inclusion on Match Lists for Residency Positions in Urology. JAMA Netw Open 2023; 6:e2250974. [PMID: 36662528 PMCID: PMC9860522 DOI: 10.1001/jamanetworkopen.2022.50974] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/22/2022] [Indexed: 01/21/2023] Open
Abstract
Importance Preference signals were to be implemented in over 15 specialties during the 2022-2023 residency match. Analyzing results from the implementation of signals during the American Urological Association (AUA) urology match may inform future behavior. Objective To characterize applicant and program signal usage and results in the Society of Academic Urology and AUA databases with respect to interview invites and rank list creation. Design, Setting, and Participants This cohort study involved all applicants and residencies in the 2021-2022 AUA match with data analysis conducted in April through July 2022. Exposures Five signals indicating interest. Main Outcomes and Measures Using verified match and survey data reported by applicants and programs, a logistic regression was performed on applicant factors associated with obtaining an interview-the main outcome (using inclusion on rank list as a proxy): age, gender, degree (MD or DO), dispersal of signal, US senior status, racial minority group status, Latino ethnicity, international medical graduate status, presence of a home program, AUA geographic section, and US Medical Licensing Examination Step 1 score. Applicant signal dispersal strategies were stratified by applicant and program competitiveness, as well as program behavior upon receipt of signal with respect to extending interviews and rank list ordering of applicants. Results A total of 2659 signals were sent by 553 candidates (mean [SD] age, 27.4 [2.9] years; 179 female [32.4%], 243 racial minority candidates [61.2%]) submitting rank lists for 364 positions at 143 programs. Programs received a median (IQR) of 352 (295-411) applications and were signaled to a median of 16 (8-26) times each. In a logistic regression estimating interview status, geographic proximity (OR, 3.25; 95% CI, 2.05-5.15; P = .001) and signal status (OR, 6.04; 95% CI, 3.50-10.40; P < .001) were associated with receiving an interview. Using multiple imputation by chained equations to impute missing data and broadening the data set, male gender (OR, 0.64; 95% CI, 0.45-0.92; P = .04) and international medical graduate status (OR, 0.35; 95% CI, 0.15-0.81; P = .04) were negative variables, while MD degree (OR, 2.36; 95% CI, 1.27-4.36; P = .02) and US senior status (OR, 1.91; 95% CI, 1.13-3.23; P = .04) were positive variables. Conclusions and Relevance This study of the usage and trends of the newly added preference signals reported the most common strategies for signal dispersal; in an analysis of factors involved in obtaining an interview, geographic similarity between applicant and program and preference signal usage were associated with successful applications.
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Affiliation(s)
- Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel Ranti
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kirsten Greene
- Department of Urology, University of Virginia, Charlottesville
| | - Michael A. Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saša Zorc
- Department of Quantitative Analysis, University of Virginia Darden School of Business, Charlottesville
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Santos-Parker KS, Hammoud MM, Winkel AF, Marzano D, Frank S, Franz P, Morgan HK. Distributions of Residency Interviews With the Implementation of Virtual Interviews and Standardization of Interview Offer Dates. JOURNAL OF SURGICAL EDUCATION 2022; 79:1105-1112. [PMID: 35477525 DOI: 10.1016/j.jsurg.2022.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Virtual interviews were widely implemented alongside many other changes in the 2021 residency application process. We investigated how these many interventions may have influenced interview distributions and completions. DESIGN Cross-sectional survey distributed electronically to obstetrics and gynecology (OBGYN) residency applicants in February 2021. Distributions of interview invitations, interviews completed, and percent of interview offers completed were compared to the previous application cycle. The odds ratios of receiving interviews were calculated based on applicant characteristics including test scores, number of applications, and race/ethnicity. SETTING All OBGYN residency applicants registered through the Electronic Residency Application Service. PARTICIPANTS The 915 (36%) of 2577 total OBGYN applicants who responded to the survey. RESULTS US allopathic medical students received fewer interview offers in 2021 (median 13 [interquartile range 9-19]) compared to 2020 (median 15 [interquartile range 11-20]). There was no difference in the absolute numbers of interviews completed. A United States Medical Licensing Exam Step 1 score ≥221 resulted in more than a five-fold increase in adjusted odds of receiving at least 12 interviews for allopathic students. Black or African American US allopathic seniors had a 2.3 odds ratio for receiving at least 12 interview invitations compared to White non-Hispanic or Latino US allopathic seniors, adjusted for Step 1 score and the number of programs applied to. Interview offers released on standardized dates had a mitigating effect on completing more interviews among allopathic seniors with at least 12 interview invitations. CONCLUSIONS Virtual interviews did not change the overall number of interviews completed. Standardization of interview offer dates mitigated excessive virtual interviewing, yet additional measures are needed to curb interview inflation and the effects on interview distributions.
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Affiliation(s)
- Keli S Santos-Parker
- University of California San Francisco, Department of Surgery, San Francisco, California.
| | - Maya M Hammoud
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan; University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan
| | - Abigail Ford Winkel
- New York University Grossman School of Medicine, Department of Obstetrics and Gynecology and Institute for Innovations in Medical Education, New York, New York
| | - David Marzano
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan; University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan
| | - Sarah Frank
- Virtua Health, Department of Obstetrics and Gynecology, Voorhees, New Jersey
| | - Patricia Franz
- Beaumont Health System - Oakland University William Beaumont School of Medicine, Department of Obstetrics and Gynecology, Royal Oak, Michigan
| | - Helen K Morgan
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan; University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan
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Strand EA, Winkel AF, Marzano DA, Morgan HK, Staples H, Hammoud MM. Stakeholder Perspectives on Limiting Residency Applications and Interviews in Obstetrics and Gynecology. JOURNAL OF SURGICAL EDUCATION 2022; 79:362-369. [PMID: 34862152 DOI: 10.1016/j.jsurg.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/29/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Application inflation in the current residency application process leads to congestion, inefficiency, and perceptions of inequity. The authors aimed to assess the interest of key stakeholders on the topic of capping applications and interviews, and their perceptions regarding equity of the process. METHODS An anonymous survey was electronically distributed in March 2021 to Obstetrics and Gynecology (OBGYN) residency applicants, clerkship directors, program directors, and student affairs deans after the submission of the rank order list for the 2021 application cycle and prior to the release of final Match results. Participants answered questions regarding the perceived equity of the current process (no limits on applications submitted or interviews completed) compared with limiting the number of applications and interviews students could submit or complete. Respondents supporting caps reported the number they considered a reasonable cap for applications and interviews. Associations between the profiles of applicants and program directors and their interest in application and interview caps were explored using chi-squared tests for non-parametric statistics and t-tests for normally distributed interval data. The University of Michigan determined the study exempt from IRB review. RESULTS The overall response rate was 36.0% (1167/3243), including 34.0% of applicants (879/2579), 50.3% of program directors (143/284), 41.8% of clerkship directors (94/225) and 32.9% of student affairs deans (51/155). All groups reported application caps for either all applicants or the most competitive applicants to be more equitable than the current process, and suggested a median application cap ranging from 25 (clerkship directors and program directors) to 40 (applicants). All groups also believed interview caps to be more equitable than the current process, and suggested a median interview cap ranging from 12 (clerkship directors) to 15 (applicants, program directors, and student affairs deans). CONCLUSIONS Stakeholders in the OBGYN application process consider caps to applications and interviews a promising means to improve equity in the Match.
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Affiliation(s)
- Eric A Strand
- Department of Obstetrics and Gynecology at Washington University, St. Louis, Missouri.
| | - Abigail Ford Winkel
- Department of Obstetrics and Gynecology and Institute for Innovations in Medical Education, New York University Grossman School of Medicine. New York, New York
| | - David A Marzano
- Department of Obstetrics and Gynecology and Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan
| | - Helen K Morgan
- Department of Obstetrics and Gynecology and Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan
| | - Halley Staples
- Department of Obstetrics and Gynecology in the Washington University/Barnes Jewish Hospital Consortium Program, St Louis, Missouri
| | - Maya M Hammoud
- Department of Obstetrics and Gynecology and Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan
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