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Oleru OO, Shamamian PE, Levy L, Gyasi A, Wang C, Seyidova N, Henderson PW. Underrepresented in Medicine Applicants are Less Likely to Successfully Match into Plastic Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:1066-1074. [PMID: 38806307 DOI: 10.1016/j.jsurg.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/02/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
IMPORTANCE The lack of underrepresented in medicine physicians in academic plastic surgery has been a topic of interest for many years, and accordingly outreach has been undertaken to address the pipeline from medical school to residency and beyond. OBJECTIVE This study aims to assess and identify the characteristics associated with plastic surgery match success for underrepresented in medicine applicants. DESIGN Residency application data for first time, US allopathic medical school seniors from the 2017-2018 to 2021-2022 applicant cycles were abstracted from Electronic Residency Application Service applications, and match results were determined using the National Residency Matching Program database and online public sources. Data included self-reported race, and multiple application characteristics. Multivariable logistic regression of application characteristics were used to assess the relationship between underrepresented in medicine status and successfully matching. Binary logistic regression was used in subgroup analyses of each application characteristic, and interactions regression was used to evaluate the relative weight of each characteristic on successfully matching. RESULTS Underrepresented in medicine applicants were 57% less likely to match than non-underrepresented in medicine applicants (OR 0.43, p = 0.001), though they were 60% less likely to match (ORadj 0.4, p = 0.216) when adjusted. Subgroup analysis revealed that odds of matching as an underrepresented in medicine applicant were significantly increased if the applicant had a home program, took a research year, and had an increased number of published research and presentations (ORs 0.43-0.48, all p < 0.05). Odds of matching as an underrepresented in medicine applicant were significantly decreased if the applicant went to a medical school ranked in the highest or lowest third (ORs 0.41-0.42, all p < 0.01); however, on interaction regression the odds of matching from a highly ranked medical school was increased (OR 3.5, 95% CI 0.98-12.55, p = 0.05). CONCLUSIONS The likelihood of matching as an underrepresented in medicine applicant is lower than the rest of the applicant population, and there are no individual applicant characteristics that can increase these odds to equal that of the general applicant population.
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Affiliation(s)
- Olachi O Oleru
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Peter E Shamamian
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Lior Levy
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029; New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595
| | - Abena Gyasi
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Carol Wang
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Nargiz Seyidova
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Peter W Henderson
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029.
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Tremonti G, Shah NR, Moreci R, Hooper RC, Gadepalli SK, Newman EA. Early Lessons From Implementation of Holistic Review for Pediatric Surgery Fellowship Applicants. J Pediatr Surg 2024:S0022-3468(24)00302-6. [PMID: 38811257 DOI: 10.1016/j.jpedsurg.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Holistic review (HR) considers applicants' unique identities and experiences rather than focusing on academic metrics. Though several residency programs have demonstrated increases in women and those underrepresented in medicine (URiM), this is the first study to examine HR in pediatric surgery (PS). METHODS Using a retrospective review of applicants, demographic, academic, and non-academic metrics of traditional review (TR) [2015-2017] were compared to HR [2018-2022]. HR initiatives include expansion of faculty reviewers, implementation of a pre-screening rubric, and greater prioritization of non-academic factors. Chi-squared/Fisher's exact tests, Wilcoxon rank-sum tests, and two sample z-test for proportions were used where appropriate. RESULTS For 635 applicants (TR: 268, HR: 367), the proportion offered interviews in the TR and HR cohorts were similar (31.7 vs 36%, p = 0.30). Candidates selected for interview pre- and post-HR most commonly graduated from residency programs affiliated with PS fellowships (56.5 vs 50%, p = 0.65). After HR implementation, no change in proportion of women interviewees (TR: 52.9 vs HR: 54.5%, p = 0.93) was observed. Though URiM residents applying to PS remained consistently low (TR: 14.6 vs HR: 10.9%, p = 0.21), significantly more received interviews with HR (30.8 vs 42.5%, p = 0.001). The median number of peer-review publications per interviewee increased (17 vs 22, p = 0.02) as did non-academic achievements (leadership, service, athletic awards, etc.) per applicant (1.0 vs 1.5, p = 0.104), though the latter did not reach significance, demonstrating similar qualification of interviewees in HR and TR. CONCLUSION Holistic review of PS fellowship applications increased the proportion of URiM interviewees, despite a persistently low URiM proportion in the applicant pool. Furthermore, implementing HR did not sacrifice the caliber of interviewees, as publications and non-academic achievements increased by over 25% in the HR cohort. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grace Tremonti
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nikhil R Shah
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Rebecca Moreci
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, MI, USA
| | - Rachel C Hooper
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Erika A Newman
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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Magura CM, Rubino MS, Bolaji T, Goldberg MB. Increasing Underrepresented Minority Representation in a General Surgery Residency Program Utilizing a 3-Phase Strategy. Am Surg 2024:31348241248687. [PMID: 38631332 DOI: 10.1177/00031348241248687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Underrepresented minority groups (URMs) in surgery are not significantly increasing despite evidence suggesting that diversity in health care providers leads to excellent patient outcomes and care. Efforts to increase URM representation in surgical residency programs are essential for addressing disparities and improving health care delivery. METHODS This retrospective study outlines a three-phase strategy implemented at a large academic-affiliated hospital to increase URM representation in its general surgery residency program. The strategy encompassed interview selection with a holistic review and implicit bias training for interviewers, modification of the interview scoring rubric, and post-interview recruitment efforts, including a virtual second look event for URM applicants. RESULTS Following the implementation of these strategies, the URM match rate improved from 0 to 33.3% in the first year and was sustained at 33.3% in the subsequent year. Consequently, the representation of URMs in the residency program rose from 6.7% before our intervention to 13.3% afterwards. DISCUSSION This structured approach successfully increased URM representation in a surgical residency program, affirming the success of targeted recruitment strategies. By promoting a diverse and inclusive environment, the program better reflects the community it serves, with aims at improved patient care and patient satisfaction.
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Affiliation(s)
- Connor M Magura
- Department of Surgery, ChristianaCare Health System, Newark, DE, USA
| | - Matthew S Rubino
- Department of Surgery, ChristianaCare Health System, Newark, DE, USA
| | - Toba Bolaji
- Department of Surgery, ChristianaCare Health System, Newark, DE, USA
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Zmijewski P, Aleman C, McLeod C, Gillis A, Sidani M, Lynch K, Parker C, Lancaster R, Lindeman B, Chen H, Fazendin J. When I Don't see me, Am I seen? Race and student perception of the surgery clerkship. Am J Surg 2024; 229:116-120. [PMID: 38123386 DOI: 10.1016/j.amjsurg.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Increasing interest in general surgery from students who are Under-Represented in Medicine (URiM) is imperative to advancing diversity, equity, and inclusion efforts. We examined medical student third year surgery clerkship evaluations quantitatively and qualitatively to understand the experiences of URiM and non-URiM learners at our institution. METHODS Evaluations from 235 graduated medical students between the years of 2019 and 2021 were analyzed. T-tests were used to compare numerical data. Free-text comments were qualitatively analyzed using inductive thematic analysis by two independent reviewers with conflicts resolved by a third. RESULTS Evaluations were completed by 214 non-URiM students (91.1 %) and 21 (8.9 %) URiM students. There were no significant differences between URiM and non-URiM students in ratings of faculty and resident teaching. When asked whether residents were positive role models for patient care, non-URiM students were more likely than URiM students to agree (3.284 vs. 2.864, p = 0.040). When asked whether they considered faculty to be positive role models, non- URM students were also more likely to answer affirmatively than URiM students (3.394 vs. 2.909 p = 0.013). Qualitative comments were similar between the two groups. When asked what the strengths of the clerkship were, the most commonly evoked theme was "interactions with team" with subthemes of "team integration" "feeling valued" and positive "faculty" or "resident" interactions. "Operative experience" was the second most commonly evoked strength of the clerkship. The most common criticisms of the clerkship involved "negative interactions with team" with subthemes of "not prioritized above other learners" and "ignored." Negative "academic experience" was the next most commonly evoked weakness, with an affiliated theme of "lack of teaching." CONCLUSIONS URiM students are less likely than non-URiM students to see surgical residents and faculty as positive role models. Integrating medical students into the team, taking time to teach, and allowing students to feel valued in their roles improves the clerkship experience for trainees and can contribute to recruitment efforts.
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Affiliation(s)
| | - Carla Aleman
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Andrea Gillis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohamad Sidani
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | | | | | | | - Herbert Chen
- University of Alabama at Birmingham, Birmingham, AL, USA
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Lai SH, Suarez-Pierre A, Jaiswal K, Travis C, Steward L, Nehler M, Zweck-Bronner S, Christian N. Implementation of a Holistic Review Process of US Allopathic Medical Students Eliminates Non-Comparable Metrics and Bias in General Surgery Residency Interview Invitations. JOURNAL OF SURGICAL EDUCATION 2023; 80:1536-1543. [PMID: 37507300 DOI: 10.1016/j.jsurg.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Use of traditional scoring metrics for residency recruitment creates racial and gender bias. In addition, widespread use of pass/fail grading has led to noncomparable data. To adjust to these challenges, we developed a holistic review (HR) rubric for scoring residency applicants for interview selection. DESIGN Single-center observational study comparing the proportion of underrepresented in medicine (URM) students and their United States Medical Licensing Exam (USMLE) scores who were invited for interview before (2015-2020) and after (2022) implementation of a holistic review process. SETTING General surgery residency program at a tertiary academic center. PARTICIPANTS US allopathic medical students applying for general surgery residency. RESULTS After initial screening, a total of 1514 allopathic applicants were narrowed down to 586 (38.7%) for HR. A total of 52% were female and 17% identified as URM. Based on HR score, 20% (118/586) of applicants were invited for an interview. The median HR score was 11 (range 4-19). There was a fourfold higher coefficient of variation of HR scores (22.3; 95% CI 21.0-23.7) compared to USMLE scores (5.1; 95% Cl 4.8-5.3), resulting in greater spread and distinction among applicants. There were no significant differences in HR scores between genders (p = 0.60) or URM vs non-URM (p = 0.08). There were no significant differences in Step 1 (p = 0.60) and 2CK (p = 0.30) scores between those who were invited to interview or not. On multivariable analysis, USMLE scores (OR 1.01; 95% CI 0.98-1.03), URM status (OR 1.71 95% CI 0.98-2.92), and gender (OR 0.94, 95% CI 0.60-1.45) did not predict interview selection (all p > 0.05). There was a meaningful increase in the percentage of URM interviewed after HR implementation (12.9% vs 23.1%, p = 0.016). CONCLUSION The holistic review process is feasible and eliminates the use of noncomparable metrics for surgical applicant interview invitations and increases the percentage of URM applicants invited to interview.
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Affiliation(s)
- Samuel H Lai
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Kshama Jaiswal
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Claire Travis
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Lauren Steward
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Nehler
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Steve Zweck-Bronner
- University of Colorado Anschutz Medical Campus, Office of University Counsel, Aurora, Colorado
| | - Nicole Christian
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
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Shaffrey EC, Moura SP, Wirth PJ, Attaluri PK, Schappe A, Edalatpour A, Bentz ML, Rao VK. Objective Residency Applicant Assessment Using a Linear Rank Model. JOURNAL OF SURGICAL EDUCATION 2023; 80:776-785. [PMID: 37012141 DOI: 10.1016/j.jsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Residency applicant assessment is imperfect, with little objectivity built into the process, which, unfortunately, impacts recruitment diversity. Linear rank modeling (LRM) is an algorithm that standardizes applicant assessment to model expert judgment. Over the last 5 years, we have used LRM to assist with screening and ranking integrated plastic surgery (PRS) residency applicants. This study's primary objective was to determine if LRM scores are predictive of match success and, secondarily, to compare LRM scores between gender and self-identified race categories. DESIGN Data was collected on applicant demographics, traditional application metrics, global intuition rank, and match success. LRM scores were calculated for screened and interviewed applicants, and scores were compared by demographic groups. Univariate logistic regression was used to evaluate the association of LRM scores and traditional application metrics with match success. SETTING University of Wisconsin, Division of Plastic and Reconstructive Surgery. Academic institution. PARTICIPANTS Six hundred seventeen candidates who applied to a single institution over 4 application cycles (2019-2022). RESULTS Using area under the curve modeling, LRM score was the most predictive indicator for match success. With every one-point increase in LRM score, there was an 11% and 8.3% increase in the likelihood of screened and interviewed applicant match success (p < 0.001). An algorithm was developed to estimate the probability of match success based on LRM score. No significant differences in LRM scores were appreciated for interviewed applicant gender or self-identified race groups. CONCLUSIONS LRM score is the most predictive indicator of match success for PRS applicants and can be used to estimate an applicant's probability of successfully matching into an integrated PRS residency. Furthermore, it provides a holistic evaluation of the applicant that can streamline the application process and improve recruitment diversity. In the future, this model could be applied to assist in the match process for other specialties.
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Affiliation(s)
- Ellen C Shaffrey
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Steven P Moura
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Peter J Wirth
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Pradeep K Attaluri
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Alyssa Schappe
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Armin Edalatpour
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Michael L Bentz
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin
| | - Venkat K Rao
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of 11 Medicine and Public Health, Madison, Wisconsin.
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