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Truong OH, Wang JY, Cronholm PF. Holistic Review in Family Medicine Residency Programs: A CERA Study. Fam Med 2024; 56:367-372. [PMID: 38652848 PMCID: PMC11229850 DOI: 10.22454/fammed.2024.515525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Interest in using holistic review for residency recruitment as a strategy to improve the diversity of the physician workforce has increased. However, no data are published on the prevalence of holistic review in the selection process for family medicine residency programs. We designed this study to assess programs' knowledge, skills, and attitudes; prevalence; barriers to implementation; and program characteristics associated with the use of holistic review. METHODS Data for this study were elicited as part of a 2023 survey conducted by the Council of Academic Family Medicine Educational Research Alliance. The nationwide, web-based survey was sent to 739 family medicine residency program directors. RESULTS A total of 309 program directors completed the holistic review portion of the survey. Programs that understood and agreed with holistic review used it more in their selection process. Holistic review was more common in programs with higher rates of residents, faculty, and patients that are underrepresented in medicine. Barriers to holistic review utilization were increased number of applicants, increased resources associated with holistic review, and lack of consensus on the holistic review approach. CONCLUSIONS The holistic review process is an area of growing interest to diversify the physician workforce, especially among residencies caring for underresourced communities. Further discussions on the specific scoring rubrics of family medicine residency programs that use holistic review are needed and could help programs that are facing barriers. Widespread use of holistic review to diversify the physician workforce has the potential to improve patient care access and health.
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Affiliation(s)
- Oanh H Truong
- Baton Rouge General Family Medicine Residency Program, Baton Rouge, LA
- School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jenny Y Wang
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
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Erickson TS, Warren BR, Pletcher SD. Cost Analysis of High-Signal Approach in Otolaryngology-Head and Neck Surgery Residency. Laryngoscope 2024; 134:2684-2688. [PMID: 38366762 DOI: 10.1002/lary.31330] [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: 11/21/2023] [Revised: 01/03/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The objective of this study is to analyze a high-signal approach for otolaryngology-head and neck surgery (OHNS) residency applicants and calculate cost savings for programs and applicants. METHODS Data from both the 2022-2024 Electronic Residency Application Service (ERAS) and a data model were used to demonstrate cost savings with a high-signal approach. Modeled data assumed that the number of applications per applicant would be equal to the number of signals allowed. Predicted and real-world cost savings across the five other specialties participating in a high-signal approach were calculated. RESULTS ERAS data cost savings for the entire OHNS applicant pool amounted to $365,950. In the modeled data, cost savings amounted to $825,921. When extrapolated to include all five high-signal specialties, total cost savings amounted to $2,570,464 (ERAS data) and $6,359,478 (modeled data). Otolaryngology programs were predicted to experience significant time savings, resulting in cost savings of $437,883 and $1,113,342 for ERAS data and modeled data, respectively. CONCLUSIONS The study highlights the advantages of a high-signal approach, including financial advantages or increased time for programs to engage in holistic review and diversify the pool of interview candidates. Cost savings in this study were shown to be significant when extrapolated across all specialties using a high-signal approach. Further research is needed to optimize the signaling system and confirm the favorable interview distribution and equity data from the low-signal OHNS experience with a high-signal approach. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2684-2688, 2024.
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Affiliation(s)
- Taylor S Erickson
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brooke R Warren
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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Tiyyagura G, Weiss J, Goldman MP, Crawley DM, Langhan ML. Selection and Recruitment Strategies among Competitive Pediatric Training Programs and the Impact of Diversity. Acad Pediatr 2024; 24:338-346. [PMID: 37748536 PMCID: PMC11217005 DOI: 10.1016/j.acap.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Aspects of the written application, interview and ranking may negatively impact recruitment of underrepresented in medicine (URiM) applicants. Our objectives were to explore knowledge, attitudes, and perceptions of pediatric faculty who assess potential trainees and how diversity impacts these assessments. METHODS We performed qualitative interviews of 20 geographically diverse faculty at large pediatric residencies and fellowships. We analyzed data using the constant comparative method to develop themes. RESULTS Four main themes emerged. CONCLUSIONS We describe ways in which bias infiltrates recruitment and strategies to promote diversity. Many strategies are variably implemented and the impact on workforce diversity in pediatric training programs remains unknown.
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Affiliation(s)
- Gunjan Tiyyagura
- Department of Pediatrics and Emergency Medicine (G Tiyyagura, MP Goldman, and ML Langhan), Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn
| | - Jasmine Weiss
- Department of Pediatrics (J Weiss), Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michael P Goldman
- Department of Pediatrics and Emergency Medicine (G Tiyyagura, MP Goldman, and ML Langhan), Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn
| | - Destanee M Crawley
- Department of Pediatrics (DM Crawley), Yale School of Medicine, New Haven, Conn
| | - Melissa L Langhan
- Department of Pediatrics and Emergency Medicine (G Tiyyagura, MP Goldman, and ML Langhan), Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn.
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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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Golden BP, Holland R, Zakowski L, Smith J. Using a Consensus-Driven Approach to Incorporate Holistic Review Into an Internal Medicine Residency Program. J Grad Med Educ 2023; 15:469-474. [PMID: 37637348 PMCID: PMC10449341 DOI: 10.4300/jgme-d-22-00637.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 04/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Despite growing interest in incorporating holistic review within residency admissions, implementation by residency programs remains challenging. Objective To incorporate holistic review into the internal medicine residency program at the University of Wisconsin and to report initial feasibility and acceptability data. Methods During the 2020-2021 application cycle, residency stakeholders performed a consensus-driven process to identify highly valued applicant attributes. We used a holistic review process to identify the presence of these attributes among applicants and updated our rank list algorithm to incorporate these attributes. We modified our interview screening criteria and rank list algorithm to de-emphasize other metrics. We surveyed stakeholders to assess time required for this process and compared our final rank list to what it would have been using our prior system. Results The final list of 10 prioritized applicant attributes included extraordinary leadership, community service, and grit, among others. Among 25 matched residents, 8 (32%) were recognized to have exceptional achievement within one of these 10 attributes. Four members of the incoming intern class (16%) would have been in a rank position lower than our historical matched resident cutoff had they not received additional points for these attributes. Faculty reported that holistic review of applications took an additional 3.8 minutes on average. It was felt that current application materials limit the ability to implement a fully holistic review. Conclusions The addition of holistic review to our residency admissions process was achieved using a consensus-driven approach and showed favorable feasibility and acceptability data.
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Affiliation(s)
- Blair P. Golden
- All authors are with the University of Wisconsin School of Medicine and Public Health. Blair P. Golden, MD, MS, is Assistant Professor, Department of Medicine
| | - Robert Holland
- Robert Holland, MD, is Associate Program Director and Associate Professor, Department of Medicine
| | - Laura Zakowski
- Laura Zakowski, MD, is Vice Chair of Education and Professor, Department of Medicine; and
| | - Jeremy Smith
- Jeremy Smith, MD, is Associate Program Director and Associate Professor, Department of Medicine
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Swails JL, Angus S, Barone MA, Bienstock J, Burk-Rafel J, Roett MA, Hauer KE. The Undergraduate to Graduate Medical Education Transition as a Systems Problem: A Root Cause Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:180-187. [PMID: 36538695 DOI: 10.1097/acm.0000000000005065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The transition from undergraduate medical education (UME) to graduate medical education (GME) constitutes a complex system with important implications for learner progression and patient safety. The transition is currently dysfunctional, requiring students and residency programs to spend significant time, money, and energy on the process. Applications and interviews continue to increase despite stable match rates. Although many in the medical community acknowledge the problems with the UME-GME transition and learners have called for prompt action to address these concerns, the underlying causes are complex and have defied easy fixes. This article describes the work of the Coalition for Physician Accountability's Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) to apply a quality improvement approach and systems thinking to explore the underlying causes of dysfunction in the UME-GME transition. The UGRC performed a root cause analysis using the 5 whys and an Ishikawa (or fishbone) diagram to deeply explore problems in the UME-GME transition. The root causes of problems identified include culture, costs and limited resources, bias, systems, lack of standards, and lack of alignment. Using the principles of systems thinking (components, connections, and purpose), the UGRC considered interactions among the root causes and developed recommendations to improve the UME-GME transition. Several of the UGRC's recommendations stemming from this work are explained. Sustained monitoring will be necessary to ensure interventions move the process forward to better serve applicants, programs, and the public good.
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Affiliation(s)
- Jennifer L Swails
- J.L. Swails is residency program director, codirector of interprofessional education, and associate professor, Department of Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas; ORCID: http://orcid.org/0000-0002-6102-831X
| | - Steven Angus
- S. Angus is designated institutional official, vice-chair for education, and professor, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael A Barone
- M.A. Barone is vice president of competency-based assessment, NBME, Philadelphia, Pennsylvania, and adjunct associate professor of pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Bienstock
- J. Bienstock is professor of gynecology and obstetrics, associate dean for graduate medical education, and designated institutional official, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jesse Burk-Rafel
- J. Burk-Rafel is assistant professor of medicine and assistant director of UME-GME innovation, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York
| | - Michelle A Roett
- M.A. Roett is professor and chair, Department of Family Medicine, Georgetown University Medicine Center, and clinical chief of family medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Dens Higano J, Tilburt JC, Hafferty FW. Words matter: Tracing the implicit meaning of diversity language (and its absence) in medical school mission statements. J Natl Med Assoc 2023; 115:18-25. [PMID: 36585294 DOI: 10.1016/j.jnma.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/15/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022]
Abstract
Despite recent attention to social justice, diversity, equity, and inclusion within medical education, little is currently known about whether and to what extent that attention has translated into the language of formal documents articulating organization purpose: medical school mission statements. Mission statements are the marquee declaration of a medical school's identity and purpose, and a recommended tool for applicants to determine "fit" when applying. This study examines whether and to what extent social justice, diversity, equity, and inclusion have made it into the formal public statements of organizational purpose and identity over the last several years. Mission statements were extracted manually from the 2007, 2017, and 2021 AAMCs Medical School Admission Requirements (MSAR) database for both U.S. and Canadian M.D. granting medical schools. Then each mission statement version was coded for the presence and degree of diversity language including words like social justice, diversity, equity, and inclusion using an agreed-upon lexicon. Frequencies and within school changes over time were analyzed. Among 139 medical schools with discoverable mission statements from 2007, 91% (n=127) changed their MSs between 2007 and 2021. In 2007, 24% (n=33) of MSs contained diversity language. By 2017 nearly half of MSs; 47% (n=65) contained any reference to such language. But by 2021, despite 46 school having changed their MSs again, only a few more included diversity language in their MSs (56%; n=77). The most common terms used were "diversity," followed by the increasing presence of words like "inclusion," "equity," and "justice" by 2021. Curiously, a few schools redacted diversity language from 2007 to 2021. A Diversity Thesaurus of 22 terms was iteratively identified, with all terms searched in all MSs. Overall, mission statement change was quite common with most medical schools making changes across the 14 years covered in this study. And despite a doubling of the number of medical schools MSs mentioning diversity over a 10-year period, that increase seemed to slow in recent years even among schools who had a chance to change their MS. As of mid-2021, two in five US medical schools still have no mention of diversity related language in their most formal, said articulation of organizational purpose.
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Affiliation(s)
- Jennifer Dens Higano
- Physical Medicine and Rehabilitation resident at Mayo Clinic in Rochester, Minnesota, United States.
| | - Jon C Tilburt
- Department of Medicine and Biomedical Ethics, Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona, United States; Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Frederic W Hafferty
- Center for Ethics, Professionalism, and the Future of Medicine, Accreditation Council for Graduate Medical Education, Chicago, Illinois, United States
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Madduri GB, Ryan MS, Collins J, Huber JN, Potisek NM, Wolbrink TA, Lockspeiser TM. A Narrative Review of Key Studies in Medical Education in 2021: Applying Current Literature to Educational Practice and Scholarship. Acad Pediatr 2022; 23:550-561. [PMID: 36572100 DOI: 10.1016/j.acap.2022.12.001] [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: 09/07/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022]
Abstract
To remain at the forefront of clinical practice and pedagogy, pediatric medical educators must stay informed of the latest research. Yet familiarization with the growing body of literature in both pediatrics and medical education is a near-impossible task for the busy medical educator. The purpose of this annotated bibliography is to summarize key manuscripts in medical education published in 2021 that have the potential to significantly influence a pediatric medical educator's practice. Using a 2-staged iterative process, discrete author pairs reviewed 1599 abstracts from 16 medical education and specialty journals. In summary, 16 manuscripts were selected and grouped into the following 6 domains: assessment and feedback, USMLE Step 1 changes, communication, wellness, diversity and inclusion, and professional development. The authors provide abridged summaries and high-yield take-aways from these manuscripts that may impact educational practices in pediatrics. This year, we also provide a 6-year retrospective review of the journals that have had selected articles for this annotated bibliography since inception.
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Affiliation(s)
- Gayatri B Madduri
- Department of Pediatrics, Stanford University School of Medicine, John Muir Medical Center (GB Madduri), Walnut Creek, Calif.
| | - Michael S Ryan
- Department of Pediatrics, University of Virginia School of Medicine (MS Ryan), Charlottesville, Va
| | - Jolene Collins
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital Los Angeles (J Collins), Los Angeles, Calif
| | - Jody N Huber
- Department of Pediatrics, Division of Pediatric Critical Care, Sanford Children's Hospital, University of South Dakota Sanford School of Medicine (JN Huber), Sioux Falls, SD
| | - Nicholas M Potisek
- Department of Pediatrics, Prisma Health Children's Hospital, University of South Carolina at Greenville School of Medicine (NM Potisek), Greenville, SC; Department of Pediatrics, Wake Forest School of Medicine and Brenner Children's Hospital (NM Potisek), Winston-Salem, NC
| | - Traci A Wolbrink
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Department of Anesthesiology, Harvard Medical School (TA Wolbrink), Boston, Mass
| | - Tai M Lockspeiser
- Department of Pediatrics, School of Medicine, University of Colorado (TM Lockspeiser), Aurora, Colo
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Al-Lami RA. To the Editor: Immigrant Applicants to Residency in the United States. J Grad Med Educ 2022; 14:358-359. [PMID: 35754640 PMCID: PMC9200263 DOI: 10.4300/jgme-d-22-00100.1] [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] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rasha A Al-Lami
- Researcher, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston
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