Evidence-Based Inclusive Graduate Medical Education Recruitment Strategies

More Than Skin Deep: Patient-Provider Racial and Ethnic Concordance and Discordance in Collegiate Athletics and Concussion Management

CONTEXT

There is strong evidence that racial and ethnic disparities exist in multiple arenas of health and wellness. The causes of racial and ethnic differences in health care are multidimensional; one factor that may affect injury/illness communication, interactions, and outcomes is patient-provider racial and ethnic concordance. At present, it is unclear what role patient-provider racial and ethnic concordance and discordance plays in facilitating concussion care for collegiate athletes.

OBJECTIVE

To investigate the presence of athlete-athletic trainer (AT) racial and ethnic concordance and discordance among diagnosed concussion cases and examine if racial and ethnic concordance and discordance influences time (in days) until diagnosis, symptom resolution, or return-to-sport clinical milestones in collegiate athletes.

DESIGN

Retrospective cohort study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

A total of 694 concussion cases (38.6% [n = 268] sustained by women, 61.4% [n = 426] sustained by men) that occurred within the 2015-2016 through 2019-2020 sport seasons at 9 institutions.

MAIN OUTCOME MEASURE(S)

The number of days from the date of injury to diagnosis, symptom resolution, and return to sport and from the date of diagnosis to symptom resolution and return to sport.

RESULTS

Overall, 68.4% (n = 475) of concussion cases had patient-provider racial and ethnic concordance, and 31.6% (n = 219) were discordant. All concordant pairs included a White athlete and White AT. Time to diagnosis differed between the concordant and discordant groups (median [interquartile range] = 1 [0-2] versus 0 [0-1], respectively) only in the model adjusted for sex, sport type, and availability of an AT (odds ratio [95% CI] = 1.46 [1.07-1.85]). There were no other group differences.

CONCLUSIONS

One-third of concussion cases had athlete-AT racial and ethnic discordance. Although this group was diagnosed with a concussion 1 day sooner than the concordant group, no differences were observed for any concussion recovery milestones. These findings suggest that patient-provider racial and ethnic concordance may play a minor role in concussion recognition or reporting but not necessarily in the management and recovery thereafter.

Promoting Equity, Diversity, and Inclusion in Medicine: A Comprehensive Toolkit for Change in Radiology

This toolkit presents a comprehensive framework for a toolkit intended to increase equity, diversity, and inclusion (EDI) within the medical field and recommendations. We advocate for clear, comprehensive definitions and interpretations of fundamental EDI terms, laying the groundwork necessary for initiating and maintaining EDI initiatives. Furthermore, we offer a systematic approach to establishing EDI committees within medical departments, accentuating the pivotal role these committees play as they drive and steer EDI strategies. This toolkit also explores strategies tailored for the recruitment of a diverse workforce. This includes integral aspects such as developing inclusive job advertisements, implementing balanced search methods for candidates, conducting unbiased appraisals of applications, and structuring diverse hiring committees. The emphasis on these strategies not only augments the diversity within medical institutions but also sets the stage for a more holistic approach to healthcare delivery. Therefore, by adopting the recommended strategies and guidelines outlined in this framework, medical institutions and specifically radiology departments can foster an environment that embodies inclusivity and equity, thereby enhancing the quality of patient care and overall health outcomes.

Variation in Transcript Reports Among Residency Applicants: An Anesthesia Program's Perspective

Background

With recent changes made to move USMLE Step 1 and COMLEX Level 1 scores to Pass/Fail, it becomes necessary to find other metrics to evaluate residency candidates. One conserved metric included in all residency applications is medical school transcripts. This study aims to highlight the highly varied transcript reporting in a new era of holistic applicant review.

Methods

Medical school transcripts were extracted from the Electronic Residency Application Service applications to our anesthesiology residency program for the 2021-2022 application cycle. All personally identifiable information was removed. Results were categorized and tallied by 2 independent reviewers. Overall, we assessed transcript information from 156 allopathic and osteopathic medical schools. Transcript data were separated into 9 different categories.

Results

The most common grading system for allopathic medical schools was Pass/Fail. The most common grading system for osteopathic medical schools was Pass/Fail and Letter Grades. There were several medical schools that had unique grading systems and many of those did not provide a grading key for interpretation. Less than half of the allopathic and osteopathic schools offered Honors or High Pass in their grading systems, often with little information provided as to how these grades were earned.

Conclusion

The information provided on medical school transcripts is extremely variable. Although many schools reported grades as Pass/Fail, there was no majority or consistent presentation among the transcripts. Much of the information provided on transcripts required interpretation by its reviewer and made the process of holistic applicant review more difficult.

Implementation of a Chief Resident Selection Process Designed to Mitigate Bias: Lessons Learned

BACKGROUND

Chief residency selection processes are often opaque and beset by bias, which can result in disparities in who is selected for this important role. As a chief residency can lead to future academic and/or leadership positions, efforts to increase diversity in academic medicine and physician leadership may be aided by an inclusive chief resident (CR) selection process designed to mitigate bias.  Objective: To implement and evaluate the acceptability of a CR selection process that is inclusive and designed to mitigate bias.  Methods: In the 2021-2022 academic year, we designed and implemented a CR selection process aligned with published strategies known to mitigate bias in academic recruitment. The four-step opt-out CR selection process included a nomination survey, structured interviews, a clinical review, and a holistic review of each candidate. Each step was clearly delineated, assigned a specific number of points, and scored on a designated rubric. The candidates with the highest and second-highest number of points were awarded the two CR positions. Our selection process excluded examination scores and precluded consideration of "fit" between the selected CRs, as these are known sources of potential bias. In January 2023, we surveyed our department to obtain post-implementation feedback and to assess satisfaction with the process, before repeating the process for 2022-2023.

RESULTS

Survey response rates were 47% (14/30) for residents and 29% (18/63) for departmental faculty. The majority of responding residents (64%) and faculty (100%) were satisfied with the CR selection process, finding it fair and inclusive. Nearly 80% of residents and 100% of faculty wished to repeat the process in 2022-2023.  Conclusions: An inclusive CR selection process utilizing strategies to mitigate bias was feasible, and acceptable to residents and faculty. We recommend that residency training programs make efforts to implement CR selection practices that are inclusive and aim to mitigate bias.

Importance of Inclusive Education in General Medicine Through the Perception of Medical Trainees: A Thematic Analysis

Background General medical education plays a pivotal role in ensuring holistic care in the context of rapidly aging populations. Japan's demographic trends underscore the significance of general medicine in elevating community care standards. Understanding and catering to the aspirations, perceptions, and ideals of medical students and residents can significantly augment the effectiveness of general medicine education. This research aimed to explore the perspectives of medical students on the ideal tenets of general medicine education in rural Japan. Method A qualitative approach was employed, focusing on medical students and residents with a keen interest in general medicine, all of whom underwent training at a rural-based Japanese hospital. Through semi-structured interviews, insightful data were garnered and subsequently subjected to a comprehensive thematic analysis. Results The thematic analysis unearthed three core themes: commitment of educators in valuing learner diversity, promotion and understanding of general medicine, and inclusivity and diversity in educational institutions. The first highlighted the centrality of educators' sincerity, emphasizing the importance of genuine, sustained interactions that foster mutual respect and collaborative learning. The second theme underscored the need to elucidate the intrinsic value and modern-day relevance of general medicine, emphasizing its deep roots in community-based practices and its continuity with long-standing medical traditions. The third theme spotlighted the crucial role of comprehensive medical education in fostering enriching dialogues, embracing varied learning experiences, and capitalizing on the distinctive strengths of educational institutions. Conclusion These findings underscore the pivotal shift required in pedagogical approaches to comprehensive medical education. A genuine collaborative educator-learner relationship, the reframing of general medicine's significance rooted in community welfare, and a strong emphasis on inclusivity and dialogue form the cornerstones of these insights. This study provides a touchstone for restructuring educational strategies, aiming for a more integrated, genuine, and encompassing framework that is particularly vital for the effective propagation of general medicine in regions such as Japan.

Will ChatGPT Match to Your Program?

ABSTRACT

ChatGPT and other artificial intelligence word prediction large database models are now readily available to the public. Program directors should be aware of the general features of this technology and consider its effect in graduate medical education, including the preparation of materials such as personal statements. The authors provide a sample ChatGPT-generated personal statement and general considerations for program directors and other graduate medical education stakeholders. The authors advocate that programs and applicants will be best served by transparent expectations about how/if programs will accept application materials created using artificial intelligence, starting with this application cycle. Graduate medical education will have many additional factors to consider for the innovative use and safeguards for the ethical application of artificial intelligence in clinical care and educational processes. However, the exponential increase in the application of this technology requires an urgent review for appropriate management of program procedures, iteration of policies, and a meaningful national discussion.

Eligible Applicants and Diversity Across Settings in a Regional Family Medicine Residency Network

OBJECTIVES

Residency programs must gather and track data on the diversity of their applicants, interviewees, and matched residents as part of the process of checking for bias in the interview and rank process. As such, the aims of this study were (1) to provide data from a large, regional network of family medicine residencies on who is applying, interviewing, and matching into our programs as a baseline for the family medicine residency community; and (2) to assess potential differences in the gender and racial diversity of the eligible applicants to programs across settings, including in rural and underserved communities.

METHODS

Survey of programs in Alaska, Idaho, Montana, Washington and Wyoming about their applicant pool in the 2020-2021 interview season.

RESULTS

Programs received a median of 100 applications per position, 57 of which were considered eligible. Programs offered 17 interviews per position and 15 of these were completed. Programs in rural and underserved communities did not have fewer eligible applicants per position, nor was there less diversity within that pool of applicants. Most programs are working to increase their program's diversity.

CONCLUSION

On average, the racial and gender diversity of eligible applicants to programs in rural and underserved settings is no different than other programs. What is important in terms of diversity varies across programs, based on community needs and program mission, but having a mechanism to extract and review data and to then be able to assess progress is a place to start.