How med schools, residency programs can diversify doctor workforce

BY BRENDAN MURPHY News Writer | American Medical Association

Increasing diversity in the physician workforce can lessen racial and ethnic health inequities. Addressing medical school admissions is an important part of the process to generate a physician population that more closely resembles the nation’s patient population.

A recent AMA webinar—“Focusing on diversity: Promoting mission-aligned medical school admission and residency selection processes”—highlights the methods by which medical schools and residency programs are working toward increased physician diversity. A recording of the webinar is available in the resources area of the Accelerating Change in Medical Education Community (registration required).

Addressing implicit bias

Members of committees for medical school admissions and residency selection may have implicit bias, which can have a significant impact on who gets selected.

In 2012, all 140 members of the Ohio State University College of Medicine (OSU) Admissions Committee took an implicit association test examining their attitudes toward race, gender and sexual orientation. The results showed that: • The majority of male (64%) and female (52%) respondents had an implicit preference for white applicants. • A small portion of admissions-committee respondents— about 10% for men and women—expressed an explicit preference for white applicants. • Nearly 70% of all faculty had an implicit gender-career stereotype bias that associated men with careers and women with lives as homemakers.

Facing such eye-opening results, OSU looked to remediate the situation. The school has since made annual implicit bias training mandatory for its entire admissions committee. Strategies covered at the workshops to mitigate bias include common-identity formation and perspective taking.

“We found that after training our admissions committee in implicit-bias reduction, the very next class we admitted was the most diverse class in the history of our college of medicine,” said Quinn Capers IV, MD, vice dean of faculty affairs at the OSU medical school.

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Holistic selection

Realizing the need for increased diversity among residents, the internal medicine program at the University of California, Davis (UC Davis), made that a priority for residency selection. To do that the program set forth on a four-step plan to improve the process.

Step one: Define mission of the program. UC Davis’ mission statement called for called an emphasis on diversity, inclusion and humility to match their community of patients and improve education of all learners.

Step two: Changes to applicant screening. New screening procedures included giving applications reviews by multiple screeners, less emphasis on board scores and more emphasis on extracurriculars.

Step three: The interview process. UC Davis has narrowed its interview pool to around 20 faculty members. Interviewers score applicants and speak over lunch that day. Final scores of interviewees are given by the end of their interview day.

Step four: Ranking. Interview scores allow for UC Davis’ rank order list to be in near final form at the conclusion of the third step. The program estimates the interview scores cutoff based on the prior year’s Match and will adjust its rank-order list based on valued criteria.

This program has yielded results. The baseline residency cycle prior to the program being initiated saw about 14% of incoming residents come from underrepresented minority backgrounds. That number has nearly tripled with the incoming class of firstyear residents who will start in July.

“We have succeeded in getting residents with a tremendous diversity in backgrounds, life experiences and work in the community,” said Craig R. Keenan, MD, internal medicine residency program director at UC Davis. “We also have more residents from the LGBTQ community. Our residency definitely has a stronger sense of community than five years ago, and there’s a tremendous amount of grit.”

Launched last year, the AMA Center for Health Equity has a mandate to embed health equity across the organization so that health equity becomes part of the practice, process, action, innovation, and organizational performance and outcomes. The center also developed the Health Equity Resource Center which provides tools and information for health equity.