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Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review

Abstract

Objective

This study aims to evaluate the capacity of a holistic review process in comparison with non-holistic approaches to facilitate mission-driven recruitment in residency interview screening and selection, with particular attention to the promotion of race equity for applicants underrepresented in medicine (URM).

Methods

Five hundred forty-seven applicants to a psychiatry residency program from US allopathic medical schools were evaluated for interview selection via three distinct screening rubrics—one holistic approach (Holistic Review; HR) and two non-holistic processes: Traditional (TR) and Traditional Modified (TM). Each applicant was assigned a composite score corresponding to each rubric, and the top 100 applicants in each rubric were identified as selected for interview. Odds ratios (OR) of selection for interview according to URM status and secondary outcomes, including clinical performance and lived experience, were measured by analysis of group composition via univariate logistic regression.

Results

Relative to Traditional, Holistic Review significantly increased the odds of URM applicant selection for interview (TR-OR: 0.35 vs HR-OR: 0.84, p < 0.01). Assigning value to lived experience and de-emphasizing USMLE STEP1 scores contributed to the significant changes in odds ratio of interview selection for URM applicants.

Conclusions

Traditional interview selection methods systematically exclude URM applicants from consideration without due attention to applicant strengths or potential contribution to clinical care. Conversely, holistic screening represents a structural intervention capable of critically examining measures of merit, reducing bias, and increasing URM representation in residency recruitment, screening, and selection.

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Acknowledgments

Thanks go to Evelyn Carter, PhD, for her contribution to conception of this Holistic Review rubric. Additional thanks to Dr. Theodore Hall and Lingqi Tan, PhD, for their insightful feedback. We additionally thank members of the “2018-19 Recruitment Task Force” including Drs. Erin Samplin, T.C. Scotton, Maria Gabriela Aguilera Nunez, and Evelyn Nelson. Finally, we thank each of the many residents who volunteered their time and energy to participate in Holistic Review.

Funding

N.B. is supported the by the APA SAMHSA Minority Fellowship, Grant 1H79SM080388-01. E.B. is supported by funding from the Los Angeles County Department of Probation and from the National Institute on Drug Abuse of the National Institutes of Health under the AACAP NIDA K12 program, Grant # K12DA000357, the California Community Foundation, and the UCLA Pritzker Center for Strengthening Children and Families. Dr. Goodsmith was supported by the VA Office of Academic Affiliations through the UCLA National Clinician Scholars Program. The contents do not represent the views of the U.S. Department of Veterans Affairs, the United States Government, or affiliated institutions.

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Correspondence to Nicolás E. Barceló.

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This study qualified for exemption by the Institutional Review Boards at UCLA Medical Center.

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Barceló, N.E., Shadravan, S., Wells, C.R. et al. Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review. Acad Psychiatry 45, 34–42 (2021). https://doi.org/10.1007/s40596-020-01327-5

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Keywords

  • Equity
  • Admissions
  • Holistic review
  • Diversity
  • GME