Family Medicine Residency Directors' Perceptions of the Position of Chief Resident.

Abstract

Petty progress has been fabricated in improving racial, gender, or intersectional diversity within academic internal medicine (IM). Master Residency fulfills a unique opportunity to target diversity efforts; Main Residents (CR) are integral in creating an inclusive environment and support organization for IM trainees, and the position serves every bit a steppingstone for future leadership positions within academia. Yet, the CR selection process often lacks transparency and includes steps that are fraught with bias, thereby disadvantaging underrepresented minority groups from gaining important feel needed to climb the academic ladder. We describe a more than standardized option procedure that will amend recruitment and selection of more than diverse CRs and ultimately improve the recruitment, retentivity, and promotion of more than diverse faculty within academic internal medicine. Key recommendations include an open telephone call for applications, the use of standardized and structured interviews, and the germination of a diverse selection committee to conduct a transparent selection process based on explicitly defined criteria.

INTRODUCTION

Picayune progress has been made in diversifying bookish internal medicine (IM); only nine.vii% of faculty identify as racially underrepresented in medicine (UiM), grossly underrepresenting the diversity of medical students (xviii.1%), residents (12%), and the U.s. population (31.v%).^1,2 With most UiM faculty working at historically Black institutions or in Puerto Rico, these disparities are further accentuated at many bookish institutions.³ Similar gaps exist for women; although women matriculate to medical schoolhouse in similar proportions as men, women remain less probable to advance in academic rank or to leadership positions.^4,five Furthermore, the proportion of women faculty identifying as UiM remains brackish at xiii%, emphasizing the demand for improvements in intersectional recruitment.^v,6 Other areas of much needed attending include transgender and nonbinary physicians, for which data are limited, and people with disabilities, who have historically been excluded from medical training.^7,8

Principal Residency, a position of honor and prestige inside bookish IM, is an important pipeline for future leadership positions.^ix,10,11 Main Residents (CR) are the outward face of many IM residency programs and play an of import role in the education, recruitment, and mentorship of trainees. Acting as resident-faculty liaison provides these early-career physicians the unique opportunity to improve their teaching, leadership, and assistants through dedicated mentorship from academic and infirmary leadership and is a stepping stone to bookish promotion.^nine,11

Although ongoing efforts are defended to promoting diversity inside academic medicine,^12,thirteen there are limited data on CRs or their selection process. Some institutions have created innovative ways to assist reduce burnout among UiM residents and thereby increase retentivity of UiM into faculty positions, such equally creating a CR position for Diversity and Inclusion.^fourteen While these creative solutions are desperately needed, all CRs should be invested in intentionally dismantling the longstanding oppressive systems that go along to hinder people of colour, committed to anti-oppression, and devoted to improving intersectional diversity in medicine.^xv We describe how a standardized choice process may improve recruitment and choice of more than diverse CRs and ultimately amend the recruitment, retention, and promotion of more than diverse faculty within academic IM.

SELECTION Procedure

Little data exists on how CRs are selected; it is often an opaque process that varies between residency programs nationwide (Table 1).²¹ Interviews, if they occur, can differ in the questions asked and in the number and academic rank of participants. The decision process may involve hospital or plan leadership and may include group discussions, a voting procedure, or scoring rubrics. Decisions are often based on information that can be fraught with bias resulting from a legacy of cultural stereotyping and exclusion. For example, women or residents who place as UiM tin exist disadvantaged during a nomination process that depends upon interpersonal relationships. Inter-group social anxiety tin can lead to racial and indigenous isolation, with members of a item racial or ethnic group being less likely to seek out interactions with dissimilar groups due to feet nigh the interactions.²² This tin can lead to othering of UiM residents and negatively affect the likelihood of being nominated by faculty or peers. Furthermore, assessments of a resident's professionalism, leadership, and communication, attributes valued for CR candidates, can exist affected by faculty and/or trainee gender.^23,24 Lastly, the descriptive language used in subjective assessments of qualifications can differ past trainees' gender or race, such equally Black applicants beingness less probable to be described with ability keywords such every bit "outstanding" relative to white applicants.²⁵ If existing academic leaders who belong to traditionally privileged groups are selecting future leaders without conscious and intentional methods of countering bias, this vicious wheel volition keep to hinder the promotion and success of physicians currently underrepresented in leadership positions.

Table 1. Published Strategies for Master Resident Choice Throughout Medicine

Full size table

RECOMMENDATIONS

Individuals from underrepresented or traditionally excluded groups are disadvantaged in the hiring process for leadership positions in many fields, including within academic IM.^5,26,26,28 We propose a series of concrete recommendations to eliminate bias and equitably select CRs (Table 2).

Tabular array 2. Recommendations for Master Resident Selection

Full size table

Open Applications

Establishing an open and standardized CR application procedure may meliorate inclusivity past providing all interested residents the opportunity to apply. This can mitigate any implicit or explicit bias that occurs during a nomination or straight appointment process. The call for applications should include a articulate and detailed task description without cultural or gendered references and should list the ideal qualities desired for potential CRs.²⁴ Desired qualifications should include a commitment to advancing disinterestedness and fostering anti-racism within the plan.

Structured Interviews

Structured interviews, which heighten the objective value of the interview or selection process, are significantly less susceptible to bias equally compared to unstructured interviews.³² Examples of these strategies include asking all candidates the same questions; asking questions that are situational, behavior-based, or focused on job knowledge; rating each answer on scales tailored for each question; using multiple interviewers and the same interviewers for all candidates; and providing extensive interviewer grooming .³³

Applying this strategy to CR interviews is paramount to mitigate biases that can arise in the interview setting. Residency programs should be intentional in selecting interviewers and seek involvement from underrepresented kinesthesia in the interviewing procedure, while as well accordingly valuing, protecting, and compensating their time with the acknowledgment of the expectations and magnitude of emotional labor expected from these faculty members.³⁴ All interviewers should exist required to undergo formal and validated implicit bias preparation that includes physical strategies for interrupting bias.³⁵ Interviews should be structured equally much equally possible and use standardized questions to maximize objectivity and improve reliability, validity, and equity.^28,36 Examples of standardized questions to assess candidates' commitment to equity, diverseness, and inclusion are provided in Tabular array 2.

Transparent Selection Process

The pick procedure should be transparent, all-inclusive, and value a commitment to health equity and anti-oppression. A formal choice committee should be formed and consist of relevant stakeholders (due east.g., program kinesthesia, hospital leadership, electric current/erstwhile CRs) and those involved in making final decisions. Committee members should explicitly define selection criteria and review applicants using an objective scoring system that considers equitably obtained information from each applicant. Information not available for all candidates, such as word of mouth or unsolicited faculty input, should exist excluded to minimize bias. Resident or faculty feedback nearly candidates should be considered and formally and systematically collected (east.m., online surveys).

Well-nigh chiefly, the committee should reevaluate any preconceived notions about who will be successful every bit a CR. Opinions regarding the ideal qualities of CRs may differ, with leadership and organizational skills being important to faculty and approachability and listening skills existence of import to trainees.²⁴ Choice committees should prioritize candidates with the skills and experience to advocate for a diverse grouping of residents. Specific interview questions should help elucidate which applicants are equipped with these skills (Table ii).

CONCLUSION

Nosotros must prioritize multifariousness and equity throughout our mission and practice every bit bookish physicians, especially given the unjust and unacceptable health inequities born by Blackness, Ethnic, queer, and disabled communities and communities of color due to generations of structural oppression and violence. This involves promoting diversity and minimizing bias among academic and infirmary leadership. A more various pool of Main Residents will create an surround in which UiM trainees feel welcome, have mentorship from those of like backgrounds, and are inspired to become bookish leaders in the future. It is i step of many in fixing a cleaved system.

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Acknowledgements

The authors would like to thank Dr. Rudolph Rodriguez for his mentorship and support on this project.

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1. Department of Medicine, Academy of Washington School of Medicine, Seattle, WA, USA

   Ryan Johnson MD, Oyinkansola Osobamiro Dr., Anna Morenz MD, Nancy Mugisha MD, Linda Liu MD & Tyler Albert Doc

2. Veteran's Affairs Puget Sound Health Care Organization, Seattle, WA, United states

   Tyler Albert Doctor

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Correspondence to Ryan Johnson Md.

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Johnson, R., Osobamiro, O., Morenz, A. et al. Primary Residency Selection in Internal Medicine: Who Is Left Out?. J GEN INTERN MED (2022). https://doi.org/x.1007/s11606-021-07364-half dozen

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• Received: 10 June 2021

• Accepted: sixteen December 2021

• Published: 24 January 2022

• DOI : https://doi.org/10.1007/s11606-021-07364-half dozen

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