Health Equity

Change resident-selection process to boost equity

Brendan Murphy , Senior News Writer

The odds of membership in one of the most prominent medical honors societies are six times greater for white medical students than Black medical students and those honors remain a factor in the physician residency-selection process.

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The lack of racial, ethnic, socioeconomic and geographic diversity in physician residency and fellowship selection was addressed in new policy adopted at the 2022 AMA Interim Meeting.

Strides have been made toward a more holistic evaluation of candidates for physician residency and fellowship positions, including several projects that have AMA backing. Still, the pressures of the process on decision-makers, such as residency program directors are immense, with applicant figures climbing on an annual basis.

That volume has led to a continued overreliance on metrics that are misconstrued as objective and may embed biases that impede efforts to achieve a more representative physician workforce, according to the recommendations of an AMA Council on Medical Education report adopted at the 2022 AMA Interim Meeting.

“Moving forward, the profession must develop a resident selection process that is mutually beneficial for applicants as well as program directors and institutions, while ensuring a commitment to a diverse, equitable and inclusive workforce,” the report says.

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To address necessary changes to the residency-and-fellowship selection process, the AMA House of Delegates adopted new policy to:

  • Encourage medical schools, medical honor societies, and residency and fellowship programs to work toward ethical, equitable and transparent recruiting processes, which are made available to all applicants.
  • Advocate and support innovation in the undergraduate medical education to graduate medical education transition, especially focusing on the efforts of the AMA Accelerating Change in Medical Education initiative, to include pilot efforts to optimize the residency-and-fellowship application and matching process and encourage the study of the impact of using filters in the Electronic Residency Application Service (ERAS) by program directors on the diversity of entrants into residency.
  • Encourage caution among medical schools and residency/fellowship programs when using novel online assessments for sampling personal characteristics for the purpose of admissions or selection and monitor use and validity of these tools.         

The House of Delegates (HOD) also modified existing policy to “recommend that medical school admissions committees and residency/fellowship programs use holistic assessments of applicants that take into account the diversity of preparation and the variety of talents that applicants bring to their education with the goal of improving health care for all communities.”

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The HOD also directed the AMA to:

  • Advocate that residency and fellowship programs avoid using objective criteria available in the ERAS process as the sole determinant for deciding which applicants to offer interviews.
  • Advocate to remove membership in medical honor societies as a mandated field of entry on the ERAS—thereby limiting its use as an automated screening mechanism—and encourage applicants to share this information within other aspects of the ERAS application.

Read about the other highlights from the 2022 AMA Interim Meeting.