Underrepresented Minorities are Underrepresented Among General Surgery Applicants Selected to Interview.
Underrepresented Minorities are Underrepresented Among General Surgery Applicants Selected to Interview.
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DOI：
10.1016/j.jsurg.2019.05.018
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发表时间：
2019-11-01
影响因子：
2.9
通讯作者：
Whiting, James
中科院分区：
文献类型：
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作者：
Jarman, Benjamin T;Kallies, Kara J;Whiting, James
目的：多样性是普外科培训中一个不明确的实体。研究生医学教育认证委员会最近提出了新的共同项目要求，包括要求住院医师多样化的措辞。在地域偏好、项目类型和申请人资格的限制下，“招聘”多元化可能具有挑战性。此外，Match过程增加了更多的不确定性。我们试图研究普外科申请人自我认定的种族/民族分布，以更好地确定普外科申请人群体中代表性不足的少数民族（URM）的特征。设计：整理2018年医学生申请周期电子住院申请服务的特定项目数据。对所有参与项目的申请人和被选中参加面试的申请人的数据进行了抽取。没有自认种族/民族的申请人被排除在分析之外。URM被定义为黑人/非裔美国人、西班牙裔/拉丁裔/西班牙裔、美洲印第安人/阿拉斯加原住民或夏威夷原住民/太平洋岛民-萨摩亚人。完成了适当的统计分析。环境：10个普通外科住院医师项目，5个独立项目和5个大学项目。参与者：参与普通外科住院医师项目的住院医师申请人。结果：10个外科住院医师项目收到了来自3192名独特申请者的10312份申请。778份申请没有包括自我认定的种族/民族，因此被排除在分析之外。本研究队列中申请人的种族/民族构成与2017年至2018年4262名分类普外科申请人的电子居留申请服务数据相似。项目收到的申请中位数为1085份（范围：485-1264份），每个项目总共选出617名独特的申请人进行面试。总体而言，2148名申请者从美国医学院毕业，其中595人（28%）获得了面试机会。平均年龄28.8±3.8岁，女性1316人（41%）。西班牙裔/拉丁裔/西班牙裔、黑人、美洲印第安人/阿拉斯加原住民/夏威夷人/太平洋岛民-萨摩亚人申请人占总申请人的12%、8%和1%，但只有8%、6%和1%的人被选中参加面试。总体而言，29%的申请人有美国医疗执照考试（USMLE）第一步得分≤220；其中37人（6%）的USMLE第一步得分≤220。与白人和亚裔申请人相比，URM申请人USMLE分数≤220的比例更高。非白人自我认同是低面试选择可能性的显著独立预测因子。女性，USMLE第一步得分为bb0 - 220，毕业于美国医学院与被选中面试的可能性增加有关。结论：URM申请人在被选中参加面试的申请人中所占的比例较小。USMLE第一步的分数在URM申请者中较低。使用谨慎的USMLE截止点的培训计划可能比非URM申请人以更高的比率排除URM。在尝试招募不同种族/民族的受训者时，应包括方案层面的分析，以确定差异，并采取有针对性的策略，对可能被传统筛选工具忽视的申请人进行面试。
OBJECTIVE: Diversity is an ill-defined entity in general surgery training. The Accreditation Council for Graduate Medical Education recently proposed new common program requirements including verbiage requiring diversity in residency. "Recruiting" for diversity can be challenging within the constraints of geographic preference, type of program, and applicant qualifications. In addition, the Match process adds further uncertainty. We sought to study the self-identified racial/ethnic distribution of general surgery applicants to better ascertain the characteristics of underrepresented minorities (URM) within the general surgery applicant pool.DESIGN: Program-specific data from the Electronic Residency Application Service was collated for the 2018 medical student application cycle. Data were abstracted for all participating programs' applicants and those selected to interview. Applicants who did not enter a self-identified race/ethnicity were excluded from analysis. URM were defined as those identifying as Black/African American, Hispanic/Latino/of Spanish origin, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander-Samoan. Appropriate statistical analyses were accomplished.SETTING: Ten general surgery residency programs-5 independent programs and 5 university programs.PARTICIPANTS: Residency applicants to the participating general surgery residency programs.RESULTS: Ten surgery residency programs received 10,312 applications from 3192 unique applicants. Seven hundred and seventy-eight applications did not include a self-identified race/ethnicity and were excluded from analysis. The racial/ethnic makeup of applicants in this study cohort was similar to that from 2017 to 2018 Electronic Residency Application Service data of 4262 total applicants to categorical general surgery. Programs received a median of 1085 (range: 485-1264) applications each and altogether selected 617 unique applicants for interviews. Overall, 2148 applicants graduated from US medical schools, and of those, 595 (28%) were offered interviews. The mean age of applicants was 28.8 ± 3.8 years and 1316 (41%) were female. Hispanic/Latino/of Spanish origin, Black, and American Indian/Alaskan Native/Hawaiian/Pacific Islander-Samoan applicants constituted 12%, 8%, and 1% of total applicants, but only 8%, 6%, and 1% of those selected for interview. Overall, 29% of applicants had United States Medical Licensing Examination (USMLE) Step 1 scores ≤220; 37 (6%) of those selected for interviews had a USMLE Step 1 score of ≤220. A higher proportion of URM applicants had USMLE scores ≤220 compared to White and Asian applicants. Non-white self-identification was a significant independent predictor of a lower likelihood of interview selection. Female gender, USMLE Step 1 score >220, and graduating from a US medical school were associated with an increased likelihood of being selected to interview.CONCLUSIONS: URM applicants represented a disproportionately smaller percentage of applicants selected for interview. USMLE Step 1 scores were lower among the URM applicants. Training programs that use discreet USMLE cutoffs are likely excluding URM at a higher rate than their non-URM applicants. Attempts to recruit racially/ethnically diverse trainees should include program-level analysis to determine disparities and a focused strategy to interview applicants who might be overlooked by conventional screening tools.