Holistic review and #match2021: Aligning screening with institutional mission, vision, and values

ABSTRACT

Learning Objectives: To develop and assess the feasibility of a structured residency interview selection process that intentionally aligns with the department's mission, vision, and values for a more authentic holistic application review aimed toward advancing diversity, equity, and inclusion in residency recruitment. Introduction: Bias has persistent downstream effects on residency recruitment and applicant selection. The COVID-19 pandemic has contributed to disparities by reducing access to away rotations and, therefore, electronic standardized letters of evaluations (eSLOEs). It has also affected applicants without home emergency medicine (EM) programs, many of which are also Historically Black Colleges and Universities (HBCU). EM programs review an average of 969 applications annually, limiting the ability to perform a holistic review of each application. Many programs use bottleneck criteria such as the United States Medical Licensing Examinations (USMLE) Steps 1 and 2 scores, which further introduce bias. Currently, there is no agreed-upon standardized approach to holistic review. Design: The Stanford EM Residency Program leadership reviewed its application screening metrics and used available evidence regarding bias. The group reallocated each metric's weight accordingly, including USMLE Step 1 as Pass/ Fail. AOA membership status no longer confers additional points, as its selection criteria are heterogeneous and have been shown to have a racial bias. HBCU applicants receive added points commensurate with applicants from the top 25 schools for research or primary care. The group developed specific criteria allocating points for alignment with published departmental mission, vision, and values (MVV) success or sustained effort in the domains of innovation, research, service, leadership, and advocacy. Effectiveness A structured screening process that eschews test scores and other traditional metrics for factors aligned with the department's MVV provides a blueprint for authentic holistic review while mitigating bias. By implementing this process, the interview offers for underrepresented students in medicine increased from 14.8% last year to 26.1% this year without impacting the application review's duration and intensity, indicating our process is feasible and acceptable.