"Time-In": A Tool for Interrupting Bias in Medical School Admissions Committee Meetings.

PROBLEM: During high-stakes committee meetings, bias is often expressed but goes uninterrupted because there is no formal structure to interrupt it. Bias impacts decision making and can further disadvantage those from backgrounds that have been marginalized. APPROACH: The MD and MD-PhD admissions committees at the Icahn School of Medicine at Mount Sinai in NY in the 2020-2021 admissions season introduced a "Time-In" tool to interrupt bias during committee meetings. This study aimed to evaluate the impact of implementing the "Time-In" tool on committee members' perception of bias as a problem and the likelihood of committee members recognizing, reporting, discussing, and educating others about bias after implementation. OUTCOMES: There were 117 responses to the pre- and postseason surveys. In aggregate, respondents reported a statistically significant reduction in the perception of bias in the admissions process from preseason to postseason. There was no change in the likelihood of committee members in aggregate endorsing comfort in recognizing, reporting, discussing, and educating about bias; however, notable gaps existed in the comfort of groups discussing bias publicly, i.e., respondents who are from backgrounds underrepresented in science and medicine, students, and new committee members were less comfortable than their comparators. By the postseason survey, these gaps were closed. NEXT STEPS: Implementing a "time-in" allows for interruption of bias, with an impact of reducing the perception of bias, empowering individuals, and reducing gaps among groups to discuss bias publicly. A "time-in" can profoundly impact decision-making bodies that are critical gatekeepers to the composition of the physician workforce. Future directions will focus on enhancing committee members' skills in educating others about bias.

All We Can Be: Innovations to Improve the Pipeline of Military Veterans in Medical Schools.

ISSUE: Medical schools are increasingly identifying military veteran applicants as a source of diversity, resiliency, and commitment-often derived from their personal experiences in the military. Yet, veterans remain significantly under-represented in entering classes; moreover, those veterans who do matriculate are not yet fully reflective of the diversity that the Armed Forces have to offer. Fortunately, specific measures have been shown to be effective at increasing both the number and diversity of student veterans in medical school. EVIDENCE: In 2019, there were less than 60 military veterans who entered the 144 civilian medical schools in the United States, according to the Association of American Medical Colleges. We identify common barriers faced by military veterans and propose best practices for medical schools to recruit and sustain them. We draw on the existing medical education literature about veteran support systems, and we underscore the unique challenges of veterans in medicine. Finally, we highlight innovative programs currently in place at several US medical schools that seek to address the needs of student veterans. This article provides a guide for how to recruit, assess, and nurture student veterans, suggesting a new way of thinking about this population of nontraditional medical students. IMPLICATIONS: This dearth of servicemembers significantly below what would be expected based on national demographic data is indicative of how medical schools offer few pathways to entry for military servicemembers-and far fewer for enlisted personnel and other populations traditionally under-represented in medicine. Should schools aim to recruit a veteran population that is truly representative of the military, additional measures need to be taken into consideration during the admissions review process.

Key Insights From the Development and Implementation of a Novel Virtual Interview Process for Medical School Admissions During the COVID-19 Pandemic.

PROBLEM: During the COVID-19 pandemic, medical schools have offered a virtual application process. Minimal literature is available to guide best practices. APPROACH: The Icahn School of Medicine at Mount Sinai (ISMMS) implemented a completely virtual interview (VI) process in April/May 2020. Large-group sessions for applicants, interviews with applicants, and ISMMS Admissions Committee meetings occurred via Zoom (Zoom Video Communications, Inc., San Jose, California). Large-group sessions and committee meetings occurred via communal conference calls, while one-on-one, semistructured interviews occurred in individual breakout rooms. ISMMS offered live, virtual question-and-answer sessions with students and faculty, plus digital resources describing program features. After the interview day, applicants and interviewers were invited to complete anonymous surveys regarding their experiences with and perspectives of VI. OUTCOMES: Of 125 applicants and 20 interviewers, 99 (79%) and 18 (90%), respectively, completed at least part of the survey. Of the applicants, 85/95 (89%) agreed VI met or exceeded expectations, with many praising the day's organization and convenience, and 71/95 (75%) agreed they received a sufficient sense of the student body. A minority (n = 39/95 [41%]) felt limited in their ability to learn about the institution (commonly related to their inability to tour campus), and a majority (n =74/91 [81%]) would have preferred an in-person interview. Most interviewers felt comfortable assessing applicants' verbal communication skills (n = 13/16 [81%]), and most (n = 12/17 [71%]) felt VI should be an option for future applicants. NEXT STEPS: VI, likely to be a temporary-but-universal fixture of upcoming application cycles, may benefit applicants and interviewers alike by saving resources and diversifying those involved. Next steps are developing programming that will permit applicants to virtually explore the institution and connect more with current students. Future research should evaluate potential bias in VI to ensure an equitable application process for all.