The latest installment of the #PWChat series centered around strategies for increasing diversity in residency training programs.
Below are the highlights from the chat. You can read the full transcript here, by scrolling down to the corresponding responses.
Welcome the latest #PWChat, w/ @philoasantemd, @jserdoc, @AllisonLarsonMD & @DrLindaMD on #diversity in #residency training programs. Our plan is to go until 3:00pm (EST), but please feel free to keep the conversation going after that. pic.twitter.com/zUY9TasarP
— Physician's Weekly (@physicianswkly) October 15, 2020
Check out the interview by @philoasantedmd with @jserdoc –her first post in a blog series on diversity in medicine—that served as inspiration for today’s #PWChat at https://t.co/fglif45F9h.
— Physician's Weekly (@physicianswkly) October 15, 2020
Q1: What criteria do you use to define “diversity” in your residency program?#PWChat pic.twitter.com/sJWKHlG3v2
— Physician's Weekly (@physicianswkly) October 15, 2020
A1. In considering candidates for #BUDermatology, diversity includes race, ethnicity, gender, LGBTQIA, socioeconomic background, geography, age, academic background, disability, and life experience. #PWChat #DiversityInMedicine
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Is religious orientation a factor? Asking for a myself and a friend.:)
— Dawna Mughal PhD RDN (@DawnaMughalPhD) October 15, 2020
But alongside, we’ve always valued gender diversity & have a long track record of recruiting those who identify as LGBTQ as well 2/4 #PWChat
— Jordan Spector MD (@jserdoc) October 15, 2020
Of course, for folks who grew up/live w/privilege, politics can be a choice. And it can’t be for those who need min wage to feed their family. Or who have to choose between paying for meds or for rent. So yeah, ideological diversity takes a backseat for me 4/4 #PWChat
— Jordan Spector MD (@jserdoc) October 15, 2020
Many Visa holders went home – many other promising brains and talent cannot come back. 2020 travel bans.
— tanglewoodtools (@dogdoornoise) October 15, 2020
Excellent
— Judith Lindsay (@judithconsult) October 15, 2020
Q2: What major challenges do you face in recruiting diverse candidates to your residency program?#PWChat pic.twitter.com/7gZIYBZQhz
— Physician's Weekly (@physicianswkly) October 15, 2020
.@AllisonLarsonMD Absolutely agree. Recruitment to #medicine must start early. One of the reasons I co-founded @IndlLearning One of our goals is to inspire students from ALL backgrounds etc. to pursue #healthcare #careers Working with some of these kiddoes has been great! #PWchat
— Jasminka Criley MD, FACP, FHM (@criley_md) October 15, 2020
Exactly right. Many #URM students have amazing grades and scores! I find the greater challenge is in recruiting those without high scores to apply to competitive specialties if they have an interest #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
2/ …There are many other approaches to assure that all students of all backgrounds have equal opportunities & representation. #Medicine and #subspecialities as it is now needs significant change. Focus from sickness to more #health & opportunities is imperative for all. #PWchat
— Jasminka Criley MD, FACP, FHM (@criley_md) October 15, 2020
#Medicine should be representative of the people we care for. We will only be able to do our best when people from all backgrounds have a seat at the table #PWChat #DiversityinMedicine
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Hey, @jserdoc, didn't you address this in your interview with @philoasantemd ?#PWChat
— Physician's Weekly (@physicianswkly) October 15, 2020
There's something to be said about cultural competency and feeling "heard" by your doctor. Ex. We now know black females are less likely to be believed by white doctors when they report issues with pregnancies, resulting in higher maternal mortality. This issue persists #PWchat
— shereesepubhlth 😷 (@ShereesePubHlth) October 15, 2020
It creates a paradox, as some URM candidates won’t ‘take the plunge’ @ a new place unless they observe other URMs already thriving in that environ. It can make it hard to ‘break the seal’. As PDs strive for D&I, this requires some examination IMO #PWChat 2/2
— Jordan Spector MD (@jserdoc) October 15, 2020
We should all mentor and sponsor #URM students and residents. For those students seeking mentors/sponsors, reach out! Email the leadership from your home program. If no home program, reach out to a local program for support #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Do you think it's getting easier for them to find mentors, given our current climate? #PWChat
— shereesepubhlth 😷 (@ShereesePubHlth) October 15, 2020
We don’t grow & nourish Black pre med students we “weed them out” with many prerequisites that aren’t even clinically applicable. The number of HBCUs decreasing is also an issue. Free MCAT review courses ( with additional stipend $ to cover missed work opportunities) can help.
— Danielle Doyle, MD (@PainGuruDC) October 15, 2020
We've struggled with this too – we have a faculty member who identifies as URM that has been invited to every recruitment event for decades. It can be a BIG ask for one indiv
— Jordan Spector MD (@jserdoc) October 15, 2020
It creates a paradox, as some URM candidates won’t ‘take the plunge’ @ a new place unless they observe other URMs already thriving in that environ. It can make it hard to ‘break the seal’. As PDs strive for D&I, this requires some examination IMO #PWChat 2/2
— Jordan Spector MD (@jserdoc) October 15, 2020
Q3: What outreach strategies have been the most effective in recruiting a diverse group of candidates for your residency program?#PWChat pic.twitter.com/5eqp4zoDpP
— Physician's Weekly (@physicianswkly) October 15, 2020
Yeah, if you don't have leadership buy-in, DEI programs can be a study in futility. #PWchat
— shereesepubhlth 😷 (@ShereesePubHlth) October 15, 2020
Exactly. It only takes one person to make difference. There are "big" sponsors & there are those who contribute in "smaller" ways by for ex. giving a great recommendation or nominating you for an award. Would love to see more sponsors of #URM physicians in medicine. #PWchat https://t.co/tg10gbwZIB
— Philomena Asante, MD MPH (@philoasantemd) October 15, 2020
I would like to give a shout out to novel programs at other institutions, such as the diversity and community engagement track within #PennDerm residency. @MishaRosenbach #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
For more info re: the Diversity & Community Engagement track that @AllisonLarsonMD mentioned, see our website: https://t.co/hExbbfghDn
— Dr. M Rosenbach (@MishaRosenbach) October 15, 2020
We are lucky to have strong support too – from our institution w/funding for URMs to do a visiting rotation or second interview ‘looks’ (preCovid of course) – thru affiliations w/minority student associations, etc 2/3 #PWChat
— Jordan Spector MD (@jserdoc) October 15, 2020
But I say it often; those who need to hear this rarely participate in these conversations. IMHO, most DEI programs are for show. The best model I've seen is from @acgme, not from actual residency programs. #PWchat
— shereesepubhlth 😷 (@ShereesePubHlth) October 15, 2020
Agree Shereese, though I fear the message that indiv programs can't do much leading to PDs saying "I am not going to do anything". If it's only broaching the tough conversations, it could help one or two of the resistant types, no?
— Jordan Spector MD (@jserdoc) October 15, 2020
Q4: How does your institution use board scores in the resident applicant review, selection and interview process?#PWChat pic.twitter.com/A73ANNYiT6
— Physician's Weekly (@physicianswkly) October 15, 2020
A4. We have #nofilter. Board scores are one factor among many in selecting for interviews (and not the most important factor). At the interview stage, our focus is on best fit for the program’s mission #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
As such, my group focuses strongly on activities & interests – commitment to the mission and values of BMC, team-based performance, evidence of resilience. Certainly grades & test scores are part of the recipe, but only a part 2/3 #PWChat
— Jordan Spector MD (@jserdoc) October 15, 2020
I got into an interesting convo this week about resilience, perseverance and mental toughness for residents. My Q was, can you develop strength in those aforementioned areas w/o sacrificing empathy? Osler eluded to as much. Studies also suggest by PY3, empathy lessens. #PWchat https://t.co/YQA9QnVS6O
— shereesepubhlth 😷 (@ShereesePubHlth) October 15, 2020
https://t.co/2gN4aDllsMhttps://t.co/IVUHdY6XuK#PWChat 3/3
— Jordan Spector MD (@jserdoc) October 15, 2020
Q5: What are the top three things you look for in selecting resident applicants to interview?#PWChat pic.twitter.com/9LMdiR1kou
— Physician's Weekly (@physicianswkly) October 15, 2020
How do you determine who possesses these values? Seems like a difficult task. #PWchat
— Linda Girgis MD (@DrLindaMD) October 15, 2020
So yes, hard to gauge, but we cull what we can from file review and interviews
— Jordan Spector MD (@jserdoc) October 15, 2020
Agreed and can also a challenge for those who have certain #disabilities. We expect to do team building development with our trainee groups and expect that not everyone will have had the same team experiences #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Interesting – it could. But we don't look exclusively for professional teams – it could include military – team sports – a non-professional work environ (i.e. working in one place in service industry for a time)
— Jordan Spector MD (@jserdoc) October 15, 2020
A5. The primary #missions of #BUDermatology are 1. care for our underserved #safetynet patients, 2. train a #diverse group who will contribute meaningfully, 3. foster a #team environment. We look for applicants who demonstrate or describe these traits/skills/interests #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Q6: How does your program limit bias in resident selection and interview process?#PWChat pic.twitter.com/Rk4nW1p9nq
— Physician's Weekly (@physicianswkly) October 15, 2020
Oh how I wish we could one day get to "mitigate" instead of "limit". Let's mitigate bias in the selection process. We know even the data itself contains bias. Some step are being taken (ex. eliminating scores) but more needs to be done, maybe with masking. #PWchat https://t.co/78Ig42DQkj
— shereesepubhlth 😷 (@ShereesePubHlth) October 15, 2020
We require everyone participating in recruiting to complete the free online implicit bias test (available at https://t.co/UpBhpvrpv9 ) #PWChat 2/4
— Jordan Spector MD (@jserdoc) October 15, 2020
The HBR article that @divadocsbos posted yesterday about leveraging process (rather than content) to reduce bias was super-fascinating – I'd love to learn from you all how best to incorporate into our hiring practices #PWChat 4/4
— Jordan Spector MD (@jserdoc) October 15, 2020
We also do regular sessions as a training program and department on #microaggressions, #unconsiousbias, #culturalsensitivity, and #socialdeterminants of health, etc #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Yes! Using structured interviews is good. We created a list of qs c scoring rubrics that all interviewers used. There were disagreement in scoring due to some inherent biases (some of them related to personal insecurities) but standardizing the process started good conv. #PWchat
— Jasminka Criley MD, FACP, FHM (@criley_md) October 15, 2020
Q7: Are your residents involved in the resident recruitment, selection or interview process? If so, how?#PWChat pic.twitter.com/6YzXdgpdxn
— Physician's Weekly (@physicianswkly) October 15, 2020
A7. Residents are critical to the interview process and make up at least ¼ of our interview team. Residents help with recruitment efforts too. @The_BMC #GME hosted a virtual #URM recruitment session last week in which I and a #derm resident participated #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
Under the heading of ‘Duh’, medicine is a stressful profession, and EM has esp high-rates of burnout. We all know that NOT having a say in your work place, not feeling like your bosses hear you, or value your input, can be very destructive to wellness #PWChat 2/3
— Jordan Spector MD (@jserdoc) October 15, 2020
I really believe that self-determination in the workplace is an ANTIDOTE to burnout. Give your trainees some real say, and you will see how invested they become in making things better (rather than lamenting all of the challenges over which they have no control) #PWChat 3/3
— Jordan Spector MD (@jserdoc) October 15, 2020
Not competitive – we offer guidance in the process, detailed instructions, and creating mult layers of oversight to ensure some consistency across all apps #PWChat
— Jordan Spector MD (@jserdoc) October 15, 2020
Q8: What do you think would help more medical schools meet the Liaison Committee on Medical Education diversity requirements on accreditation?#PWChat pic.twitter.com/Nx5jN4KDcd
— Physician's Weekly (@physicianswkly) October 15, 2020
#LCME also describes training in culturally competent care, health care #disparities, and needs of underserved populations. It is the responsibility of all institutions (not just #safetynet hospital systems) to ensure #medicalschool graduates are educated in these areas #PWChat
— Allison Larson, MD (@AllisonLarsonMD) October 15, 2020
How about an annual report of ‘Med Schools with Most Diverse Stud Bodies’, analogous to the US News college rankings each year? Some pomp and circumstance for those schools committed to these ideals #PWChat 2/3
— Jordan Spector MD (@jserdoc) October 15, 2020
Until smart people start proposing real incentives, I don't know that the LCME has the cure to all that ails us here #PWChat 3/3
— Jordan Spector MD (@jserdoc) October 15, 2020
We’re “officially” out of time, but let’s keep the convo going. Thanks to all who joined today’s #PWChat on #Diversity in #Residency training. Special thanks to co-hosts @philoasantemd, @jserdoc, @AllisonLarsonMD, & @DrLindaMD! pic.twitter.com/AxnRbsONil
— Physician's Weekly (@physicianswkly) October 15, 2020
