The diversity “Easter egg” hunt: Deciphering diverse residency applicants

Each year, across the nation, residency program directors and their faculty spend countless hours on what has become a time‐honored tradition: the diversity Easter egg hunt. Residency programs that have made a commitment to increasing diversity spend numerous hours scouring applications for evidence of diversity, looking for the hints or signs to identify diverse applicants to truly complete holistic review and evaluate every aspect of a student's application. The conventional metrics of letters of evaluation, personal statements, board scores, medical student performance evaluations, and overall grades are components that are frequently utilized for scoring. However, for residency programs with a deep commitment to the underserved, for programs that are focused on improving pipelines to medicine, and programs that are dedicated to improving the diversity of their own program, identifying diverse applicants can be extremely challenging. For example, does being the president of a LGBTQIA group mean that an applicant is LGBTQIA? Is there a clear placeholder where a student can highlight that they are a first‐generation college graduate? In fact, currently, race is the only demographic factor available in the Electronic Residency Application System (ERAS), the platform that medical students use to apply to residency, to clearly identify applicants underrepresented in medicine. Fostering a diverse workforce means being inclusive of more than just racial diversity, but also sexual orientation, gender, religion, socioeconomic status, first‐generation status, and disability as a well as other factors. Without consistent mechanisms in place to allow students to self‐identify based on these factors, program directors are left to conduct this “Easter egg” hunt, a process that may even increase bias, and open the door for inequitable identification of underrepresented applicants.

In fact, a significant amount of the data needed for programs to make these important decisions is already available. The American Medical College Application Service (AMCAS), the system that medical students use to apply to medical school, actually requires much of this material when applying to medical school. For example, there are fields for students to disclose that they come from a disadvantaged background, to self‐identify using gender identity specifics, and to present their parents’ highest level of education.¹ The AMCAS system is run by the American Association of Medical Colleges (AAMC), which is the same organization that manages the ERAS. In fact, applicants to medical school are assigned a unique AAMC identification number that is the same identifier that they use to apply to residency programs. As such, it seems that making this already collected data available from AMCAS to ERAS would not only be possible but would provide residency programs with the opportunity to expand their efforts in specifically recruiting diverse applicants across a broad spectrum of demographics.

However, there are reasons to not automatically insert these data. Some residency applicants may not be willing to share this material or worry about bias, either implicit or explicit, affecting their chances of matching. Some students may feel that this information should not be germane to their application and want program directors to focus on other elements that they feel represent them better, and they may be correct. There is still a significant amount of bias in residency application selection, just as there is bias in selection for AOA, medical student mistreatment, MCAT scores, and acceptance to residency.², ³, ⁴, ⁵ An easy solution would be to include these fields in the ERAS application and allow students the opportunity to self‐disclose as they see fit. This would not only lessen the burden on residency programs in trying to identify diverse candidates but would also create a more equitable solution to ensure all underrepresented applicants had the opportunity to self‐disclose, while still allowing students control over inclusion of material.

The call to increase diversity in our residency training programs, to better match our physician workforce with the patients that we serve, is clear, with specific calls to action from organizations including the Accreditation Council for Graduate Medical Education (ACGME),⁶ the American Board of Emergency Medicine (ABEM),⁷ the Council of Emergency Medicine Program Directors (CORD),⁸ and the AAMC.⁹ Ironically, the current system is fraught with inequity as two underrepresented in medicine applicants may receive variable treatment by a single program only because one applicant was more readily identifiable as underrepresented. To meet the necessary challenge of improving the diversity of our workforce, we need to be armed with the information necessary to identify and tailor our recruitment to all underrepresented applicants in medicine.

CONFLICT OF INTEREST

The authors have no potential conflicts to disclose.

Sungar WG, Druck J, Angerhofer C, Buchanan J, Ward‐Gaines J. The diversity “Easter egg” hunt: Deciphering diverse residency applicants. AEM Educ Train. 2021;5(Suppl. 1):S152–S153. 10.1002/aet2.10666