For most aspiring physicians, medical school is only the first step toward establishing a career. Applying for residencies, in which they will train in their medical specialties, is an expensive, time-consuming and high-stakes process. But as with many aspects of life, there are disparities in how residents are selected, according to a new Yale-led study published in Open JAMA Network.
Researchers sought to predict the likelihood of postgraduate medical education (GME) placement based on race and ethnicity, gender, and socioeconomic status. They conducted a retrospective analysis of medical students who applied for residency from 2018 to 2021 using Association of American Medical Colleges (AAMC) GME Track Resident Survey The data.
“In previous studies, we’ve really only looked at one dimension of identity, but there’s intersectionality and the composition of multiple marginalized identities,” says Mytien Nguyen, MSc, lead author of the study. . “We wanted to see how these identities came into play in the application process.
Demographics associated with admission rates
Black or African American and Hispanic male students were the least likely to be placed in GME, and female Native American or Alaska Native and Hawaiian or Pacific Islander female students. Black female students and Hispanic female students also had much higher non-grading rates than white female students. These groupings correspond to the AAMC’s definition of underrepresented medical students (URIM). The students covered by the data may belong to more than one of these categories.
Low-income students were also less likely to be placed, but even more so when associated with another marginalized identity. “There is a clear cumulative effect of being an underrepresented, low-income medical student,” says Nguyen. “There’s a double whammy when it comes to how classist and racialized medicine is.”
Asian and white students are not classified in URIM. Although, according to a previous study led by Nguyen and Boatright, students who identify as Asian and male experience significant discrimination. This discrimination may explain the disproportionately high attrition rates of Asian male students compared to their white peers. Similarly, in the present study, Asian men were less likely to place themselves in GME than their white male peers.
“Based on the data we have, it’s unclear what is actually driving the higher rates of unsuccessful GME placement,” says Dowin Boatright, MD, MBA, MHS, adjunct assistant professor of emergency medicine , another study researcher. Boatright and Nguyen suggest that this initial lower GME placement for URIM students could impose a minority tax, forcing some students to extend their independent practice time, limiting their lifetime earning potential, and restricting workforce diversity. – of medical work.
In future studies, Nguyen and Boatright would like to assess more aspects of identity such as disability status and gender identity, but are limited by the identifiers collected by the AAMC GME Resident Survey. Track.
Addressing Placement Disparity
Nguyen and Boatright insist that improving GME placement rates for students who are disproportionately affected must happen intentionally at the structural level. For residency programs, Nguyen recommends considering which aspect of an application takes priority — test scores, awards, publications, volunteering, and more. – and to pay more balanced attention to all components.
“Residency programs need to start looking at students more holistically,” says Nguyen. “Residency programs should also create spaces for diverse students and not rely on assessments based on the individual’s eloquence, for example.”
Besides judging the student’s application, a student’s social and financial capital can also affect the placement. Nguyen and Boatright believe that institutions can take more responsibility for leveling this disparity. “From what I’ve seen, there are a lot of subtle, behind-the-door conversations happening throughout the application process,” says Nguyen. “Programs need to be more aware that many disadvantaged students, namely URIM, women and low-income, arrive with less social capital.”
Boatright says not getting a residency can also be self-perpetuating. “There’s definitely a stigma associated with not placing yourself,” he says. “When you apply next year, those places will know and the likelihood of someone matching will be much lower.” With regard to financial capital, Boatright adds: “Without a doubt, I think all students would benefit from relief from financial burden to apply.”
Additionally, Nguyen and Boatright believe the Accreditation Council for Higher Medical Education should provide greater oversight of the process. They recommend incorporating their diversity standards into credentialing by evaluating programs on diversity of matriculators and placement in particular specialties based on applicants’ gender, race/ethnicity, and intersections.
Nguyen points to the Liaison Committee on Medical Education as a model of success. “The LCME has implemented its diversity standards which has resulted in increased recruitment of female URIM and female students into medical schools,” she says. “A similar accreditation standard at the postgraduate medical education level could prove very effective.”