Associate Clinical Professor of Pediatrics Children's Hospital Los Angeles Los Angeles, California, United States
Background: The Association of American Medical Colleges promotes holistic review to reduce bias and create a more equitable process for those from underrepresented backgrounds. Implicit bias, however, can impact the way evaluations and letters of recommendation are written. The Supreme Court decision of Students for Fair Admissions v Harvard deemed use of race/ethnicity in applicant selection as unconstitutional. More guidance is needed to help programs implement holistic review. Objective: To analyze the impact of a “Distance Traveled” score and other weighting adjustments on applicants who identify as underrepresented in medicine (URiM). Design/Methods: T-test analyses were used to compare applicants who identify as URiM to those who do not on various measures during the 2021-2022 and 2022-2023 application cycles at a large-sized, urban pediatric residency program. An applicant was deemed in “position to match” if their rank list position was above that of the final applicant to match into the internship class for the program. URiM status was defined as applicants who self-identified as Black, Hispanic/Latino, American Indian/Alaska Native, or Southeast Asian. A separate analysis was conducted removing SE Asian applicants from this definition (URiM2). For 2022-2023, a Distance Traveled score was added, the weight of letters of recommendation (LOR) and Dean’s Letter were decreased, and that of the interview increased. Results: In the 2021-2022 application season, URiM applicants were noted to have a lower position to match (p < 0.01) due to scores for Dean’s Letter (p < 0.01) and academics (p < 0.01). In 2022-2023, URiM applicants had a higher score for Distance Traveled (p < 0.01), and lower scores for LOR (p=0.02) and academic performance (p < 0.01). Position to match was similar (p=0.8). In both cycles, the Interview score for URiM applicants was not statistically significantly different.
For URiM2 applicants, the results from the 2021-2022 application season were consistent. Results were similar for 2022-2023 except that no difference in Distance Traveled score (p=0.08) and a higher score on a standardized interview question about experience with diversity (p=0.02) were noted.
Conclusion(s): Despite holistic review, URiM applicants scored lower in 2021-2022 due to possible bias in written evaluations. The introduction of a Distance Traveled score, and adjusting the weight of these categories eliminated the disparity noted in the previous application cycle for URiM status. Data analysis of a program’s holistic review system is encouraged to create a more equitable process.
