TY - JOUR
T1 - Is There Unconscious Bias in the Orthopaedic Residency Interview Selection Process?
AU - Webber, Colton R.J.
AU - Davie, Ryann
AU - Herzwurm, Zachary
AU - Whitehead, Jonathon
AU - Paré, Daniel W.
AU - Homlar, Kelly C.
N1 - Publisher Copyright:
© 2022
PY - 2022/7/1
Y1 - 2022/7/1
N2 - OBJECTIVE: Orthopaedic surgery has historically been a white male-dominated field. Given the diverse patient population presenting to providers with musculoskeletal pathology, it is thought that it would be beneficial for the orthopaedic workforce to more closely mirror this patient population. This study aims to elucidate whether unconscious bias may have an effect on the scoring of applications for residency interview selection. DESIGN: Applications for the 2019-2020 residency match cycle were initially reviewed and scored by faculty members. Applications were then redacted of all information suggestive of race or gender and returned to evaluators for rescoring after at least 6 months. The pre and post-redaction data was compared using ANOVA and student's two-tailed t tests. SETTING: Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University. PARTICIPANTS: Thirteen attending surgeons scored 320 2019-2020 Electronic Residency Application System (ERAS) applications, unblinded and blinded of applicant identifying information. RESULTS: Interviewed applicants were similar to the non-interviewed group in all measured variables except for higher pre-redaction scores (8.73-7.81; p = 0.02) which was expected (Table 2). Minority applicants had significant differences in Step 1 scores (243 vs 247; p < 0.01), Step 2 scores (251 vs 254; p = 0.01), articles (5.9 vs 3.8; p < 0.01), posters (5.9 vs 3.5; p < 0.01), and pre-redaction scores (7.44 vs 8.07; p = 0.01) compared to white applicants (Table 4). There was no relationship noted between step score and number or type of research items (Table 5). Pre-redaction and post-redaction scores were significantly different in white applicants who experienced a negative change (8.07-7.88; p = 0.03 (Table 6)). Males had statistically significant differences compared to females in Step 1 score (246 vs 243; p = 0.01) (Table 7). CONCLUSIONS: This study was unable to prove unconscious bias based on a lack of statistically significant change of score when blinded, however the direction in change of scores was unlikely to be accounted for exclusively by objective differences between applicants, suggesting a trend toward unconscious bias. It remains unclear how influential subjective portions of the ERAS application such as personal statements, Letters of Recommendation, hobbies, and activities are on the overall assessment of an applicant and whether or not unconscious bias manifests in these subjective portions. Further investigation is needed in this area. Until then, residency programs should take immediate measures to mitigate potential implicit bias in the residency interview selection process. Actions can include implicit bias training for all faculty members involved in resident selection, standardization of application scoring and possibly redacting all or portions of the ERAS application so that only objective academic markers are presented to evaluators. Gaining a better understanding of these barriers is not only essential for their removal, but also allows for better preparation of applicants for success in the match with the ultimate goal being to correct the persistent disparity in the field of orthopaedic surgery.
AB - OBJECTIVE: Orthopaedic surgery has historically been a white male-dominated field. Given the diverse patient population presenting to providers with musculoskeletal pathology, it is thought that it would be beneficial for the orthopaedic workforce to more closely mirror this patient population. This study aims to elucidate whether unconscious bias may have an effect on the scoring of applications for residency interview selection. DESIGN: Applications for the 2019-2020 residency match cycle were initially reviewed and scored by faculty members. Applications were then redacted of all information suggestive of race or gender and returned to evaluators for rescoring after at least 6 months. The pre and post-redaction data was compared using ANOVA and student's two-tailed t tests. SETTING: Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University. PARTICIPANTS: Thirteen attending surgeons scored 320 2019-2020 Electronic Residency Application System (ERAS) applications, unblinded and blinded of applicant identifying information. RESULTS: Interviewed applicants were similar to the non-interviewed group in all measured variables except for higher pre-redaction scores (8.73-7.81; p = 0.02) which was expected (Table 2). Minority applicants had significant differences in Step 1 scores (243 vs 247; p < 0.01), Step 2 scores (251 vs 254; p = 0.01), articles (5.9 vs 3.8; p < 0.01), posters (5.9 vs 3.5; p < 0.01), and pre-redaction scores (7.44 vs 8.07; p = 0.01) compared to white applicants (Table 4). There was no relationship noted between step score and number or type of research items (Table 5). Pre-redaction and post-redaction scores were significantly different in white applicants who experienced a negative change (8.07-7.88; p = 0.03 (Table 6)). Males had statistically significant differences compared to females in Step 1 score (246 vs 243; p = 0.01) (Table 7). CONCLUSIONS: This study was unable to prove unconscious bias based on a lack of statistically significant change of score when blinded, however the direction in change of scores was unlikely to be accounted for exclusively by objective differences between applicants, suggesting a trend toward unconscious bias. It remains unclear how influential subjective portions of the ERAS application such as personal statements, Letters of Recommendation, hobbies, and activities are on the overall assessment of an applicant and whether or not unconscious bias manifests in these subjective portions. Further investigation is needed in this area. Until then, residency programs should take immediate measures to mitigate potential implicit bias in the residency interview selection process. Actions can include implicit bias training for all faculty members involved in resident selection, standardization of application scoring and possibly redacting all or portions of the ERAS application so that only objective academic markers are presented to evaluators. Gaining a better understanding of these barriers is not only essential for their removal, but also allows for better preparation of applicants for success in the match with the ultimate goal being to correct the persistent disparity in the field of orthopaedic surgery.
KW - Residency interviews
KW - orthopaedic surgery
KW - resident applications
KW - unconscious bias
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U2 - 10.1016/j.jsurg.2022.02.003
DO - 10.1016/j.jsurg.2022.02.003
M3 - Article
C2 - 35241397
AN - SCOPUS:85125457362
SN - 1931-7204
VL - 79
SP - 1055
EP - 1062
JO - Journal of surgical education
JF - Journal of surgical education
IS - 4
ER -