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Bridging the Gap

Holistic Review to Increase Diversity in Graduate Medical Education

Aibana, Omowunmi MD, MPH; Swails, Jennifer L. MD; Flores, Renee J. MD; Love, LaTanya MD

doi: 10.1097/ACM.0000000000002779
Innovation Reports
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Problem Racial and ethnic disparities in health outcomes remain pervasive in the U.S. health care system. Increasing the diversity of the physician workforce is recognized as an important component of addressing these disparities. Holistic review, which gives balanced consideration to applicants’ academic metrics, experiences, and attributes, has gained popularity in undergraduate medical education and led to improvement in student diversity. Limited research has investigated how holistic review and other strategies can be implemented in graduate medical education to enhance diversity.

Approach The internal medicine (IM) residency program of the John P. and Kathrine G. McGovern Medical School implemented a pilot intervention in academic years (AY) 2016–2017 and 2017–2018 aimed at increasing the number of matriculating residents who are underrepresented in medicine (URM). The intervention included (1) using holistic review in the process of selecting applicants for interview, (2) standardizing the interview encounters, and (3) explicitly highlighting the program’s commitment to diversity on interview days.

Outcomes From AY 2015–2016 (preintervention) to AY 2017–2018, the percentage of URM applications reviewed increased from 14.1% (180/1,276) to 20.4% (183/897), the proportion of URM applicants interviewed rose from 16.0% (60/374) to 24.5% (95/388), and the proportion of URM residents matriculating increased from 12.5% (5/40) to 31.7% (13/41).

Next Steps Further efforts are needed to expand the pool of URM applicants at McGovern and elsewhere and to identify how holistic review can be widely employed in other IM residency programs and in other specialties.

O. Aibana is assistant professor of internal medicine, John P. and Kathrine G. McGovern Medical School at UT Health, Houston, Texas; ORCID: https://orcid.org/0000-0003-0665-5393.

J.L. Swails is assistant professor of internal medicine and program director, Internal Medicine Residency, John P. and Kathrine G. McGovern Medical School at UT Health, Houston, Texas.

R.J. Flores is assistant professor of internal medicine and associate program director, Internal Medicine Residency, John P. and Kathrine G. McGovern Medical School at UT Health, Houston, Texas.

L. Love is associate professor of pediatrics and associate dean of diversity and inclusion, John P. and Kathrine G. McGovern Medical School at UT Health, Houston, Texas.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Approval provided by the Institutional Review Board of the John P. and Kathrine G. McGovern Medical School at UT Health on June 2, 2017.

Previous presentations: Description of this pilot program and results were presented at the Association of American Medical Colleges (AAMC) Continuum Connections meeting in Orlando, Florida in April 2018, and the Academic Internal Medicine Week meeting in Philadelphia, Pennsylvania in April 2019.

Correspondence should be addressed to Omowunmi Aibana, 6431 Fannin St., MSB 1.122, Houston, TX 77030; telephone: (713) 500-6714; email: omowunmi.aibana@uth.tmc.edu; Twitter: @mcgovernmed.

© 2019 by the Association of American Medical Colleges