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Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping

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Published on: August 12, 2019

Reducing implicit bias in the neurosurgery application and interview process: a single-institution experience.

Georgia M Wong¹, Kelsey Cobourn^2,3, Kitara Smith¹

¹1Department of Neurosurgery, Georgetown University School of Medicine.

Neurosurgical Focus

|November 1, 2023

Summary

This study demonstrates a feasible holistic review process for neurosurgery residency applications, reducing reliance on biased metrics like USMLE scores and Alpha Omega Alpha status. The new system prioritizes interview scores for ranking, promoting a more equitable selection process.

Keywords:

NRMP National Resident Matching Program USMLE United States Medical Licensing Examination implicit bias interview process neurosurgery application residency program

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Area of Science:

Neurosurgery Residency Admissions
Medical Education Research
Bias Mitigation in Healthcare

Background:

The neurosurgical match is highly competitive, often relying on metrics like USMLE scores and AOA status for applicant screening.
These traditional metrics have been identified as potential sources of racial bias, impacting fairness in the selection process.
Residency programs face challenges in holistically evaluating a large pool of applicants within limited interaction time.

Purpose of the Study:

To demonstrate the feasibility of modifying the residency application process to reduce reliance on biased metrics.
To implement and evaluate a holistic review system that de-emphasizes USMLE scores and AOA status.
To promote a more equitable and values-aligned neurosurgery residency selection process.

Main Methods:

Instituted a holistic application review process with dual reviewer redundancy, blinding reviewers to photographs and test scores.
Implemented a domain-based interview evaluation focusing on knowledge, commitment to neurosurgery, and integrity.
Conducted regression analysis to assess the impact of AOA status, USMLE scores, and interview performance on the final rank list.

Main Results:

Total interview score was the only significant predictor of the final rank list, with a 1-point increase correlating to a 15-position rank increase (p < 0.05).
USMLE board scores and AOA status did not significantly affect the final rank list.
The implemented system demonstrated that rank lists closely reflected total interview scores.

Conclusions:

A holistic review process focusing on core qualities can effectively mitigate bias associated with traditional metrics like board scores and AOA status.
Shifting focus from traditional metrics to a domain-based interview score promotes a more equitable and values-driven selection process.
This modified application system aims to reduce downstream effects of bias and foster a more diverse and representative neurosurgery workforce.