Need for a More Objective, Inclusive, and Equitable Selection Process for Gastroenterology Fellowships

Diseases related to the digestive system account for a significant proportion of the diseases burden in the United States and result in 36.8 million ambulatory visits, 3.8 million hospital admissions, and 22.2 million gastrointestinal endoscopies. To meet the challenge that this quantum of gastroenterological disorders poses, we are obligated to select and train competent gastroenterologists. Admission into a Gastroenterology (GI) fellowship program is highly selective. In 2023, only 62.7% of candidates who applied were successful in matching into a fellowship program, making it even more competitive than a cardiology fellowship (match rate of 68.4%). Therefore, it is imperative that we ensure that the selection process is fair and transparent. Additionally, we need to be socially more responsible by emphasizing diversity and inclusivity to produce gastroenterologists who reflect the changing society we live in. An analysis of current practices indicates that the process of selection is not standardized and is more subjective than objective. This review is an attempt to identify deficiencies that can be rectified by the introduction of a standardized system that includes structured interviews, Standard Letters of Recommendation (SLOR), and objective scoring protocols-all of which would make the process of selection more equitable, diverse, and inclusive. Newer methods like Casper exam, Psychometric testing, and Preference Signaling can also be explored to this end.