Designing and Implementing a Pilot Anti-racism and Structural Competency Assessment for Graduate Medical Admissions

Novel mission-aligned assessments can be an option to incorporate into the supplementary application to enhance the holistic review process within graduate medical education (GME). This article describes an exploratory proof-of-concept study to design, implement, and incorporate a pilot anti-racism and structural competency assessment into the supplementary application for a child and adolescent psychiatry (CAP) fellowship program. The program team also sought to understand whether responses to the pilot assessment would yield useful information for integration into a holistic review admissions framework.

We designed a pilot assessment by identifying Likert scale items from validated tools designed to assess racial attitudes and structural competency that were deemed mission-aligned and relevant to health, medicine, and education policy as well as an open-constructed response item. The pilot assessment was distributed to all interviewees to a CAP fellowship during the 2020-2021 applicant cycle (n = 29). We conducted a thematic analysis and descriptive quantitative analysis of the responses to the pilot assessment to understand patterns and trends.

On the Likert scale items, there was general agreement on items related to social determinants of health. There was more spread in responses to questions related to biological race and policies to combat structural racism. Thematic analysis of the open-constructed response items revealed six core themes: disparities in healthcare access, social determinants of health, racial bias in society, inequities in medicine, with some responses coded as cautionary indicators, which expressed potentially negative racial attitudes or limited engagement with question content.

A novel mission-aligned assessment provided applicants with an additional opportunity to demonstrate anti-racism competencies, identified as mission-aligned for a CAP fellowship program. Responses to the pilot assessment appeared to yield meaningful differences, which may be valuable for incorporating into a holistic review framework. Such program-specific assessment within the supplementary application is a promising strategy to enhance holistic review by deepening programs' ability to select mission-aligned applicants.