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

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Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
|November 25, 2025
PubMed
Summary
This summary is machine-generated.

A pilot anti-racism and structural competency assessment for child and adolescent psychiatry fellowships showed promise. It offered insights into applicants

Keywords:
AdmissionsDiversityGraduate medical educationHolistic review

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Area of Science:

  • Medical Education
  • Psychiatry
  • Health Equity

Background:

  • Holistic review in graduate medical education (GME) admissions aims to assess applicants beyond traditional metrics.
  • Incorporating mission-aligned assessments can enhance the holistic review process by evaluating competencies relevant to program goals.
  • Child and Adolescent Psychiatry (CAP) fellowship programs seek to recruit diverse and capable future leaders in the field.

Purpose of the Study:

  • To design, implement, and evaluate a pilot anti-racism and structural competency assessment for a CAP fellowship program.
  • To determine if responses to the pilot assessment provide valuable information for holistic review admissions.
  • To explore the feasibility of integrating novel, mission-aligned assessments into GME supplementary applications.

Main Methods:

  • Developed a pilot assessment using Likert scale items from validated tools and an open-constructed response item.
  • Items were selected for mission alignment with CAP program goals and relevance to health policy and education.
  • Administered the pilot assessment to 29 interviewees during the 2020-2021 CAP fellowship application cycle and conducted thematic and quantitative analysis of responses.

Main Results:

  • Applicants showed general agreement on social determinants of health items but varied responses on biological race and anti-racism policies.
  • Thematic analysis of open-ended responses identified six key themes: healthcare access disparities, social determinants of health, societal racial bias, and medical inequities.
  • A subset of responses indicated potentially negative racial attitudes or limited engagement, serving as cautionary indicators.

Conclusions:

  • A novel, mission-aligned assessment can provide a platform for applicants to demonstrate anti-racism competencies relevant to CAP fellowship goals.
  • Responses to the pilot assessment yielded meaningful differences, suggesting its potential value for holistic review frameworks.
  • Program-specific assessments integrated into supplementary applications are a promising strategy to enhance holistic review and select mission-aligned candidates.