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Examining Differential Rater Functioning and Bias in the Holistic Review of Residency Applications
Leandra A Barnes1, Stefanie S Sebok-Syer2, Stefanie A Wind3
1is an Instructor, Department of Dermatology, Stanford University School of Medicine, Palo Alto, California, USA.
Journal of Graduate Medical Education
|June 17, 2026
Summary
Faculty raters showed bias in residency interviews, favoring applicants with matching gender and underrepresented in medicine (URiM) status. This bias impacts fair applicant selection in medical education.
Area of Science:
- Medical Education Research
- Dermatology Residency Admissions
- Bias in Healthcare
Background:
- Rater bias in residency selection is not well understood.
- Holistic review aims for equitable applicant assessment.
- Understanding bias is crucial for fair admissions.
Purpose of the Study:
- To quantify faculty rater bias regarding applicant gender and URiM status.
- To assess bias in interview recommendations for dermatology residency.
- To measure the impact of rater-applicant concordance on interview decisions.
Main Methods:
- Cross-sectional study of dermatology residency applicants (n=3875) and raters (n=69) from 2014-2023.
- Utilized the many-facet Rasch model to analyze rater judgments.
- Examined bias based on applicant and rater gender and URiM status.
Main Results:
- Overall rater bias for gender and URiM status was minimal.
- Significant leniency observed when applicant and rater gender or URiM status were concordant.
- Conversely, severity increased with discordant rater-applicant characteristics.
- Over 50% of raters showed gender bias, and 33% showed URiM bias when concordant.
Conclusions:
- Faculty raters favor interview invitations for applicants with concordant gender and URiM status.
- Raters are less likely to recommend interviews for applicants with discordant characteristics.
- Addressing rater bias is essential for equitable residency selection.
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