Bridging the Gap: Holistic Review to Increase Diversity in Graduate Medical Education

TLDR

Racial and ethnic disparities in health outcomes persist in the U.S., and increasing physician workforce diversity—supported by holistic review—has been shown to improve student diversity in undergraduate medical education. This study investigates how a pilot holistic‑review intervention can be applied in graduate medical education to boost the number of underrepresented‑in‑medicine residents. The intervention applied holistic review to select interviewees, standardized interview encounters, and prominently highlighted the program’s commitment to diversity during interview days. From 2015‑2016 to 2017‑2018, URM application review rose from 14.1% to 20.4%, interview rates from 16.0% to 24.5%, and matriculation from 12.5% to 31.7%, indicating a substantial increase in URM residency enrollment.

Abstract

Racial and ethnic disparities in health outcomes remain pervasive in the U.S. health care system. Increasing the diversity of the physician workforce is recognized as an important component of addressing these disparities. Holistic review, which gives balanced consideration to applicants' academic metrics, experiences, and attributes, has gained popularity in undergraduate medical education and led to improvement in student diversity. Limited research has investigated how holistic review and other strategies can be implemented in graduate medical education to enhance diversity.The internal medicine (IM) residency program of the John P. and Kathrine G. McGovern Medical School implemented a pilot intervention in academic years (AY) 2016-2017 and 2017-2018 aimed at increasing the number of matriculating residents who are underrepresented in medicine (URM). The intervention included (1) using holistic review in the process of selecting applicants for interview, (2) standardizing the interview encounters, and (3) explicitly highlighting the program's commitment to diversity on interview days.From AY 2015-2016 (preintervention) to AY 2017-2018, the percentage of URM applications reviewed increased from 14.1% (180/1,276) to 20.4% (183/897), the proportion of URM applicants interviewed rose from 16.0% (60/374) to 24.5% (95/388), and the proportion of URM residents matriculating increased from 12.5% (5/40) to 31.7% (13/41).Further efforts are needed to expand the pool of URM applicants at McGovern and elsewhere and to identify how holistic review can be widely employed in other IM residency programs and in other specialties.