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Implicit Bias and the Association of Redaction of Identifiers With Residency Application Screening Scores
JAMA Ophthalmology ( IF 8.1 ) Pub Date : 2021-12-01 , DOI: 10.1001/jamaophthalmol.2021.4323
Suzann Pershing 1, 2 , Laurel Stell 1, 3 , A Caroline Fisher 1 , Jeffrey L Goldberg 1, 2
Affiliation  

Importance Diversity in the ophthalmology profession is important when providing care for an increasingly diverse patient population. However, implicit bias may inadvertently disadvantage underrepresented applicants during resident recruitment and selection.

Objective To evaluate the association of the redaction of applicant identifiers with the review scores on ophthalmology residency applications as an intervention to address implicit bias.

Design, Setting, and Participants In this quality improvement study, 46 faculty members reviewed randomized sets of 462 redacted and unredacted applications from a single academic institution during the 2019-2020 ophthalmology residency application cycle.

Interventions Applications electronically redacted for applicant identifiers, including name, sex or gender, race and ethnicity, and related terms.

Main Outcomes and Measures The main outcome was the distribution of scores on redacted and unredacted applications, stratified by applicant’s sex, underrepresentation in medicine (URiM; traditionally comprising American Indian or Alaskan Native, Black, and Hispanic individuals) status, and international medical graduate (IMG) status; the application score β coefficients for redaction and the applicant and reviewer characteristics were calculated. Applications were scored on a scale of 1 to 9, where 1 was the best score and 9 was the worst score. Scores were evaluated for a significant difference based on redaction among female, URiM, and IMG applicants. Linear regression was used to evaluate the adjusted association of redaction, self-reported applicant characteristics, and reviewer characteristics with scores on ophthalmology residency applications.

Results In this study, 277 applicants (60.0%) were male and 71 (15.4%) had URiM status; 32 faculty reviewers (69.6%) were male and 2 (0.4%) had URiM status. The distribution of scores was similar for redacted vs unredacted applications, with no difference based on sex, URiM status, or IMG status. Applicant’s sex, URiM status, and IMG status had no association with scores in multivariable analysis (sex, β = –0.08; 95% CI, –0.32 to 0.15; P = .26; URiM status, β = –0.03; (95% CI, –0.36 to 0.30; P = .94; and IMG status, β = 0.39; 95% CI, –0.24 to 1.02; P = .35). In adjusted regression, redaction was not associated with differences in scores (β = −0.06 points on a 1-9 scale; 95% CI, –0.22 to 0.10 points; P = .48). Factors most associated with better scores were attending a top 20 medical school (β = −1.06; 95% CI, –1.37 to –0.76; P < .001), holding an additional advanced degree (β = −0.86; 95% CI, –1.22 to –0.50; P < .001), and having a higher United States Medical Licensing Examination Step 1 score (β = −0.35 per 10-point increase; 95% CI, –0.45 to –0.26; P < .001).

Conclusions and Relevance This quality improvement study did not detect an association between the redaction of applicant characteristics on ophthalmology residency applications and the application review scores among underrepresented candidates at this institution. Although the study may not have been powered adequately to find a difference, these findings suggest that the association of redaction with application review scores may be preempted by additional approaches to enhance diversity, including pipeline programs, implicit bias training, diversity-centered culture and priorities, and targeted applicant outreach. Programs may adapt this study design to probe their own application screening biases and track over time before-and-after bias-related interventions.



中文翻译:

隐性偏见和标识符编辑与居留申请筛选分数的关联

在为日益多样化的患者群体提供护理时,眼科专业的多样性非常重要然而,隐性偏见可能会在居民招聘和选拔过程中无意中使代表性不足的申请人处于不利地位。

目的 评估申请人标识符的编辑与眼科住院医师申请的审查分数之间的关联,作为解决隐性偏见的干预措施。

设计、设置和参与者 在这项质量改进研究中,46 名教职员工在 2019-2020 年眼科住院医师申请周期期间审查了来自单一学术机构的 462 份编辑和未编辑申请的随机组。

干预 申请以电子方式编辑申请人标识符,包括姓名、性别或性别、种族和民族以及相关术语。

主要成果和措施 主要结果是编辑和未编辑申请的分数分布,按申请人的性别、医学代表性不足(URiM;传统上包括美洲印第安人或阿拉斯加原住民、黑人和西班牙裔人)身份和国际医学毕业生(IMG)身份进行分层;计算了修订的申请分数β系数以及申请人和审稿人的特征。应用程序的评分范围为 1 到 9,其中 1 是最好的分数,9 是最差的分数。根据女性、URiM 和 IMG 申请人之间的修订,评估分数是否存在显着差异。线性回归用于评估修订、自我报告的申请人特征和审稿人特征与眼科住院医师申请分数之间的调整关联。

结果 在本研究中,277 名申请者(60.0%)为男性,71 名(15.4%)为 URiM 状态;32 名教师评审员 (69.6%) 为男性,2 名 (0.4%) 具有 URiM 身份。编辑与未编辑应用程序的分数分布相似,在性别、URiM 状态或 IMG 状态方面没有差异。申请人的性别、URiM 状态和 IMG 状态与多变量分析中的分数无关(性别,β = –0.08;95% CI,–0.32 至 0.15;P  = .26;URiM 状态,β = –0.03;(95% CI,–0.36 至 0.30;P  = .94;和 IMG 状态,β = 0.39;95% CI,–0.24 至 1.02;P  = .35)。在调整回归中,修订与分数差异无关(β = -0.06 分,1-9 分;95% CI,–0.22 至 0.10 分;P = .48)。与更高分数最相关的因素是就读于排名前 20 的医学院(β = -1.06;95% CI,–1.37 至 –0.76;P  < .001),持有额外的高级学位(β = -0.86;95% CI, –1.22 至 –0.50;P  < .001),并且美国医师执照考试第 1 步得分较高(β = -0.35 每增加 10 分;95% CI,–0.45 至 –0.26;P  < .001) .

结论和相关性 这项质量改进研究没有发现申请人特征对眼科住院医师申请的修改与该机构代表性不足的候选人的申请审查分数之间存在关联。尽管该研究可能没有足够的动力来发现差异,但这些发现表明,编辑与申请审查分数的关联可能会被其他增强多样性的方法所取代,包括管道计划、隐性偏见培训、以多样性为中心的文化和优先事项和有针对性的申请人外展。项目可以调整这项研究设计,以探索他们自己的申请筛选偏见,并随着时间的推移跟踪与偏见相关的干预措施前后的情况。

更新日期:2021-12-15
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