In Reply to Bowe et al.

Abstract

We thank Bowe and colleagues for their comments regarding our article on a framework for inclusive graduate medical education (GME) recruitment strategies. The authors acknowledge there is evidence that non-White race is an independent predictor of lower likelihood for interview selection and matriculation in surgery residency, 1 which substantiates the concerns for bias in selection and matriculation we highlighted in our article. In addition, Bowe and colleagues raise concerns about the need for data to support initiatives to diversify training programs. We agree that data are an important driver of change and that changes to recruitment strategies are necessary nationwide to improve workforce diversity and inclusion. Our article was meant to provide a framework for inclusive recruitment strategies for individual GME programs, and in-depth program-level analysis is one way to assess individual programs and institutions for progress and opportunities for improvement. 1 However, Bowe and colleagues highlight that residency programs and the Accreditation Council for Graduate Medical Education have difficulty assessing progress in diversifying efforts on a larger scale. Some data exist to aide in specialty-specific analyses via the Association of American Medical Colleges (AAMC). For example, one of us (C.M.O.) coauthored a study using data from the AAMC GME Track survey 2 to investigate race disparities in nephrology fellowship training, highlighting trends in the racial makeup of medical student graduates, internal medicine trainees, and nephrology fellows. 3 However, using only the AAMC and GME track data that are currently available has its limitations, particularly in the applicant-to-matriculant stage, such as “Withdrew” and “No Rank List” categories, from the National Resident Matching Program (NRMP), as Bowe and colleagues have mentioned. Bowe and colleagues also bring to our attention that the currently available NRMP data show disparities in non-U.S. graduate Match rates. It is plausible that other disparities (e.g., ethnic, gender, and disability) exist in the Match, the Supplemental Offer and Acceptance Program, and matriculation rates. For instance, some ethnic minority groups are also disproportionately represented in the category of non-U.S. medical school graduates. It is unclear why the NRMP has limited its collection and reporting to “applicant-type.” Collection, analysis, and sharing of NRMP sociodemographic data, such as race, ethnicity, gender, disability, and geographic location, in collaboration with the currently available NRMP, AAMC, and GME Track data, is necessary as it enables programs, institutions, specialties, and organizations, such as the ACGME, to track trends and increase accountability for workforce diversity and inclusion efforts. Acknowledgments: The authors acknowledge Dr. James Appiah-Pippim for contributions to their framework and support.