Unraveling the medical residency selection game

Lokke M Gennissen,Matthijs De Hoog,Karen M Stegers-Jager,Cornelia R M G Fluit,Jacqueline De Graaf

doi:10.1007/s10459-020-09982-x

Abstract

The diversity of modern society is often not represented in the medical workforce. This might be partly due to selection practices. We need to better understand decision-making processes by selection committees in order to improve selection procedures with regard to diversity. This paper reports on a qualitative study with a socio-constructivist perspective conducted in 2015 that explored how residency selection decision-making occurred within four specialties in two regions in the Netherlands. Data included transcripts of the decision-making meetings and of one-on-one interviews with committee members before and after the group decision-making meetings. Candidates struggled to portray themselves favorably as they had to balance playing by the rules and being authentic; between fitting in and standing out. Although admissions committees had a welcoming stance to diversity, their practices were unintentionally preventing them from hiring underrepresented minority (URM) candidates. While negotiating admissions is difficult for all candidates, it is presumably even more complicated for URM candidates. This seems to be having a negative influence on attaining workforce diversity. Current beliefs, which make committees mistakenly feel they are acting fairly, might actually justify biased practices. Awareness of the role of committee members in these processes is an essential first step.

Highlights

The increasing sociocultural diversity in Western society is underrepresented in the medical workforce (Leyerzapf and Abma 2012; Verdonk and Janczukowicz 2018), partly because we seem to lose medical graduates with a sociocultural diverse background, i.e. underrepresented minorities (URM) in the transition to residency (Leyerzapf and Abma 2012)
This study shows how selection committees unconsciously construct barriers in their selection procedures, which keep them from including URM talents in our medical workforce
Based on our study of residency selection decision-making in the Netherlands, we argue that selection committees, led by their dedication to look for the best candidates, construct merit as nearly impossible combinations of good qualities

Summary

Introduction

The increasing sociocultural diversity in Western society is underrepresented in the medical workforce (Leyerzapf and Abma 2012; Verdonk and Janczukowicz 2018), partly because we seem to lose medical graduates with a sociocultural diverse background, i.e. underrepresented minorities (URM) in the transition to residency (Leyerzapf and Abma 2012). This increased attention has not been reflected in a formal policy regarding diversity Are they generally underrepresented, the proportion of URM medical graduates appears to decrease along the career path to becoming a medical specialist (Leyerzapf and Abma 2012; Sopoaga et al 2017). This phenomenon has been referred to as the ‘leaky pipeline’ (Freeman et al 2016)

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Conclusion