Standardized Interview Questions Research Articles

Removing Implicit Bias From Cardiothoracic Surgery Resident Recruitment: Changing the Paradigm

IntroductionThe cardiothoracic (CT) surgery workforce continues to suffer from underrepresentation of women and minority physicians. The presence of implicit bias in the recruitment process may impair efforts to enhance the diversity of our training programs. Using a systematic approach, we aimed to investigate and optimize our candidate selection processes to minimize implicit bias. MethodsInternal review of a single center's CT fellowship program selection process was conducted. Areas of potential bias were evaluated. Specifically, we investigated how interview questions were selected, how candidates were assessed during interviews, and how they were compared after interviews. Proactive measures were implemented to remove identified sources of bias. ResultsSeveral areas of potential bias were identified, including variability in types of questions asked and disparities in how candidates were scored. We noted the presence of potentially gendered language, cultural bias, and stereotyping within traits being scored. With the goals of intentionally promoting diversity and inclusion, we selected five traits as likely predictors of success which served as the framework from which standardized interview questions were created. The interview scoresheet was modified to include all attributes felt to be important, while eliminating irrelevant confounders and language that could carry potential advantage to specific groups. ConclusionsBy implementing strategies to identify and remove sources of implicit bias in the interview and recruitment process, our training program improved its process for the recruitment of a diverse cadre of matriculants. We must aim not only to diversify the composition of our trainee classes, but also to ensure equitable support, mentorship, and sponsorship throughout training and career advancement.

Comparing open-ended question methods to vignette methods to explore willingness to obtain pre-exposure prophylaxis access in pharmacies among black men who have sex with men

ABSTRACT Black men who have sex with men (BMSM) are at higher risk of HIV transmission than any other group; however, their uptake of the highly effective HIV prevention medication, pre-exposure prophylaxis (PrEP), is low. In collaboration with a communitybased organization in Atlanta, Georgia, we explored ten HIV-negative BMSM’s willingness to obtain PrEP in pharmacies using standard open-ended and vignette qualitative methods. Three overarching themes were identified: privacy, patient-pharmacist interactions, and HIV/STI screening. While open-ended questions allowed participants to provide broad answers on their willingness to receive prevention services at a pharmacy, the vignette drew out specific responses to facilitate in-pharmacy PrEP delivery. Using both openended questions and vignette data collection strategies, BMSM reported high willingness to screen for and uptake PrEP in pharmacies. However, the vignette method allowed for greater depth. Open-ended questions elicited responses that highlighted general barriers and facilitators of PrEP dispensing in pharmacies. However, the vignette allowed participants to customize a plan of action that would best fit their needs. Vignette methods are underutilized in HIV research and may be helpful in supplementing standard open-ended interview questions to uncovering unknown challenges about health behaviors and obtain more robust data on highly sensitive research topics in HIV research.

Opinions of Pre-service English Teachers on Distance Practicum in the Covid-19 period: An example from Turkey

Within the context of distant practicum procedures implemented during the coronavirus (COVID-19) period, the aim of this study is to highlight the experiences and views of pre-service English teachers on e-practicum. The study also examines whether pre-service teachers’ experiences contrasted with what they expected from the standard practicum procedures. The participants of the study included 20 fourth-year prospective English teachers studying at a Turkish university. Data were collected through standardized open-ended interview questions and content analysis was used to categorize the responses. The findings of this study in general show that teaching practicum is a significant part of teacher education programs as pre-service teachers believe that it particularly supports gaining teaching experience in a real school environment. However, the outbreak of the COVID-19 pandemic has led teaching practicum to be sustained as a part of distance education which has caused certain drawbacks especially in terms of lacking face-to face teaching experience. Findings revealed that distant practicum during the COVID-19 had more negative sides for the participants than positive ones. Participants expressed their demands for e-practicum regulations that address all aspects of the teaching profession and give them the opportunity to put theory into practice.

Reviews on the Job Interview Approaches in Malaysia Context

The job interview has become a popular topic for research among scholars and is a common format employed by any stake holders, recruitment agencies, companies and institutions. It is also called an assessment to select a suitable candidate for hiring. A common instrument used for the job interview is standard interview questions or semi-structured interview questions internally or locally with the set of common objective. There were several studies conducted by scholars on employment interviews. It was found that three common areas of interest are explored in this paper: (1) comprehending what standardised interviews envisage, (2) investigating how interview concepts can be evaluated, and (3) categorise the candidate and interview components that may impact the interview procedure. It was further found that there are also three equally important factors that require moderate research focus to be incorporated: (1) constructing a general standard and value for the interview format or standard interview questions for fresh graduates and behavioural interview questions for senior positions, (2) focus on the best attributes or personal traits, and (3) reliable explanations, classification and quantification of candidate characteristics and employability skills. It is hope that these approaches can be utilized and contributes in the field of job interviews, especially in Malaysia context which prepare the young generations.

Reifying discrimination on the path to school leadership: Black female principals’ experiences of district hiring/promotion practices

Using intersectionality as a guiding framework, this qualitative study focuses on the hiring/promotion experiences of 20 Black female principals and explores how their hiring/promotion practices reified and/or interrupted traditional discriminatory pathways to school leadership. We find that gendered racism operated across all facets of the principal recruitment and hiring processes in which these women participated. First, relationships and political connections with those already in power (e.g., predominately White men) seemed to be a key mechanism for entering the applicant pool and, later, accessing leadership opportunities. Opportunities were often explicitly racialized such that considerations for leadership positions were stated as being based on the participants being Black. Second, interview processes were frequently described as more performative than substantive with many of the women highlighting questions and comments that reinforced problematic tropes about Black women. Questions also abounded about whether interview panels were reflective of the community and/or if the questions were standardized to ensure fairness and transparency. Finally, district level hiring decisions were frequently disconnected from the interview process and lacked transparency with superintendents, in particular, who overrode or ignored prior steps in, or recommendation from, the school-based part of the process. In this way, findings suggest a hiring/promotion system desperately in need of revision starting with the most basic design features (e.g., standardized interview questions, transparent performance indicators, process accountability via decision-making) and including disrupting discrimination across all facets of the system.

Medical student program to learn from families experiencing developmental disabilities

Patients and families experiencing developmental disabilities (DDs) may lack trust in physicians due to negative experiences in healthcare. DDs include conditions impairing physical, learning, language, or behavior areas, beginning during the developmental period and impacting daily functioning ('Developmental Disabilities'). Medical students generally do not receive standard training to effectively communicate with and diagnose patients with DDs. ARIE is a program for medical students to meet and learn from these patients and their families. Students learn about these families’ experiences during home visits, guided by standardized interview questions and surveys about families’ trust in physicians. Families did not appear to strongly trust physicians, with no significant changes after the program. Families shared they experienced physicians’ lack of empathy and knowledge when caring for patients with DDs. Families wanted future physicians to be empathetic and informed when treating children with disabilities. Students reported increased comfort and confidence in interacting with patients with DDs as well as their families after completing the training program. Implementing a service-learning model focused on DDs at other medical schools, incorporating training with communication techniques and home visits, can increase students’ confidence and experiences when engaging with patients with DDs and their families.

Diversity Practices for Hiring the New Graduate Nurse.

A multistep selection process was established to assist in securing top talent while achieving diversity objectives for a nurse residency program. The selection process incorporated objective scoring tools, diverse panel interviews, unconscious bias training, and standardized interview questions to decrease unconscious and implicit bias. As a result, the entry-level nursing workforce has become more diversified by race, gender, age, and academic training.

Perceptions of the Virtual Neurosurgery Application Cycle During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Program Director Survey

ObjectiveThe novel coronavirus disease 2019 (COVID-19) pandemic has led to a shift to virtual residency interviews for the 2020–2021 neurosurgery match, with unknown implications for stakeholders. This study seeks to analyze the perceptions of residency program directors (PDs) and associate program directors (APDs) regarding the current virtual format used for residency selection and interviews.MethodsAn anonymous, 30-question survey was constructed and sent to 115 neurosurgery PDs and 26 APDs to assess respondent demographics, factors used to review applicants, perceptions of applicants and applicant engagement, perceptions of standardized letters and interview questions, the effect of the virtual interview format on various stakeholders, and the future outlook for the virtual residency interview format.ResultsA total of 38 PDs and APDs completed this survey, constituting a response rate of 27.0%. Survey respondents received significantly more Electronic Residency Application Service applications in the 2020–2021 cycle compared with the 2019-2020 cycle (P = 0.0029). Subinternship performance by home-rotators, (26.3%), letters of recommendation (23.7%), and Step 1 score (18.4%) were ranked as the most important factors for evaluating candidates during the current virtual application cycle.ConclusionsOur study highlights that applicants applied to a greater number of residency programs compared with years prior, that the criteria used by PDs/APDs to evaluate applicants remained largely consistent compared to previous years, and that the virtual residency interview format may disproportionately disadvantage Doctor of Osteopathic medicine and international medical graduate applicants. Further exploring attitudes toward signaling mechanisms and standardized letters may serve to inform changes to future neurosurgery match cycles.

Ameliorating the disadvantage for autistic job seekers: An initial evaluation of adapted employment interview questions.

Despite possessing valuable skills, social communication differences mean that autistic people are frequently disadvantaged in job interviews. We examined how autistic and non-autistic adults compared on standard (unmodified) job interview questions, and then used these findings to develop and evaluate supportive adaptations to questions. Fifty adults (25 autistic, 25 non-autistic) took part in two mock job interviews. Interview 1 provided a baseline measure of performance when answering typical, unmodified interview questions. Employment experts (unaware of participants’ autism diagnoses) rated all interviewees on question-specific performance and overall impressions and then provided feedback about how interviewees could improve and how questions could be adapted to facilitate this. Interviewees also provided feedback about the interview process from their perspective. Adaptations to the questions were developed, with Interview 2 taking place approximately 6 months later. Results demonstrated that, in Interview 1, employment experts rated autistic interviewees less favourably than nonautistic interviewees. Ratings of both autistic and non-autistic participants’ answers improved in Interview 2, but particularly for autistic interviewees (such that differences between autistic and non-autistic interviewees’ performance reduced in Interview 2). Employers should be aware that adaptations to job interview questions are critical to level the playing field for autistic candidates.Lay abstractDespite possessing valuable skills, differences in the way that autistic people understand and respond to others in social situations mean that they are frequently disadvantaged in job interviews. We examined how autistic and non-autistic adults compared on standard (unmodified) job interview questions, and then used these findings to develop and evaluate supportive adaptations to questions. Fifty adults (25 autistic, 25 non-autistic) took part in two mock job interviews. Interview 1 provided a baseline measure of performance when answering typical, unmodified interview questions. Employment experts (unaware of participants’ autism diagnoses) rated all interviewees on their responses to each question and their overall impressions of them and then provided feedback about how interviewees could improve and how questions could be adapted to facilitate this. Interviewees also provided feedback about the interview process, from their perspective. Adaptations to the questions were developed, with Interview 2 taking place approximately 6 months later. Results demonstrated that, in Interview 1, employment experts rated autistic interviewees less favourably than non-autistic interviewees. Ratings of both autistic and non-autistic participants’ answers improved in Interview 2, but particularly for autistic interviewees (such that differences between autistic and non-autistic interviewees’ performance reduced in Interview 2). Employers should be aware that adaptations to job interview questions are critical to level the playing field for autistic candidates.

Virtual Interviews at Graduate Medical Education Training Programs: Determining Evidence-Based Best Practices

The COVID-19 pandemic has had a profound impact on the nation's health care system, including on graduate medical education (GME) training programs. Traditionally, residency and fellowship training program applications involve in-person interviews conducted on-site, with only a minority of programs offering interviews remotely via a virtual platform. However, in light of the COVID-19 pandemic, it is anticipated that most interviews will be conducted virtually for the 2021 application cycle and possibly beyond. Therefore, GME training programs need to prepare for the transition to virtual interviews using evidence-based practices. At the University of California, San Francisco, a multidisciplinary task force was convened to review existing literature about virtual interviews and determine best practices. This article summarizes these findings, first discussing the advantages and disadvantages of the virtual interview format and then providing evidence-based best practices for GME training programs. Specifically, the authors make the following recommendations: develop a detailed plan for the interview process, consider using standardized interview questions, recognize and respond to potential biases that may be amplified with the virtual interview format, prepare your own trainees for virtual interviews, develop electronic materials and virtual social events to approximate the interview day, and collect data about virtual interviews at your own institution. With adequate preparation, the virtual interview experience can be high yield, positive, and equitable for both applicants and GME training programs.

Use of lexical items in job interviews by recent graduates in Malaysia

PurposeThe purpose of this paper is to explore the knowledge of lexical items in a job interview by recent graduates.Design/methodology/approachThe data were collected from one of the organisations in the Klang Valley, Malaysia. Twenty-seven recent graduates participated in the study. The structured standard interview questions were used to elicit the job interview data. The data were recorded and analysed qualitatively by using Allwood's (1999a, b, c) communicative behaviour theory.FindingsThe findings showed that the lexical items used by the interviewees varied and revealed their knowledge of lexical items in relation to these five characteristics: personality, skills, capability, experience and self-motivation. The successful interviewees reflected their knowledge of lexical items that indicated their confidence in in the job interviews. The lexical items used by the reserved interviewees were limited that displayed their personalities and reflected uncertainty and lack of confidence. The unsuccessful interviewees used limited lexical items and were vague and evasive in answering questions. This could also be not convincing enough to influence the outcome of the interviews positively.Practical implicationsThe findings of this study can assist policymakers such as officials of higher learning institutions to integrate interview workshops and mock interviews into their current curriculum as a form of preparation for undergraduates. These mock interviews can be more appropriate if experienced interviewers are utilised from the outsourcing organisations.Social implicationsIt creates an awareness for job applicants especially undergraduates after completing their studies that knowledge of lexical items are important in job interviews.Originality/valueThe use of appropriate lexical items play an important role in job interviews as they have shown that all the successful interviewees had used them to good effect in their interactions with the interviewer.

Yükseköğretim Personeline İlişkin 7100 Sayılı Kanun ile Getirilen Yeni Düzenlemelerin Öğretim Üyesi Perspektifinden Değerlendirilmesi

This study aims to find out the faculty member opinions regarding the new regulations introduced with the Higher Education Law No. 7100. It employs the phenomenological design, which is a qualitative research design. The study group consists of 44 faculty members who voluntarily participated in the research. The faculty members' opinions were collected using a form that included standardized open-ended interview questions, which were then interpreted through content analysis. The results show that although academics have positive opinions about the new academic promotion system, they find the new regulations relatively inadequate. The participants making positive comments on the new regulations think that the new academic titles have international equivalence, differences between the titles are considered, and what these titles entail is made clearer thanks to these regulations. The participants who assert negative opinions about the regulations, on the other hand, think that these changes fail to bring a satisfactory improvement since they have simply changed instructors' titles, and even caused a loss of status for them. Therefore, they argue that such a change was not necessary. While the participants consider the granting of associate professorship title by the Interuniversity Board (UAK) without performing an oral exam as a positive development, they are mostly negative about the university tenure granting policies for the holders of this title.

Preparedness for the World of Work Among Malaysian Diploma Students in a Local Institution

The purpose of this study is to investigate the use of appraisal system-attitude and cooperative solidarity principle and also the perception of interviewees and interviewer of the job interview interactions. The data was collected in one of the local education institutions in Kuala Lumpur Malaysia. There were 20 students participated in the study. Job interviews were recorded and analysed qualitatively by using appraisal system-attitude and cooperative solidarity principle theories. Semi-structured interviews as well as in-depth interview were done on the interviewees and interviewer to triangulate the study. The findings show that most of interviewees were covered the categories affect, judgment and appreciation but due to lacked English language proficiency, certain occurrences were not reflected to these categories. In relation to cooperative solidarity principle both interviewer and interviewees attribute to the interaction. The findings further reveal that most of the interviewees had difficulty in comprehending the standard interview questions and feeling nervous and anxious to answer the questions. Based on the in-depth interview with the interviewer, it was found that most of the interviewees were not able to expose to the standard interview questions and not able to understand the questions. It is hoped that the present study would be helpful for undergraduates, fresh graduates or in general job seekers as well as interviewer to carry out a smooth interaction in job interviews by having a better understanding on the standard interview questions.

Predicting Personality Using Answers to Open-Ended Interview Questions

One's personality is widely accepted as an indicator of job performance, job satisfaction and tenure intention. The ability to measure an applicant's personality in the selection process helps recruiters, hiring managers and the applicant make better hiring decisions. Our work shows that textual content of answers to standard interview questions related to past behaviour and situational judgement can be used to reliably infer personality traits. We used data from over 46,000 job applicants who completed an online chat interview that also included a personality questionnaire based on the six-factor HEXACO personality model to self-rate their personality. Using natural language processing (NLP) and machine learning methods we built a regression model to infer HEXACO trait values from textual content. We compared the performance of five different text representation methods and found that term frequency-inverse document frequency (TF-IDF) with Latent Dirichlet Allocation (LDA) topics performed the best with an average correlation of r = 0.39. As a comparison, a large study of Facebook messages based inference of Big 5 personality found an average correlation of r = 0.35 and IBM's Personality Insights service built using twitter text data reports an average correlation of r = 0.31. We further validated our model with a group of 117 volunteers who used an agreement scale of yes/no/maybe to rate the individual trait descriptors generated based on the model outcomes. On average, 87.83% of the participants agreed with the personality description given for each of the six traits. The ability of algorithms to objectively infer a candidate's personality using only the textual content of interview answers presents significant opportunities to remove the subjective biases involved in human interviewer judgement of candidate personality.

Self-reported functional status predicts post-operative outcomes in non-cardiac surgery patients with pulmonary hypertension.

BackgroundPulmonary hypertension (PHTN) is associated with increased post-procedure morbidity and mortality. Pre-procedure echocardiography (ECHO) is a widely used tool for evaluation of these patients, but its accuracy in predicting post-procedure outcomes is unproven. Self-reported exercise tolerance has not been evaluated for operative risk stratification of PHTN patients.ObjectiveWe analyzed whether self-reported exercise tolerance predicts outcomes (hospital length-of-stay [LOS], mortality and morbidity) in PHTN patients (WHO Class I–V) undergoing anesthesia and surgery.Methods and findingsWe reviewed 550 non-cardiac, non-obstetric procedures performed on 370 PHTN patients at a single institution between 2007 and 2013. All patients had cardiac ECHO documented within 1 year prior to the procedure. Pre-procedure comorbidities and ECHO data were collected. Functional status (< or ≥ 4 metabolic equivalents of task [METs]) was assigned based on responses to standard patient interview questions during the pre-anesthesia clinic visit. Multiple logistic regression was used to develop a risk score model (Pulmonary Hypertension Outcome Risk Score; PHORS) and determine its value in predicting post-procedure outcomes. In an adjusted model, functional status <4 METs was independently associated with a LOS >7 days (p < .003), as were higher ASA class (p < .002), open surgical approach (p < .002), procedure duration > 2 hours (p < .001), and the absence of systemic hypertension (p = .012). PHORS Score ≥2 was associated with an increased 30-day major complication rate (28.7% vs. 19.2%; p < 0.001) and ICU admission rate (8.6% s 2.8%; p = .007), but no statistical difference in hospital readmissions rate (17.6% vs. 14.0%; p = .29), or mortality (3.5% vs. 1.4%; p = .75). Similar ECHO findings did not further improve outcome prediction.ConclusionsPoor functional status is associated with severe PHTN and predicts increased LOS and post-procedure complications in patients with moderate to severe pulmonary hypertension with different etiologies. A risk assessment model predicts increased LOS with fair accuracy. A thorough evaluation of underlying etiologies of PHTN should be undertaken in every patient.

Risk Factors for Low Back Disorders in Saskatchewan Farmers: Fieled-based Exposure Assessment to Build a Foundation for Epidemiological Studies

BackgroundStudies of many geographical settings and agricultural commodities show that low back disorders are an important public health issue among farmers, who represent a special rural population. However, few studies have examined the impact of low back disorders on farmers’ work or the strategies that they adopt to avoid associated pain and disability.ObjectiveThis study protocol will investigate 3 issues related to low back disorders in Saskatchewan farmers: (1) the vibration, heavy lifting, and awkward postures farmers encounter during their work that might contribute to low back disorders; (2) the impact low back disorders have on farmers in terms of their ability to work; and (3) the types of preventative measures and solutions that farmers implement to reduce the occurrence of low back pain.MethodsTo answer these questions, researchers will travel to 30 farms to make measurements of vibration, lifting, and posture during the farmers’ regular work tasks. Farmers will be interviewed about any pain and/or disability using standardized interview questions. Farmers will also be asked about safety measures they have implemented at their farm, such as modified tools or equipment, to reduce the occurrence of low back disorders or pain.ResultsData collection is currently underway for this study, with the intention to complete all data collection and analysis by the end of 2018.ConclusionsOccupational determinants of health such as vibration, heavy lifting, and awkward postures are important in the development and progression of low back disorders, and the results of this study will allow for cost-effective epidemiological studies of these determinants in the future. In identifying prevention strategies, this study will also facilitate future research evaluating the effectiveness of safety measures.

Postmethod Education: Its Applicability and Challenges in Iran

The present study endeavored to unveil the perception of Iranian EFL teachers on the applicability of postmethod, also the facilitative and deterrent factors in implementing it. To fulfill the purpose of this study, after selecting 23 male and female teachers, as the quantitative phase, a piloted questionnaire was distributed among them and the results were analyzed through Chi-Square, which showed that 36% of the respondents considered incorporating the parameter of particularity into their teaching practice as ?moderately important?, and 18% regarded it as ?greatly important?. The data analysis of the importance of teacher?s active involvement in postmethod procedure showed that 37% of the respondents considered this involvement ?moderately important?, and 19% regarded it as ?very important?. Also, Descriptive analysis of the factor of possibility shows that 37% of the respondents considered following the parameter of possibility in their teaching ?rarely possible?, and 18% regarded it as ?impossible?. Also, to fulfill the qualitative phase, the participants were interviewed by some standardized structured interview questions. The analysis of the results revealed that language center and supervisors are among the facilitative factors and time limitation and students? lack of interest are among the challenges.

General surgery residency interviews: are we following best practices?

BackgroundThe interview is one of the most important factors in selecting candidates for general surgery residency. There is significant research on best practices for conducting interviews. Blinded interviews and standardized questions improve interview utility and accuracy; however, their utilization in surgical residency programs is unclear. The purpose of this study was to determine the current practices of surgery residency programs in the interview process and the application of established best practices. MethodsAn online survey consisting of 26 questions was distributed to program directors of accredited surgery residency programs in the United States and Canada. ResultsOverall, 108 responses (40%) were received. The vast majority of programs (90%) reported basing at least 25% of their final ranking on the interview score. Only 22 (20%) programs reported using some form of blinding for their interviewers. Five programs (5%) reported using standardized interview questions. ConclusionsFew residency programs use blinded interviews or standardized questions. This may indicate a gap between research findings and practice and may represent an area for improvement in the resident selection process.

Pain-QuILT

To evaluate clinical feasibility of the Pain-QuILT (previously known as the Iconic Pain Assessment Tool) from the perspective of adolescents with chronic pain and members of their interdisciplinary health team. The Pain-QuILT (PQ), a web-based tool that records the visual self-report of sensory pain in the form of time-stamped records, was directly compared with standard interview questions that were transformed to a paper-based tool. Qualitative, semi-structured interviews were used to refine the PQ. Adolescents with chronic pain aged 12 to 18 years used the PQ and comparator tool (randomized order) to self-report pain before a scheduled clinic appointment, and then took part in a semi-structured interview. The health team used these pain reports (PQ and comparator) during patient appointments, and later participated in focus group interviews. Interview audio recordings were transcribed verbatim and underwent a simple line-by-line content analysis to identify key concepts. A total of 17 adolescents and 9 health team members completed the study. All adolescents felt that the PQ was easy to use and understand. The median time required for completion of the PQ and comparator tool was 3.3 and 3.6 minutes, respectively. Overall, 15/17 (88%) of adolescents preferred the PQ to self-report their pain versus the comparator. The health team indicated that the PQ was a clinically useful tool and identified minor barriers to implementation. Consultations with adolescents and their health team indicate that the PQ is a clinically feasible tool for eliciting detailed self-report records of the sensory experience of chronic pain.

106: From Fax Machine to First Appointment: Mapping The Management of Referrals to Pediatric Sub-Specialists

Wait time reduction for outpatient appointments has been connected to reduced healthcare costs and improved patient outcomes. At the pediatric hospital where this study was performed, one key goal of the administration was to reduce wait times for pediatric sub-specialists, particularly appointments for new referrals (also known as “Wait One”). However, attempts to measure and improve these entry-level wait times were hampered by an incomplete understanding of how referrals were handled by the sub-specialist divisions. The purpose of this ethnographic study was to describe the steps by which a new referral to each of ten of the pediatric sub-specialist divisions was processed, triaged, and booked. A qualitative study using standardized open-ended interview questions was carried out with each divisional administrator involved in referrals. They were asked to describe the process they followed from ‘when the new referral hits the fax machine’ to when the machine outpatient appointment was booked. Sub-specialist physicians in charge of triaging the referrals were also interviewed to gain greater insight into the process. In addition, employees in the central booking department, which most of the sub-specialist divisions use, were interviewed. Rough time estimates for the different steps were requested, if available. The data collected were arranged into flowcharts. The managements of referrals to sub-specialists had some similarities: all 10 had successful mechanisms for funneling urgent appointments into timely appointments if necessary. However, there was variation between divisions for less urgent new referrals: 60% of divisions utilized many triage categories based on three or more priority levels, and 20% booked based on ‘see by’ time frames, in contrast to others using only urgent and non-urgent categories; 30% had new referral declination/redirection measures to reduce backlog, while others accepted virtually all referrals; 30% pooled all referrals to be distributed to any specialist in the division, while others assigned a referral to a specific physician based on the preliminary diagnosis. These flowcharts we created highlight differences and similarities between divisions for dealing with new referrals. This information is useful in guiding future data collection on Wait One times in our hospital, and this in turn will help in the design and institution of effective and feasible measures for reducing such Wait One times.