SHARPening Residency Selection: Implementing a Systematic Holistic Application Review Process.

PROBLEM: Traditional metrics used in residency application review processes are systematically biased against applicants from minoritized communities that are underrepresented in medicine (URiM). These biases harm not just URiM applicants but also residency programs and patients. Although several residency programs have implemented holistic reviews to mitigate these biases, few tested tools exist that can be adapted and implemented in a wide variety of settings within academic medicine. APPROACH: This article describes advances made in the third year of a longitudinal, ongoing quality improvement project that used the A3 framework to improve recruitment of URiM residents to a family medicine residency program. The authors devised a systematic holistic application review process (SHARP) to determine which applicants to invite to interview with the program. SHARP's development began in August 2019, and after significant discussion with program leadership and iterations of rubric refinement, the program adopted SHARP in September 2020 to review applications for the 2021 application cycle. OUTCOMES: Compared with the 2016 to 2020 period before SHARP implementation, data from the 2021 and 2022 residency application cycles after SHARP implementation showed a significant increase in the proportion of interviewed candidates who identify as URiM (from 23% to 38%, P < .001) and matched candidates who identify as URiM (from 27% to 62%, P = .004). There was also a notable increase in the number and diversity of reviewers who evaluated applicants to the program. NEXT STEPS: SHARP is a promising tool to mitigate the effects of racism and other biases against URiM applicants to residency programs. Residency programs across specialties may benefit from adopting SHARP and adapting it based on their own goals and priorities.

Community Health Needs Assessment as a Teaching Tool in a Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Community-based primary care is a fundamental concept taught in family medicine. Best practices for community-oriented and public health training in medical training programs are underreported in the published literature. A Community Health Needs Assessment (CHNA) offers an opportunity for family medicine residents to practice research and evaluation skills while learning about public health and the community they serve. METHODS: A family medicine residency program in Harlem, NY, conducted a CHNA in order to assess their community's health landscape and as an opportunity to teach the resident trainees research skills. Primary and secondary data were collected by the residents using public databases, surveys, focus groups, and key informant interviews. Residents completed a survey at the project's completion to assess their experience with the CHNA and to obtain suggestions for improving the process in the future. RESULTS: More than 50% of the 15 residents surveyed reported that the CHNA greatly improved their comfort level speaking to patients about social factors that affect their health. Participants responded that they valued the opportunity to engage with community members and to understand their patients on a population level. The greatest challenge for most residents was lack of devoted time to complete the project considering competing residency responsibilities. CONCLUSIONS: Conducting a CHNA in a primary care training program can help the next generation of family physicians become culturally competent and community focused in their work.