Linear Modeling to Reduce Bias in Plastic Surgery Residency Selection.

BACKGROUND: Consistently selecting successful, productive applicants from an annual candidate pool is the goal of all resident selection practices. Efforts to routinely identify high-quality applicants involve scrutiny of multiple factors and formulation of an ordinal rank list. Linear modeling offers a quantified approach to applicant selection that is strongly supported by decades of psychological research. METHODS: For the 2019 residency application process, the University of Wisconsin Plastic Surgery Residency Program used linear modeling in their evaluation and ranking process. A linear model was developed using United States Medical Licensing Examination Step 1 and Step 2 scores, letters of recommendation, publications, and extracurricular activities as inputs. RESULTS: The applicant's total score was calculated from a maximum total score of 100. The mean and median scores were 49 and 48, respectively, and applicants were ranked according to total score. A separate rank list was maintained using our program's standard methodology for applicant ranking, which involves global intuitive scoring during the interview process. The Spearman rank correlation coefficient between the two lists was 0.532, and differences between the rank lists were used as a fulcrum for discussion before making the final rank list. CONCLUSIONS: This article presents the first known instance of the use of linear modeling to improve consistency, increase fairness, and decrease bias in the plastic surgery residency selection process. Transparent sharing of methodology may be useful to other programs seeking to optimize their own ranking methodology. Furthermore, it indicates to applicants that they are being evaluated based on fair, quantifiable criteria.

The burden of service for faculty of color to achieve diversity and inclusion: the minority tax.

The exclusion of Blacks/African-Americans, Latinx/Hispanics, and Indigenous people from science has resulted in their underrepresentation in the biomedical workforce, especially in academia. Faculty diversity at academic institutions is unacceptably low (<6%) and has remained unchanged in the past 20 years. Despite low representation, faculty of color are disproportionately tasked with service to enhance diversity and inclusion of the academy, often to the detriment of their research and academic success. This essay offers a perspective on the undue burden of service placed on underrepresented faculty to achieve institutional diversity and inclusion. I reflect on the challenges that faculty of color face trying to maintain a competitive research program while serving the needs of the academy, often in a capacity greater than that of their well-represented peers. I also discuss opportunities for faculty of color to leverage related diversity and inclusion work to boost their career progression and academic advancement.

Diversity through equity and inclusion: The responsibility belongs to all of us.

Despite the recognized benefits of diversity and the decades of programs targeted at increasing diversity in science, technology, engineering, mathematics, and medicine, the underrepresentation of historically excluded groups continues due to persisting systemic inequalities. It is imperative that we reassess our current recruitment strategies and reimagine our campus and workplace environments to provide an inclusive and equitable culture that is free of institutional barriers, affording equal opportunities for each individual to succeed, thrive, and be their whole self. For too long this vision has been the fight of a heroic few, but it must become the fight of all in order to achieve true change. I am working toward, and look forward to, a future where contributing to diversity, equity, and inclusion is fully integrated into the core mission of our institutions and is an expectation for all of us.

Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire.

WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code's principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code's principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.

Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?

BACKGROUND: The gender disparity between the number of female and male chairs and program directors has been previously established. The aim of this study was to determine whether any differences in objective credentials existed between male and female plastic surgery department chairs/division chiefs and program directors. METHODS: Information about each plastic surgery program director and chair/chief was extracted from the websites of all institutions affiliated with a plastic surgery residency program. For each individual, information about the length of their career, number of fellowships completed, and number of publications was recorded. The two-tailed t test was used to compare differences between male and female chairs and program directors. RESULTS: A total of 99 chairs were recorded, of which nine (9.1 percent) were female. Of the 99 program directors, 13 (13.1 percent) were female. There was no difference in the number of years in practice or number of fellowships between men and women for either position. On average, male chairs had significantly fewer publications than female chairs (71.9 versus 128; p < 0.05). There was no significant difference in the number of publications between male and female program directors. Compared to program directors, chairs had significantly more years in practice and numbers of publications, which held true for both men and women. CONCLUSIONS: Women are not only underrepresented in the department chair and program director positions, but also possess higher qualifications that may reflect differences in standards for promotion and appointment. Additional research is needed to elucidate the reasons behind the observed differences in qualifications.

Comparing demographics of signatories to public letters on diversity in the mathematical sciences.

In its December 2019 edition, the Notices of the American Mathematical Society published an essay critical of the use of diversity statements in academic hiring. The publication of this essay prompted many responses, including three public letters circulated within the mathematical sciences community. Each letter was signed by hundreds of people and was published online, also by the American Mathematical Society. We report on a study of the signatories' demographics, which we infer using a crowdsourcing approach. Letter A highlights diversity and social justice. The pool of signatories contains relatively more individuals inferred to be women and/or members of underrepresented ethnic groups. Moreover, this pool is diverse with respect to the levels of professional security and types of academic institutions represented. Letter B does not comment on diversity, but rather, asks for discussion and debate. This letter was signed by a strong majority of individuals inferred to be white men in professionally secure positions at highly research intensive universities. Letter C speaks out specifically against diversity statements, calling them "a mistake," and claiming that their usage during early stages of faculty hiring "diminishes mathematical achievement." Individuals who signed both Letters B and C, that is, signatories who both privilege debate and oppose diversity statements, are overwhelmingly inferred to be tenured white men at highly research intensive universities. Our empirical results are consistent with theories of power drawn from the social sciences.

Promoting anti-corruption, transparency and accountability in the recruitment and promotion of health workers to safeguard health outcomes.

Background: Human Resources for Health are a core building block of a health system, playing a crucial role in improving health outcomes. While the existing literature has examined various forms of corruption that affect the health sector, few articles have examined the role and impact of corruption in the recruitment and promotion of health-workers.Objectives: This study reviews the role of corrupt practices such as nepotism, bribery and sextortion in health-worker recruitment and promotion and their implications for health systems.Methods: The study is based on an interdisciplinary non-systematic review of peer-reviewed journal articles in the public health/medicine and political science literature, complemented with the 'grey' literature such as technical reports and working papers.Results: Political and personal ties, rather than merit are often factors in the recruitment and promotion of health-workers in many countries. This results in the employment or promotion of poorly qualified or unsuitable workers, with negative implications for health outcomes.Conclusion: Corrupt practices in health-worker recruitment and promotion 'set the tone' for other forms of corruption such as absenteeism, embezzlement, theft and bid-rigging to flourish, as those recruited corruptly can collude for nefarious purposes. On the other hand, merit-based recruitment is important for curbing corruption. Corrupt recruitment practices have deleterious effects on health-worker motivation and retention, quality and competency, citizens' trust in health services and health outcomes. Whereas international law and policy such as the United Nations Convention Against Corruption and the WHO Handbook on Monitoring and Evaluation of Human Resources for Health state that recruitment of public officers and health workers respectively should be done in a transparent and accountable manner, more research is needed to inform policies on merit-based recruitment.

Rosalinda Dimapilis-Baldoz: balancing domestic and international needs for health workers.

Rosalinda Dimapilis-Baldoz talks to Fiona Fleck about the health worker migration policy of the Philippines and discusses the challenges faced by the WHO Global code of practice on the international recruitment of health personnel.

The Presence of Gender Bias in Letters of Recommendations Written for Urology Residency Applicants.

OBJECTIVE: To determine whether implicit gender bias exists in the urology residency application process, we compared linguistic differences in letters of recommendation (LOR) submitted for male and female applicants. METHODS: LOR were abstracted from residency applications to a urology residency program. Linguistic Inquiry and Word Count, a validated text analysis software program, characterized the linguistic content of the letters. Analyzed letters were compared according to gender of the applicant using multivariable analysis, examining the association of applicant gender, letter writer, and letter characteristics. Multivariable analysis was also performed to determine the association of letter characteristics with matching into a urology residency. RESULTS: Of 460 letters evaluated, letters for male applicants are written in a more authentic tone compared to letters written for female applicants. Letters written for male applicants contain significantly more references to personal drive, work, and power than letters written for female applicants. Significant differences are maintained on multivariable analysis when controlling for race and Step 1 score of the applicant. Letters with references to power were significantly more likely to be associated with an applicant who matched into urology than an applicant who didn't match. CONCLUSION: Significant linguistic differences exist among LOR written for men and women applying into urology, suggesting that gender bias may permeate resident recruitment. These differences may affect the likelihood of women matching into urology.

Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive?

PURPOSE: To evaluate for appearance-based discrimination in the selection of radiology residents. METHOD: A deception study simulating the resident selection process examined the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from 5 academic radiology departments reviewed mock residency applications in September and October 2017. Each application included demographic information and a photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed- and random-effects models. RESULTS: Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive vs unattractive, B = 0.30 [SE = 0.056]; neutral vs unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (vs not obese) (B = -0.14 [SE = 0.024]). CONCLUSIONS: Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.

Overlapping surgeries: defining the 'critical portions' of the procedure.

INTRODUCTION: An important aspect of overlapping surgery is to determine the 'critical portion' of an operation. Currently, there are no guidelines that standardize the critical portions of common urologic procedures. We sought to determine the relationship between the critical portions of common urologic operations as defined by the primary surgeon compared to the trainee at a single academic medical center. MATERIALS AND METHODS: In an open-ended survey of the Urology Department at Thomas Jefferson University, attending surgeons and urology residents, were asked to list five of their most commonly performed surgeries and subsequently identify what they defined as the critical portion for each. Responses were examined for surgeon-trainee congruence. Response agreement was defined as identifying key words that provided reasonable evidence that the responders were referring to identical portions of the case. RESULTS: Nine residents and eight attending physicians provided 67 and 63 responses, respectively, encompassing 28 different procedures. Six procedures were chosen for further analysis based on high volume of responses. Overall, of the 67 resident-reported critical portions, 32 (47.8%) were in agreement with attending-reported critical portions. Year of training in residency was not a predictor of surgeon-trainee agreement. CONCLUSION: External pressures from the public and lawmakers alike may demand that providers be present during all 'critical portions' of a procedure. Our study shows that the understanding of critical portions of an operation is often incongruent between surgeons and trainees. Critical portions of all procedures should be established by the surgical team in order to accurately schedule overlapping surgeries.