Is Beauty in the Eye of the Beholder? Differences in Residency Training Program Preferences Among Women and Minorities.

INTRODUCTION: Training programs are now more than ever seeking ways to promote recruitment and retention of a diverse resident workforce. The goal of this study was to examine how gender and ethnic identities affect applicant attraction to surgery training programs. METHODS: Applicants to general surgery residency in 2018 to 2019 completed a 31-item assessment measuring preferences for training program characteristics and attributes. Differences in preferences across candidate gender and ethnicity were investigated. Factor analyses and analysis of variance (ANOVA) were used to explore these differences. RESULTS: 1491 unique applicants to 7 residency programs completed the assessment, representing 67% of all applicants to general surgery during the 2018 to 2019 season. Women preferred training programs that had high levels of social support (p < 0.001), were less traditional (p < 0.001), and with less turbulence (p < 0.05). Non-white candidates reported greater preference for programs with higher levels of established academics (p < 0.001), clinical experiences (p < 0.001), social support (p < 0.05), traditionalism (p < 0.001), flexibility (p < 0.001), and innovation (p < 0.001). CONCLUSIONS: Organizational efforts to attract and retain a diverse workforce may benefit from considering the aspects of work that align with female and underrepresented minority preferences.

An Examination of Burnout Predictors: Understanding the Influence of Job Attitudes and Environment.

Burnout amongst healthcare employees is considered an epidemic; prior research indicates a host of associated negative consequences, though more research is needed to understand the predictors of burnout across healthcare employees. All employees in a cancer-focused academic healthcare institution were invited to participate in a bi-annual online confidential employee survey. A 72% response rate yielded 9979 complete responses. Participants completed demographic items, a validated single-item measure of burnout, and items measuring eight employee job attitudes toward their jobs and organization (agility, development, alignment, leadership, trust, resources, safety, and teamwork). Department-level characteristics, turnover, and vacancy were calculated for group level analyses. A univariate F test revealed differences in burnout level by department type (F (3, 9827) = 54.35, p < 0.05) and post hoc Scheffe's tests showed employees in clinical departments reported more burnout than other departments. Hierarchical multiple regression revealed that employee demographic and job-related variables (including department type) explained 8% of the variance of burnout (F (19, 7880) = 37.95, p < 0.001), and employee job attitudes explained an additional 27% of the variance of burnout (F (8, 7872) = 393.18, p < 0.001). Relative weights analysis at the group level showed that, of the constructs measured, alignment is the strongest predictor of burnout, followed by trust and leadership. The relationships are inverse in nature, such that more alignment is related to less burnout. Turnover and vacancy rates did not predict group level burnout. The results reported here provide evidence supporting a shift in the focus of research and practice from detection to prevention of employee burnout and from individual-focused interventions to organization-wide interventions to prevent burnout.

Can Better Selection Tools Help Us Achieve Our Diversity Goals in Postgraduate Medical Education? Comparing Use of USMLE Step 1 Scores and Situational Judgment Tests at 7 Surgical Residencies.

PURPOSE: Use of the United States Medical Licensing Examination (USMLE) for residency selection has been criticized for its inability to predict clinical performance and potential bias against underrepresented minorities (URMs). This study explored the impact of altering traditional USMLE cutoffs and adopting more evidence-based applicant screening tools on inclusion of URMs in the surgical residency selection process. METHOD: Multimethod job analyses were conducted at 7 U.S. general surgical residency programs during the 2018-2019 application cycle to gather validity evidence for developing selection assessments. Unique situational judgment tests (SJTs) and scoring algorithms were created to assess applicant competencies and fit. Programs lowered their traditional USMLE Step 1 cutoffs and invited candidates to take their unique SJT. URM status (woman, racial/ethnic minority) of candidates who would have been considered for interview using traditional USMLE Step 1 cutoffs was compared with the candidate pool considered based on SJT performance. RESULTS: A total of 2,742 general surgery applicants were invited to take an online SJT by at least 1 of the 7 programs. Approximately 35% of applicants who were invited to take the SJT would not have met traditional USMLE Step 1 cutoffs. Comparison of USMLE-driven versus SJT-driven assessment results demonstrated statistically different percentages of URMs recommended, and including the SJT allowed an average of 8% more URMs offered an interview invitation (P < .01). CONCLUSIONS: Reliance on USMLE Step 1 as a primary screening tool precludes URMs from being considered for residency positions at higher rate than non-URMs. Developing screening tools to measure a wider array of candidate competencies can help create a more equitable surgical workforce.

Great Expectations? Future Competency Requirements Among Candidates Entering Surgery Training.

INTRODUCTION: We describe a multimethod, multi-institutional approach documenting future competencies required for entry into surgery training. METHODS: Five residency programs involved in a statewide collaborative each provided 12 to 15 subject matter experts (SMEs) to participate. These SMEs participated in a 1-hour semistructured interview with organizational psychologists to discuss program culture and expectations, and rated the importance of 20 core competencies derived from the literature for candidates entering general surgery training within the next 3 to 5 years (1 = importance decreases significantly; 3 = importance stays the same; 5 = importance increases significantly). RESULTS: Seventy-three SMEs across 5 programs were interviewed (77% faculty; 23% resident). All competencies were rated to be more important in the next 3 to 5 years, with team orientation (3.87 ± 0.81), communication (3.82 ± 0.79), team leadership (3.81 ± 0.82), feedback receptivity (3.79 ± 0.76), and professionalism (3.76 ± 0.89) rated most highly. CONCLUSIONS: These findings suggest that the competencies desired and required among future surgery residents are likely to change in the near future.

If You Build It, Will They Come? Candidate Completion of Preinterview Screening Assessments.

INTRODUCTION: Residency applicant screening practices are inefficient and costly. However, programs may not consider using alternative assessments for fear that candidates will be "turned off" by additional hurdles in the application process. This study explores the relationship between candidate completion of preinterview screening assessments, applicant examination scores, and program factors. METHODS: Applicants to any of 7 general surgery residency programs were invited to take a preinterview online assessment. Program characteristics and applicant United States Medical Licensing Exams scores were considered in relation to each program's assessment completion rate. RESULTS: A total of 2960 applicants were invited to take the assessment and 97% (2870/2960) completed it. Program completion rates ranged from 95% to 98%. There was no correlation between program characteristics and applicant completion rates. Candidates who did not complete the assessment had significantly lower United States Medical Licensing Exams scores. CONCLUSIONS: Incorporating preinterview assessments to objectively measure candidate competencies and fit will not detract applicants from a general surgery program.