Health professions school applicant experiences of discrimination during interviews.

BACKGROUND: Bias pervades every aspect of healthcare including admissions, perpetuating the lack of diversity in the healthcare workforce. Admissions interviews may be a time when applicants to health profession education programs experience discrimination. METHODS: Between January and June 2021 we invited US and Canadian applicants to health profession education programs to complete a survey including the Everyday Discrimination Scale, adapted to ascertain experiences of discrimination during admissions interviews. We used chi-square tests and multivariable logistic regression to determine associations between identity factors and positive responses. RESULTS: Of 1115 respondents, 281 (25.2%) reported discrimination in the interview process. Individuals with lower socioeconomic status (OR: 1.78, 95% CI [1.26, 2.52], p = 0.001) and non-native English speakers (OR: 1.76, 95% CI [1.08, 2.87], p = 0.02) were significantly more likely to experience discrimination. Half of those experiencing discrimination (139, or 49.6%) did nothing in response, though 44 (15.7%) reported the incident anonymously and 10 (3.6%) reported directly to the institution where it happened. CONCLUSIONS: Reports of discrimination are common among HPE applicants. Reforms at the interviewer- (e.g. avoiding questions about family planning) and institution-level (e.g. presenting institutional efforts to promote health equity) are needed to decrease the incidence and mitigate the impact of such events.

US Medical School Applicant Experiences of Bias on the Interview Trail.

BACKGROUND: U.S. medical schools have been unsuccessful in creating a diverse physician workforce. Implicit bias is pervasive in medicine, including potentially in medical school admissions. METHODS: We invited all 2018-2019 interviewees at one U.S. medical school to complete the eight-item Everyday Discrimination Scale (EDS) asking about experiences of bias during interview experiences to date. RESULTS: Three hundred forty-seven (30%) of 1,175 interviewees completed the survey, with participant demographic characteristics matching those of the broader interviewee pool. Seventy-two (21%) responded affirmatively to one or more EDS items. Gender, age, race, religion, and sexual orientation were all sources of discrimination. Those reporting bias had completed more interviews (5.2 vs. 3.9, P<.05) and were more likely to be Latinx (30.6% vs. 16.4%, P<.05) than their counterparts. Only three (4%) reported the incident to the institution where it occurred. CONCLUSION: Further work exploring experiences of bias during medical school admissions and how to decrease their frequency is warranted.

Commentary: criminal background checks for entering medical students: history, current issues, and future considerations.

In this commentary, the authors aim to contextualize the history and rationale for what has become the Association of American Medical Colleges-facilitated criminal background check process for entering medical students. As the process was being considered, many issues with a standardized process were identified. There were concerns that demographic or socioeconomic factors might unfairly burden certain applicants or discourage them from applying to medical school. On the other hand, a unified, national program would minimize cost and enhance quality assurance. The authors discuss these issues. Lessons learned in the first three years of the program are also addressed, including some unexpected and favorable consequences such as the identification of accepted applicants with at-risk behaviors (e.g., substance abuse), who would have otherwise gone undetected. Several challenges remain, including the fact that the criminal background check process creates an enhanced role for prehealth advisors and encourages undergraduate institutions to establish standards and processes relating to professionalism. While this is, no doubt, an evolving program which needs continued oversight and ongoing reevaluation, the authors support the continued advancement of the criminal background check process for entering medical students.