Health professions school applicant experiences of discrimination during interviews

Abstract

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.

Keywords:

• Medical education
• interviews
• workforce
• diversity
• bias

Disclosure statement

We undertook this study in conjunction with an author from Altus Assessments, in order to utilize their list of applicants to health professions education program applicants from the United States and Canada for this study. To avoid the potential of bias, with review and approval from our Institutional Review Board, the author from Altus Assessments was given no access to raw data and was not involved in data analysis. We are happy to answer more questions about the steps we took to avoid bias while conducting this study in conjunction with a staff member from Altus Assessments.

Glossary

Microaggression: Brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional.

Additional information

Notes on contributors

Avik Chatterjee

Avik Chatterjee, MD, MPH, is an Assistant Professor at Boston Medical Center and Boston University School of Medicine and a physician at Boston Health Care for the Homeless Program. 801 Massachusetts Ave, Boston, MA 02118. [email protected]. 781-221-6565. Twitter: @AvikChatterMD

Spencer Dunleavy

Spencer Dunleavy, MSc, MSc, is a medical student at Columbia Vagelos College of Physicians and Surgeons. 630 W 168^th St, New York, NY 10032. [email protected].

Tiffany Gonzalez

Tiffany Gonzalez is a student at Harvard College. 86 Brattle St, Cambridge, MA 02138. [email protected].

Jalen Benson

Jalen Benson is a student at Harvard Medical School. 25 Shattuck St, Boston, MA 02115. [email protected].

Lori Henault

Lori Henault is a Project Director in the Section of General Internal Medicine, Department of Internal Medicine, at Boston University School of Medicine. 801 Massachusetts Ave, Boston, MA 02118. [email protected].

Alexander MacIntosh

Alexander MacIntosh, PhD is a Scientist and Manager of Research Partnerships at Altus Assessments. 325 Front St W, 2nd Fl, Toronto, Ontario M5V2Y1, Canada. [email protected].

Kristen Goodell

Kristen Goodell, MD is Associate Dean for Admissions and Assistant Professor of Family Medicine at Boston University School of Medicine. 72 E Concord St, Boston, MA 02118. [email protected].

Robert Witzburg

Robert Witzburg, MD, is Professor of Medicine, Emeritus at Boston University School of Medicine and served as Admissions Dean for 16 years. 72 E Concord St, Boston, MA 02118. [email protected].

Michael Paasche-Orlow

Michael Paasche-Orlow, MD, MA, MPH is Professor of Medicine at Boston Medical Center and Boston University School of Medicine. 801 Massachusetts Ave, Boston, MA 02118. [email protected].