Program Name: Family Medicine Residency Program - Alvernon
Program Director: Jessie Pettit, MD, IBCLC
Algorithm for Holistic Review
Over the past 8 years, our program has refined our process of holistic application review and interviewing; for the past 3 years, we have used a values-based rubric to select applicants, and a blinded interview process.
Our values-based rubric was designed to select the ideal applicant to our program: a leader with a deep commitment to working with underserved populations. The scoring system minimizes test scores, medical school performance, and letters of recommendation which are all subject to bias (1-4), and focuses on the experiences described on the applicant’s CV and in their personal statement. Applicants who speak a language spoken by patients of our family medicine clinic receive bonus points based on the degree of fluency, given that language concordance between medical providers and patients leads to better health outcomes (5).
Applicants chosen to interview have met our program’s minimal academic criteria. The interview, therefore, is to explore applicants’ experiences and aspirations. Interviewers are provided with the applicants’ CV and personal statement to provide a background for this discussion, and to reduce bias that may come with including the other pieces of the application.
Working with diverse and underserved populations has been a key tenet of our residency program since the early 1970s. In the past decade, we have refined our understanding of diversity and inclusion and continue to grow in this understanding and our actions to live out this core value.
As a family medicine residency program that serves many minoritized patient populations, our goal is to reduce health care disparities in our residency clinic as measured by various preventive health and chronic disease metrics including cancer screenings and control of blood pressure and diabetes. To accomplish this goal, we must first recruit a diverse cohort of residents and faculty, and create and maintain an environment that provides equitable growth and support to our learners and faculty (a topic for another spotlight!).
Our residents appreciate that our program is constantly learning from its mistakes and evolving to improve the resident experience. One of our recent graduates, Dr. Iman Ahmed, described her experience in our program in an email to our leaders.
“Hi Dr Pettit and Dr Elliott,
As I reflect and digest the events of the last couple of weeks, I wanted to share something with you. There is alot of negativity in the world right now and I wanted to highlight something positive. Growing up in Minnesota, I didn't know or ever saw any physicians who were POC. I didn't think I had a chance of becoming a physician until I met woman from a program called Minnesota Future Doctors (similar to the Pathway Program at the U of A).
According to the AAMC, of all the active physicians in this country: 56.2% identify as white, 17.1% identify as Asian, 5.8% identify as Hispanic, and 5.0% identify as Black, (other: 13.7%). Keeping this in mind, among our current 24 residents at Alvernon, we represent (my estimate):
-Races: White (41.6%), Black (20.8%), Asian (20.8%), Hispanic (16.6%)
-Religions: Christianity, Islam and Judaism
-Languages: English, Spanish, Somali, Bengali, Urdu/Punjabi, Haitian Creole, Mandarin, Farsi, French (54% of the residents speak a second language)
I've always been a firm believer that representation matters. TO BE REPRESENTED IS TO BE SEEN and boy do we paint a beautiful picture. Thank you for leading a program that recruits bright, well rounded physicians from all walks of life, who I hope will be leaders of tomorrow. I've said this before and I'll say it again, I AM INCREDIBLY PROUD OF THIS PROGRAM!! I hope our program continues to value diversity, not just among our residents, but among the faculty and support staff as well. May we always be leaders and in the forefront fighting for equality!
Love always,
Iman M. Ahmed”
Rubric -
The rubric was sent across the FM PD listserv to give credit where it is due, and some pearls of wisdom with implementation:
Our then Associate Program Director Taiwona Elliott—now Program Director at Duke/Southern Regional AHEC Family Medicine Residency—and I created this values-based rubric with our chief residents (Erica Gadzik and Christine Chan) a few years ago.
My program manager Kelsey Gender, whose mentor is Bobbi Kruse at UMN Medical Center Residency Program, was urging us to use this framework—Bobbi has presented on this annually at the AAFP’s Resident Program Solutions for a few years.
I recommend creating yours and validating it with past applicants, especially those who may have struggled with board exams but became leaders in your program, as well as training everyone who will use it to do so in the same way.
Thanks!
Jessie Pettit, MD, IBCLC
Associate Professor
Residency Program Director
University of Arizona Family Medicine Residency Program
References:
1. Powers A, Gerull KM, Rothman R, Klein SA, Wright RW, Dy CJ. Race- and Gender-Based Differences in Descriptions of Applicants in the Letters of Recommendation for Orthopaedic Surgery Residency. JB JS Open Access. 2020;5(3):e20.00023-e20.00023. Published 2020 Jun 26.
2. Naples R, French JC, Lipman JM. Best Practices in Letters of Recommendation for General Surgery Residency: Results of Expert Stakeholder Focus Groups [published online ahead of print, 2020 Jul 7]. J Surg Educ. 2020;S1931-7204(20)30229-4. doi:10.1016/j.jsurg.2020.06.036
3. Lin F, Oh SK, Gordon LK, Pineles SL, Rosenberg JB, Tsui I. Gender-based differences in letters of recommendation written for ophthalmology residency applicants. BMC Med Educ. 2019;19(1):476. Published 2019 Dec 30. doi:10.1186/s12909-019-1910-6
4. Miller DT, McCarthy DM, Fant AL, Li-Sauerwine S, Ali A, Kontrick AV. The Standardized Letter of Evaluation Narrative: Differences in Language Use by Gender. West J Emerg Med. 2019;20(6):948-956. Published 2019 Oct 17. doi:10.5811/westjem.2019.9.44307
5. Ngo-Metzger Q, Sorkin DH, Phillips RS, et al. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med. 2007;22 Suppl 2(Suppl 2):324-330. doi:10.1007/s11606-007-0340-z