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The effect of implicit racial bias in residency applicant selection

Purpose: To determine if preference for white over Asian and Black applicants exists in the evaluation of Ob/Gyn residency program applicants.


Background: Medical trainees from minoritized backgrounds often face higher rates of negative evaluations compared to their white counterparts.


Methods: Randomized subjects received Survey A or B with four contrived ERAS profiles, stratified by USMLE scores, educational institutions, and recommendation letter strength into top, middle, and low tiers, with different names and races. Survey A’s applicants were: white top-tier, white mid-tier without hardship, Asian mid-tier with hardship, and white low-tier. Survey B contained: Black top-tier, Asian mid-tier without hardship, white mid-tier with hardship, and white low-tier. Primary outcome was applicant ranking from most to least desirable. Subjects’ baseline characteristics were compared with chi-square tests or Fisher’s exact tests where appropriate. Rankings between groups were compared with two-sample Z-tests of proportions.


Results: 93 subjects completed the surveys (A: n=46, B: n=47). Subjects included 37 Ob/Gyn residents, 18 fellows, and 40 attendings; 82 were female, and 14 male. Both survey respondent groups were demographically similar. The white top-tier candidate was ranked highest by 89.1%, while the Black counterpart was ranked highest by 66% (p< 0.008). The white mid-tier candidate with hardship was ranked higher by 66.0% of subjects while the Asian counterpart was ranked higher only by 39.1% (p=0.010).


Discussions: Despite the exact same qualifications, a stronger preference for white applicants over Black or Asian applicants was found. This bias could act as a barrier for minoritized applicants in applying to Ob/Gyn residency.

Topics: CREOG & APGO Annual Meeting, 2022, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, Advocacy,

General Information

Student,Resident,Faculty,Clerkship Director,Clerkship Coordinator,Residency Director,Residency Coordinator,
Professionalism,Interpersonal & Communication Skills,
Clinical Focus

Author Information

Thammatat Vorawandthanachai, BA, Albert Einstein College of Medicine; Calvin Lambert, MD; David Flomenbaum, BS; Francine Hughes, MD

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