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Interviewed while Black | NEJM


Inside a conference room with a long wooden table, a black residency applicant sat next to 12 other applicants on the day of the interview. None of his companions were Black. Across the table hung photos of faculty members, including the program director, medical director and department head. Nobody was black. In the corner of the room, administrators and coordinators were monitoring the agenda. Nobody was black. Rosters with descriptions and headshots of faculty interviewers were distributed. Nobody was black. Later, the residents spoke to the applicants at lunch, and the nurses sat at their chores during the tour. Nobody was black.

During the day of the interview, the Black applicant was asked if they were lost and twice considered an applicant for someone else. He was told that he had an unusual name and was outspoken. His hair was mixed.

At the end of the interview, the black applicant wondered, “Am I fit here?”

We believe that it is time for reviewers to discuss the ways in which different aspects of the interview day affect black applicants at the student, resident, fellow, and faculty levels. Although the application process involves several components, the interview day is a solid opportunity to determine compatibility between the applicant and the program. According to a 2018 National Resident Matching Program survey, the factors most considered important by program directors for ranking applicants are “interaction with faculty during interviews and travel” (96%), “interpersonal skills” (95%) , And “interacting with in-house staff during interviews and travel” (91%). There are personal advisors, textbooks, online resources and workshops that help applicants improve their interviewing skills and programs in their recruitment efforts. Helps to maximize success. Despite the resources available for interview preparation, there is a clear and implicit bias in the application processes that favor white applicants. This bias, along with the importance of the interview day, is what blacks Makes it necessary to explore interview experiences while being.

Concepts and experiences of Black applicants during interviews.

Five percent of physicians and 7.3% of medical students matriculated in the 2019–2020 school year, despite the fact that black people make up 13.4% of the US population. In 2019, the Accreditation Council for Graduate Medical Education issued a statement giving priority to the recruitment and training of members of racial and ethnic groups who are presented in medicine. Although there are many concerns that widely affect Black people in medicine, such as institutional racism and inequality of educational opportunities, there is especially pressure on the experience of Black interviewers. During Black’s interview, microaggression and emotion confrontation and stereotype threat, tokenism, imposter syndrome, and homophily-related experiences (see The table). Many of these experiences are rooted in unconscious bias, while some may arise from extremism. In return, Black interviewers collect impressions that make them suspect they will be welcomed and valued in medicine.

Black students have reported to knowingly or unknowingly experience hostile or rudeness – behavior, comments, or questions during medical training.1 In one study, more than half of medical students experienced microaggression.1 The impact of micro-progress on the applicant’s performance is profound, and such experiences may adversely affect a black applicant’s chances of passing matriculation in a program or hiring in a department. During an interview, comments and behaviors may be microorganisms based on bias, racism, or stereotypes.

Fear of being an experience or stereotype may reduce a black applicant’s ability to perform during an interview. Stereotype threat was defined by Claude Steele and Joshua Aronson in 1995 as “the risk of affirming one’s own character, a negative stereotype about one’s group.” In historical research, Steele and Aaronsson demonstrated that Black participants performed worse than White participants during a trial when they believed they were at risk for meeting stereotypes about Black people’s intellectual abilities. When that stereotype threat was removed, Black participants performed similarly to their White counterparts. Stereotype threat has been found to exist in medicine. In a 2020 study of medical students, 82% of black respondents had higher scores of stereotype threat, compared to 4% of white respondents.2 When black applicants see only pictures of non-black graduates on the walls, they may feel a threat of negative stereotypes, such as “black people don’t get smart” and perform worse than expected.

Another challenge confronting Black interviewers is Importer Syndrome. In 1978, Pauline Kleins described Imposter Syndrome as “an internal experience of intellectual loneliness among people who are not considered intelligent, capable or creative despite evidence of high achievement”. The study revealed feelings of imposter syndrome in up to 82% of students, with minorities and women reporting such feelings at a higher rate than white men.3 Imposter syndrome can make eligible black applicants feel disqualified and isolated.

A sense of isolation can lead to black applicants, who often interview without any other black applicants, questioning the sincerity of their recruitment and interview opportunity. Tokenism emphasizes cursory progress towards diversity and inclusion. The recruitment of black candidates reduces the applicant’s educational value to obtain only one metric and dismisses the difficulty associated with navigating medicine as a member of a minority group. An awareness of tokenism and the ways that it can lead to depression, burnout, attrition and minority tax – additional responsibility on lower minority tax with the goal of achieving diversity – begins as early as interview day .4 A clear demonstration of efforts to recruit, retain, support, and promote Black applicants better reflects their dedication to diversity in medicine.

Finally, it is widely recognized that people connect with others and move towards people whose backgrounds and interests are similar to their own.5 This phenomenon called homophily increases the restlessness and isolation of black applicants. The concept of homophily was popularized in 1954 by Paul Lazarsfeld and Robert Merton. While the tendency to socialize with people like yourself creates opportunities for positive, lasting relationships, homophili may exclude applicants based on differences.

The academic world is often isolated to Black applicants, and the lack of inclusion is complicated for Black women, Black immigrants, and Black lesbian, gay, bisexual, transgender, and Qatar applicants. Leaders in educational medicine should be cognizant of the identity of black applicants, as they are not a monolithic group; They have personal identities and experiences associated with varying degrees of harassment and discrimination.

During the Kovid-19 epidemic, as programs and departments transition to video interviews, many have discussed the potential effects of bias on applicants from underrepresented groups. It is unrealistic to expect intense subliminal bias and systemic racism to be eliminated by a switch to virtual interviews.

Several strategies can improve interviewing experiences of Black applicants. First, educational leaders must acknowledge that inequitable treatment of Black applicants exists and will take time to correct. Second, everyone involved in the interview process from host institutions should be educated about microaggression, stereotype threat and other challenges and prejudices that harm Black applicants. We recommend Understander and Opposite Training to prepare people to be a witness to discrimination, prejudice or racism. Third, we favor the careful and appropriate recruitment of diverse interviewers to create a welcoming environment. We also suggest incorporating work related to diversity and inclusion when describing the mission and values ​​of the program or institution. On a broader scale, we recommend the creation of an institutional database – or, ideally, a national database – where applicants can report experiences of racism or prejudice during interviews, which will be collected to protect their identities . Improving the experiences of Black applicants will be the first step toward increasing the diversity of programs and subsequently meeting the needs of the diverse patient population they serve.

During this interview cycle, there will be no conference room with a long wooden table. We still challenge programs to address the concerns of the black applicant, who wonders, “Am I fit here?”



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