Blog Archives

Implicit Bias in Medical School Admissions

I participated in a great Harvard Medical School webinar on implicit bias in medicine with cardiologist Dr. Quinn Capers IV, who is a dean at UT Southwestern Medical School. Dr. Capers has published work documenting racial and gender bias in medical school admissions, among other realms. He has also published recommendations on how clinicians and medical educators can mitigate implicit bias in patient care and candidate selection

In the webinar, Dr. Capers covered strategies to reduce or neutralize implicit bias, including 

1. Common identify formation – Ask interviewee questions about interests and activities that you share in common.

2. Perspective taking – Take the perspective of a member of the group against which you have unconscious bias.

3. Consider the opposite – When data seem to point to one conclusion, briefly look for information supporting the opposite conclusion before making a final decision.

4. Counter stereotypical exemplars – Spend time with or focus on individuals you admire from groups against which you have a bias.

Dr. Capers described providing an implicit bias “cheat sheet” that included these strategies to medical school interviewers at The Ohio State College of Medicine, where he previously worked. If you have a chance to hear a lecture by Dr. Capers, make sure to grab the opportunity.

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Five ERAS Platform Quirks to Heed

I’ve been editing a lot of ERASes lately. Let’s briefly cover five quirks of the ERAS platform to help you get through the drafting process. The ERAS platform…

  1. Does not support italics. While journal articles and some phrases (e.g. “summa cum laude”) should be italicized, don’t be surprised when you can’t. 
  2. Prompts you for a supervisor for each activity. In some cases, you simply may not have one, but whenever you can, name someone. A name validates the experience.
  3. Prompts you for average hours per week for each activity. It can be difficult to calculate this number for certain experiences, especially those that are intermittent, but it’s worth making your best estimate rather than leaving the question blank. 
  4. Offers space to include a “reason for leaving” for each activity. Don’t skip this section, but keep your answers brief. 
  5. Limits you to 1020 characters for experiences, 510 for the interruption in medical training section, and 510 for each of the awards sections. Be aware of these limits as you write, so you are not furiously cutting later. 

For tips on how to craft your ERAS, check out this short blog entry. 
Contact me for help with this weird and wild process. 

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Your Residency Application: What Do Program Directors Really Want?

Imagine that you’re a program director (PD) going through scores of ERASes and interviews. What questions would you ask yourself as you assessed each residency candidate to avoid big headaches?

1) Can this person do the job? Is s/he competent?

2) Will this person “play well with others” and not create complaints from patients, faculty, or other services.

3) Will this person stick with the program and not leave prematurely? A PD does not want to scurry around to fill an open call schedule/ residency slot.

As you approach your interviews, consider how you can demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extra curricular activities that demonstrate teamwork, and – if asked – hobbies and reading materials that demonstrate your personality. For the latter, highlight research projects in the specialty, sub-internships, and knowledge about the program and city. 

Making sure the PD knows you are not going to cause him/her trouble is at least half the battle.

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How the Show ER and New Residency Programs Change the Economy of a Specialty

Here’s an interesting piece called “Are There Too Many Emergency Physicians?” by Thomas Cook MD, an emergency medicine program director. Dr. Cook chronicles the growth of emergency medicine residency positions from a total of 1821 in 2015 to 2488 in 2019. This rapid growth in the field may lead to an oversupply of emergency physicians.

The paradox here is that only recently there was a shortage of emergency physicians. And back when I graduated from medical school in the mid-1990s, almost no one was applying for emergency medicine. In my class of around 150 students, there were three of us. As the popularity of the show “ER” waxed, the number of applicants to the field swelled. Then, years later, the field contracted again. 

Other fields have also recently seen a boom in the number of residency spots, including family medicine, psychiatry, and anesthesiology. Of course, opening up more residency positions is a good thing for medical students (especially international medical graduates) and patients, but the growth in certain fields may lead to a change in the economy of those specialties. It will be an interesting experiment.

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The Week I Spent 138 Hours in the Hospital

During my internship, on my surgical rotation, I once spent 138 hours in the hospital in one week. If you think this isn’t mathematically possible, I will tell you that I was on call from Monday morning to Tuesday evening, from Wednesday morning to Thursday evening, in-house on Friday, and then on call from Saturday morning until the next Monday morning. (I had to stay in-house that Monday until evening rounds were over too.) As you can imagine, I was barely human by the end. How this schedule was good for patient care is beyond me.

I thought of that ghastly time recently when reading this article in the New York Times called “How Job Stress Can Age Us” written by Dr. Dhruv Khullar. The author reports on a study, “Physician-Training Stress and Accelerated Cellular Aging” that assessed the DNA of 250 first-year medical residents around the country. Researchers examined the saliva samples of these residents, focusing on their telomeres – the bumpers at chromosome ends that prevent DNA damage – before and after the first year of residency. Researchers found that the DNA of first-year residents aged six times faster than normal.

Six times faster.

I found this both shocking, upsetting, and validating. Residency training is as hard as we think it is. 

What I would strongly recommend is that you compare residency programs’ hours before you create your Match list. Strangely, many applicants don’t even consider this important issue when making decisions about their next three to five years. Also, many residencies support physician wellness programs and night coverage. Especially in the setting of severe burnout among doctors, your happiness should be a primary factor in your career choices. If you’re not sure, consider your shrinking telomeres. 

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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