Implementation of a Holistic Review Pipeline for Radiation Oncology Residency Applicants: A Test Case Evaluating Gender Equity

• Published in: International journal of radiation oncology, biology, physics Vol. 120; no. 2; pp. e702 - e703
• Main Authors: Liu, E.Y., Nash, D.L., Savjani, R.R., Courtney, P.T., Rose, K., Steinberg, M.L., Xiang, M., Raldow, A., Venkat, P.S.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2024
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2024.07.1543

Gender disparity persists in US Radiation Oncology (RO) residency programs. Although the proportion of female applicants to RO has increased over the past two years, a substantial gender gap remains apparent in leadership positions. Efforts on both national and organizational levels have been intensified to promote diversity and inclusion, yet a more thorough examination of equity within the residency training pathway is crucial. The purpose of this study is to introduce a holistic review tool and pipeline for practical use during residency recruitment to facilitate consistency amongst reviewers and ensure comprehensive assessment. Gender outcomes from one residency application season serve as a test case for the tool's use. While holistic application review has been a staple at our institution, the proposed tool seeks to balance this evaluation across multiple reviewers, to ensure that each measure of the applicant is taken into careful consideration, and to quantify the evaluation for equitable comparison. Life experiences that may affect opportunities for development as a physician are taken into account. This evaluates non-academic factors such as inherent systemic bias due to underrepresentation in medicine, economic disadvantage, disabilities, and other such circumstances. Initial screening was performed by both clinical “first pass” stakeholders and by members of the Department's Equity, Diversity, and Inclusion (EDI) Committee. Applicants selected to interview were then evaluated by 7 interview groups spanning research and clinical faculty, as well as collaborative multidisciplinary staff, with a similar scoring tool. For the particular year studied, 48.6% of the applicants interviewed identified as female, and 51.3% as male. The average total score using the holistic review tool across all female interviewees was not found to be significantly different (p = 0.076) from that of male interviewees. The score given for life circumstances was also not significantly different by gender (p = 0.837). The scores given by the EDI committee and “first pass” screeners were compared to scores given by interviewers; the average pre-interview score was not significantly different by gender (p = 0.886) and the difference in score from pre- to post-interview was not significantly different by gender (p = 0.224). There was thus no significant difference in scoring between female and male interviewees at all levels of this tool's implementation. We demonstrate here a holistic review pipeline that can be utilized by residency program stakeholders to mitigate fluctuating differences in scoring amongst evaluators. Gender differences were highlighted here as a test case of the tool; this holistic approach may help increase the representation of female physicians in the RO workforce and the gradual improvement of disparities in leadership positions. Future work will highlight the tool's use in improving racial and socioeconomic diversity.