• Elizabeth Harkin, Michael Murphy, Tomas Liskutin, Lukas Nystrom, Karen Wu, and Adam Schiff.
• Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
• Postgrad Med J. 2021 Jun 1; 97 (1148): 355-362.

BackgroundThe National Resident Matching Program (NRMP) policy requires interview officials to refrain from asking illegal or coercive questions that may introduce discrimination; however, compliance is insufficient.MethodAn Institutional Review Board-approved 12 question survey was distributed to 130 allopathic medical schools with 551 responses from 18 187 students applying in the 2015-2016 residency match. In addition, a 16-question survey was distributed through residency coordinators to residency programme interviewers with 481 responses from 21 of 22 residency specialities.ResultsDiscriminatory topics were frequently discussed across all specialities. Surgical interviews were significantly more likely to discuss age (relative risk (RR) 2.0, p<0.01) and gender (RR 2.7, p<0.01) during formal interviews. More-competitive specialities more frequently discussed age (RR 1.9, p<0.01) and gender (RR 2.0, p<0.01) during the formal interview, and gender (RR 1.4, p<0.05) during informal interview events. 47.8% of interviewers discussed potentially coercive topics during the interview, 57.5% considered these topics when evaluating candidates and 72.6% had misunderstandings. Interviewers given both oral and written instruction showed the greatest effect change towards discussing coercive topics (p<0.01) and correctly identifying non-discriminatory and discriminatory topics (p<0.01). While age and gender both constitute discriminatory topics, each of these topics is included in the majority of written The Electronic Residency Application System applications (85.5% and 89.8%, respectively).ConclusionsIn modern recruitment where differential attainment is of interest, the presence of such explicit discrimination is worrisome. Formal interview training might reduce discrimination, but more active overnight is needed and a zero-tolerance approach to overt discrimination should be the ambition.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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