Selection into physician training ‘an inexact process’

medical education

By Siobhan Calafiore

20 Apr 2023

Selection processes for basic physician training are inconsistent and “evidence-sparse”, with some practices favoured by training sites suggestive of bias and even nepotism, Australian researchers say.

They anonymously surveyed 70 education directors from training sites across Australia and New Zealand in January and February last year to create a snapshot of the current practices used to select trainees.

They noted that while the RACP was responsible for overseeing the three-year training program, it was not directly involved in recruiting candidates.

Just over half (56%) of the education directors who responded to the survey were from an adult medicine training site, 16% were from a paediatric site and 28% were from a site that offered both types of training.

All but four sites reported having a formal selection process, which, for most, heavily relied on candidate interviews and character references.

Respondents had varying opinions of selection tools, with some regarding cover letters as “generic and repetitive” and impressive CVs or interviews as an unreliable predictor of the candidate’s ability to succeed in training.

There were also mixed views on the usefulness of referee reports and the way in which they were delivered, from written responses to phone calls and in-person, as well as the preferred traits of the “ideal” recruit.

An enthusiasm for and commitment to training was the most frequently cited attribute, but wasn’t mentioned in more than one-third of responses.

“There was no consensus regarding the optimal selection process or the most desirable candidate qualities. Furthermore, while there were some shared challenges, others were site-specific,” wrote Dr Anna Grosse and Associate Professor Josephine Thomas in the Internal Medicine Journal [link here].

The influence of location

The University of Adelaide researchers said some inconsistencies could be attributed to differences in trainee supply and demand between the sites, noting more “regimented selection processes may be required when competition is high”.

One training site reported in the free text response: “[We have difficulty with] overcoming the perception that the urban centres offer higher quality training, higher pass marks in exams and job opportunities following training. [We also have difficulty with] minimising the last minute resignations that occur in the last week of any academic year as people accept offers elsewhere.”

Other challenges faced included shortages of time and manpower, given that many selection processes depended on doctors making themselves available.

The researchers said the variability of reported practices, the reliance on subjective assessments, and discrepancies between the success rates of internal and external applicants all raised concerns about bias.

One respondent cited a 90-95% success rate for candidates who were already employed at their site, despite having 250 applicants for 28 positions, the researchers noted.

“That candidates’ reputations were sometimes valued as highly as, or more highly than, other objective measures of merit could be considered prejudicial. Likewise, the higher success rates reported for internal over external candidates insinuates institutional nepotism,” they said.

“‘Embracing diversity’ is a key principle in the RACP’s training selection policy, yet some of the practices that we have identified may be actively discouraging it.

“Bias… is not only detrimental to unsuccessful applicants but has the potential to threaten the diversity of health services and the broader medical workforce.”

While they conceded there was likely no “one-size-fits-all” approach to selection, they called for further research into the various methods to establish best practice.

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