Underrepresented in medicine in graduate medical education: Historical trends, bias, and recruitment practices

Health inequities disproportionately impact children of color in the United States. Research demonstrates that a diverse physician workforce that reflects the demographic profile of the United States population has been associated with better health outcomes and physicians of color are more likely to work in communities that are medically underserved. Therefore, a key driver to reducing health inequities is recruiting a physician workforce that reflects the racial/ethnic composition of the population. Although efforts on increasing UIM applicants and matriculants into medical school and more recently, graduate medical education (GME) programs have shown some small successes, there has still not been significant change in decades. This narrative review examined the historical trends and current landscape of recruitment in GME to better understand the barriers and facilitators that continue to exist and identify successful interventions that might serve as a model to support recruitment of UIM applicants. There is evidence for racial disparities and bias in traditional residency selection metrics (USMLE, Clerkship Evaluations, MSPE, AOA status, etc.) and a need for more holistic recruitment strategies. Along with implementing new holistic recruitment practices, there is a need for ongoing research and collaboration to study inclusive and equitable learning environments and assessments that will eliminate racial disparities in educational outcomes. Additionally, there must be better longitudinal data utilization and transparency across Electronic Residency Application Services (ERAS) and National Resident Matching Program (NRMP) for accountability and tracking of interventions.