Virtual Brunches to Enhance Recruitment of Residents and Fellows Who Self-Identify as Underrepresented in Medicine

The Accreditation Council for Graduate Medical Education (ACGME) supports efforts to recruit and retain a more diverse workforce, given the crucial value that a diverse group of physicians brings to medical care.^1,2  To diversify the physician workforce, institutions and programs implemented interventions, including holistic review of applicants, mentorship, mission-driven recruitment, and development of diversity, equity, and inclusion (DEI) committees.^3,4  Little is known if graduate medical education (GME)-wide recruiting events are an effective method for underrepresented in medicine (UIM) trainee recruitment.

To address the racial and ethnic discordance between physicians and patients, our sponsoring institution implemented Virtual UIM Recruitment Diversity Brunches (VURDBs) as a novel approach to enhance diversity among our resident and fellow workforce. To the best of our knowledge, our study is a novel UIM recruitment strategy, and we based our intervention on prior experiences with a few departments. We hypothesized that VURDBs would increase the number of UIM trainees matriculating to our institution.

This study was conducted within the UPMC GME department, which oversees more than 150 residency and fellowship programs including 1500 trainees across Pennsylvania.

Our VURDBs were created and first implemented in fall 2020 by the GME DEI subcommittee. The brunches provided an open forum with applicants about our current state of need and highlighted our DEI initiatives. In prior years our departments of medicine, psychiatry, and pediatrics hosted in-person optional brunches for UIM applicants scheduled to interview in their respective programs. In 2020-2021, in response to the COVID-19 pandemic, the in-person brunches were adapted to a virtual format and broadened to include all our GME programs such that every UIM applicant receiving an interview was invited. Our program used the Association of American Medical Colleges' definition of UIM: “those racial and ethnic populations underrepresented in the medical profession relative to their numbers in the general population.”⁵ 

We received feedback and suggestions through an anonymous, 5-question, post-event survey sent to each attendee directly after each brunch. UPMC GME office leadership, including the designated institutional official (DIO) and vice chair of DEI, developed the current structure by modifying the agenda and content based on feedback received, and corrected initial technical issues by creating program-specific virtual breakout rooms.

For fall 2021, our program consisted of each virtual brunch beginning with introductions from organizational diversity leadership, including a welcome by the DIO. Following the welcome and introductions, we provided a didactic session on health inequality in our region and a presentation of several local initiatives to enhance equity and retention. Following this 30-minute didactic session, we featured a video of minority-owned local businesses and local cultural offerings. Lastly, applicants attended specialty-based breakout sessions attended by individual program leadership and current trainees from various programs. Individual program leaders spoke briefly about their efforts to enhance diversity, cultivate an inclusive environment, and promote health equity, followed by a question-and-answer session for applicants. In the 2021-2022 recruitment season, 116 UPMC representatives, including 80 faculty physicians, 28 residents, and 8 fellows from 34 different programs representing 16 specialties, attended the events. We did not require that faculty or trainee representatives were UIM; instead, we invited representatives without specification of race or ethnicity hoping to convey cohesion and allyship while also making this project more feasible for smaller training programs with few or no UIM physicians. To organize and host 6 brunches (2 hours/each), staff spent a total of 31 hours, including 12 hours of email correspondence and 4 hours of creating presentations. Food was not provided for the brunches.

Participants were emailed a program evaluation survey via Microsoft Teams, created by GME leaders, immediately after each brunch concluded on the same day. We asked participants to rate the event with a Likert scale 1-4 (1=fair, 4=excellent) and also choose the likelihood of recommending the event to a colleague using a Likert scale 1-4 (1=not at all, 4=extremely). The GME staff accessed UIM trainee status data and compared it to prior years using a 2-sample test of proportions with STATA analysis to compare percentage of new UIM trainee hires between the pre- and post-implementation periods.

This study was conducted as program evaluation and did not constitute human subject research, thus institutional review board (IRB) oversight was not required by the University of Pittsburgh IRB.

Between September 2021 and January 2022, we hosted 6 virtual UIM recruitment brunches. A total of 280 applicants attended our events out of 503 applicants who initially RSVPed. The November 14 brunch was the most attended (Table 1). We received 137 completed surveys from brunch participants for a response rate of 48.9% (137 of 280). Of the survey respondents, 57.7% (79 of 137) rated the program as excellent (4), and 94.2% (129 of 137) were extremely likely (4) or very likely (3) to recommend the event via a Likert scale 1-4 (Table 2). The mean scores were 3.5 and 3.4 (SD 1.0), respectively.

The percentages of UIM applicants in 2021-2022 and 2022-2023 recruitment seasons were 18.0% (6298 of 34 974) and 17.9% (6320 of 35 316), respectively. The percentage of new UIM resident and fellow hires significantly increased from 10.9% (67 of 612; 95% CI 8.4-13.3) in academic year 2021-2022 to 15.4% (104 of 675; 95% CI 12.7-18.1) in academic year 2022-2023 (absolute difference of 4.5%; 95% CI 0.8-8.2; P=.017). Overall, the percentage of brunch attendees who matriculated into our programs in academic year 2022-2023 was 7.9% (22 of 280).

VURDBs were associated with a statistically significant increase in the percentage of UIM trainees matriculating to our GME programs. We have demonstrated this GME-wide recruiting event to be a feasible and effective intervention program to enhance recruitment of a more diverse physician workforce. In addition, VURDBs were well-received from applicants, with the majority rating the event as “excellent” and “good” and would recommend to their colleagues. Although dedicated GME staff are necessary to coordinate with various programs, this program is an innovative and low-cost implementation to diversify a sponsoring institution's physician workforce.

While this intervention is associated with an increase in diversity in academic year 2022-2023, this intervention was done in parallel with several other interventions. Specifically, our sponsoring institution educated on mitigating bias in residency selection, holistic review of applicants, and mission-driven recruitment, along with implementing similar measures to also enhance diversity in the faculty. Determining the relative impact of each intervention is challenging. This program could have unintended negative consequences. Specifically, UIM applicants may feel obliged to accept such invitations, while non-UIM applicants feel less compelled to attend diversity brunches, thus creating additional time demands for UIM applicants. However, implementing intentionally targeted recruiting events tailored to UIM trainees is a potential tool to convey institutional commitment to DEI. It also highlights program attributes that may be meaningful to UIM applicants.

VURDBs are a feasible intervention associated with increased matriculation rates of UIM trainees into our GME programs.

The authors would like to thank all the program directors, program coordinators, core faculty, residents, and fellows who participated along with special gratitude to Dr. Naudia Jonassaint, Dr. Loreta Matheo, Dr. Elizabeth Miller, Dr. Nicholas Szoko, and Ms. Val Chavis for creating a dynamic program for the brunches; Jacqueline Hudson in the Office of Graduate Medical Education who coordinated the diversity brunches with all applicants; and Dr. Christian Martin-Gill in the Department of Emergency Medicine who assisted statistical analysis.