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Improving Program Transparency in Dermatology

A recent study found both applicants to dermatology residency programs and program directors believe there needs to be more transparency between residency programs and applicants. Study authors, Kristin Nord, MD, and Justin Jia discuss their findings and share recommendations for programs to consider including on their websites to increase information transparency.

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Dr Nord is a clinical professor of dermatology and residency program director at Stanford University.

Mr Jia is a medical student at Stanford University School of Medicine.


Dr Kristen Nord:  My name is Kristen Nord. I'm Clinical Professor of Dermatology at Stanford as well as a clinical staff physician at the Palo Alto VA Healthcare System.

Today, we'll be talking about our study, "Improving Information Transparency Between Dermatology Residency Programs and Trainees," a report from the Association of Professors of Dermatology Work Group on Transparency, and one of my co‑authors will introduce himself.

Dr Justin Jia:  Hello, everybody. My name is Justin Jia. I'm a medical student at the Stanford School of Medicine, and I work with Dr Nord on a number of medical education projects, including this one on transparency.

Dr Nord:  When we think about this particular study, it's probably good to think about it as a small piece of a broader effort that came to be at the fall 2019 meeting for the Association of Professors of Dermatology. At this meeting each year, academic dermatologists come together and talk about topics that are challenges that we're all facing.

At the fall 2019 meeting, we all found ourselves talking about topics that had come up the year before and the year before that related to residency training and making the process for residency recruitment equitable, improving diversity in our specialty, improving pipelining.

The suggestion was made that perhaps we need a task force to look into this, a task force of residency program directors who can use their collective experience to not just talk about but actually move the needle and be more solution‑oriented in this regard.

In early 2020, as the pandemic was evolving, we also were able to pull together a program director task force of 37 program directors from around the country who represent large programs and small programs in each geographic area.

Then we were subdivided into seven work groups. One of the work groups was on residency transparency. I was a member of this work group, along with five of our co‑authors. At our first small group meeting, we got together to think about what does residency transparency mean, what are the downstream effects of residency transparency, and how can we improve this.

The more we talked about it, it was clear that we need to improve transparency. We need to make sure that applicants know information about our programs that's up to date and accurate so that they can determine which programs to apply to.

That can have, actually, effect for the programs as well so that they get applicants who are sincerely interested in their programs applying and maybe a decreased number of applications.

The more we talked, we realized that we are such a small group of individuals. We don't really have all of the perspectives, so we needed to really reach out and get information from the key stakeholders in this topic.

Those are the applicants themselves, medical students interested in applying to dermatology, as well as people who were recent applicants and matched in dermatology, like dermatology residents and interns who've matched in dermatology, and then the program perspective.

We were a group of six program directors, but we don't represent the views and experiences of all program directors. There's 144 ACGME‑approved dermatology programs in the country.

That was sort of the idea behind this project, was to survey these groups about what they felt were important pieces of information to be shared from programs to applicants and then where should that be shared. Where do applicants tend to go to get this information about residency programs? From the program director perspective, what are the barriers to providing this transparency?

We also decided that even in the design of the study and the design of the survey, we didn't want to be biased in that way. We quickly realized we should invite some of those stakeholders to be a part of the research team. We invited three medical students who we had worked with on other projects to be a part of it. Justin is one of those students.

It was so helpful to have their input from the very beginning, in terms of study design and what questions should be asked, all the way through to analysis and writing up the publication. I will then turn it over to Justin to talk a little bit more about what we found.

Dr Jia:  Absolutely. In the study, we actually received 500 responses between program directors and trainees, which was so wonderful to see how excited and interested people were on this topic.

What we found was that there was a lot of agreement between program directors and trainees about the topic of transparency. Both groups highlighted that there really needs to be a almost revolutionary change in terms of pushing information transparency forward, especially on program websites, on social media and other forms of areas where students and applicants access information.

In terms of particular areas that needed improved transparency, both groups highlighted board score cutoffs as well as application requirements and special considerations of particular applicant groups as specific areas.

Faculty members also reported that the largest barrier for improved transparency was simply a lack of standardized guidelines on what information should be shared, which we thought was particularly noteworthy and something that we're working on right now.

I think our most important and most surprising finding was that over 40 percent of residents who had already spent time in their residency programs reported that they would have changed their rank lists if programs had been more transparent, especially transparent on information regarding call schedules, research opportunities, and elective opportunities.

This was statistic that stood out to us, in particular because it demonstrates and highlights why information transparency is so important in the application process for applicants but also for residents once they match the programs.

Dr Nord:  I will echo what Justin highlighted as something that really was very informative for us, that these residents who have already matched into a dermatology program, who offered this hindsight view of "Had I had more information at the outset, when I was making my rank list, would I have done it differently? Because now I'm at this program, and I may know more now than I did then."

That number, as Justin said, was really very surprising to us, that so many, nearly half of residents who responded to the survey, felt that they would have changed their rank list with more information.

We presented that at the July Association of Professors of Dermatology meeting, as well as sharing it in the publication because we feel like it really highlights how important information is to creating that sense of good fit. That is the goal, really, for information transparency, is to create a good fit for the resident to thrive and become the dermatologist they want to be.

Also, it reflects on the program because if the program has a resident who is thriving, then the others are probably going to be thriving. It's kind of a trickle‑down effect to the entire health and well‑being of your residency program to have people who want to be there and are feeling like they are primed to succeed there.

Teamwork is such a critical element of the residency experience, so you really want to make sure you are thinking about the collective experience as well as the individual experience of all of the residents in your program.

Dr Jia:  As Dr Nord mentioned, information transparency plays such a huge role in not only the application process but also the wellness and experiences of the residents once they arrive at the residency program. When there's a good match between expectations and experiences of residents, I think it can really improve resident satisfaction and fit within each program.

On the applicant side ‑‑ Dr Nord alluded to this ‑‑ a lot of applicants are applying to 100 or even 144 programs at a time, which can be really resource‑intensive for programs to review all of these applications and make decisions on who to interview, who to invite, and so on.

With the sheer volume of applications, student applicants may also not be identifying what makes a particular program a good fit for themselves.

I think with better information transparency, hopefully we can not only decrease the overall number of applications each program has to review and read but also allow for applicants to be more selective and intentional with the programs that they might be applying to.

Zooming out a little bit and thinking about applications this cycle in the context of COVID, where applicants are unable to interview in person at programs and thus are more reliant on information that they glean from program websites, there's an even greater need for programs to be transparent about this information.

Call schedules, electives, research opportunities, faculty members who they may be interested in working with, all of this information will hopefully allow for a student to make a good fit with the programs that they're interested in.

I think in a way, COVID‑19 has almost forced us to change and adapt. Thus we have an opportunity to improve transparency for the better and for future cycles.

Dr Nord:  I completely agree, Justin. I feel like COVID‑19 has also forced us to address the fact that while we aren't able to do resident rotations or outside rotations right now, students sometimes are thinking that they're going to go to an institution to learn more about it and get the pieces of information that we've been referring to already today.

If we can provide that information up front in some way to applicants and students on our websites, that will also help level the playing field overall, again, taking that bigger picture, broader lens, thinking about the future, about how not every applicant or student is able to take the time or of that financial burden of doing an away rotation.

By being more transparent at the outset and providing as much information as we can about what it's like to be a resident in our programs, we are able to, again, level that playing field and make it a fairer experience for everyone with transparency. A lot of the change needs to come from the residency programs.

In response to the results that showed that the largest barrier to transparency from the program director perspective was a lack of guidelines on what information should be shared, the work group put together a standardized list of recommendations of what information, at the bare minimum, programs should consider sharing on their websites.

Information like who the faculty are or if you have cutoffs, specifically any requirements that would make it that an applicant would not be considered for a position in your program, should be out there for the applicant to be aware so that they don't put forth effort and finances towards applying to a program where they won't be considered.

We felt that we had a responsibility to share this information with all of the program directors. We first did so through the APD program director listserv, but then we realized that there were 60 programs that were not represented on that listserv, of the 144 ACGME‑approved programs.

We actually sent emails to those program directors or program contacts through the ACGME website. We were able to reach every single program through this way in the last six weeks so that everyone has the information and hopefully can make some changes to their website for this year and, if not for this year, then at least maybe for future years.

The seed has been planted to improve the information and update the information so that it's as transparent as possible.

Dr Jia:  We're so excited that there's been so much interest in our work. Hopefully, we hope that this will catalyze a broader conversation in our field and in others about information transparency and equity in the match process. Thank you so much for inviting and having us on "The Dermatologist."

Dr Nord:  Yes. Thank you, on behalf of ourselves and all of our co‑authors, for your interest in this topic.

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