Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive?

Published online

Journal Article

PURPOSE: To evaluate for appearance-based discrimination in the selection of radiology residents. METHOD: A deception study simulating the resident selection process to examine the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from five academic radiology departments reviewed mock residency applications in September and October 2017. Applications included demographic information and photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed and random effects models. RESULTS: Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive versus unattractive, B = 0.30 [SE = 0.056]; neutral versus unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (versus not obese) (B = -0.14 [SE = 0.024]). CONCLUSIONS: Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.

Full Text

Duke Authors

Cited Authors

  • Maxfield, CM; Thorpe, MP; Desser, TS; Heitkamp, DE; Hull, NC; Johnson, KS; Koontz, NA; Mlady, GW; Welch, TJ; Grimm, LJ

Published Date

  • May 28, 2019

Published In

PubMed ID

  • 31149924

Pubmed Central ID

  • 31149924

Electronic International Standard Serial Number (EISSN)

  • 1938-808X

Digital Object Identifier (DOI)

  • 10.1097/ACM.0000000000002813

Language

  • eng

Conference Location

  • United States