"Time-In": A Tool for Interrupting Bias in Medical School Admissions Committee Meetings

Abstract

Problem: During high-stakes committee meetings, bias is often expressed but goes uninterrupted because there is no formal structure to interrupt it. Bias impacts decision making and can further disadvantage those from backgrounds that have been marginalized.

Approach: The MD and MD-PhD admissions committees at the Icahn School of Medicine at Mount Sinai in NY in the 2020-2021 admissions season introduced a "Time-In" tool to interrupt bias during committee meetings. This study aimed to evaluate the impact of implementing the "Time-In" tool on committee members' perception of bias as a problem and the likelihood of committee members recognizing, reporting, discussing, and educating others about bias after implementation.

Outcomes: There were 117 responses to the pre- and postseason surveys. In aggregate, respondents reported a statistically significant reduction in the perception of bias in the admissions process from preseason to postseason. There was no change in the likelihood of committee members in aggregate endorsing comfort in recognizing, reporting, discussing, and educating about bias; however, notable gaps existed in the comfort of groups discussing bias publicly, i.e., respondents who are from backgrounds underrepresented in science and medicine, students, and new committee members were less comfortable than their comparators. By the postseason survey, these gaps were closed.

Next steps: Implementing a "time-in" allows for interruption of bias, with an impact of reducing the perception of bias, empowering individuals, and reducing gaps among groups to discuss bias publicly. A "time-in" can profoundly impact decision-making bodies that are critical gatekeepers to the composition of the physician workforce. Future directions will focus on enhancing committee members' skills in educating others about bias.

Figure 1

Timeline of “Time-In” tool incorporation, Icahn School of Medicine at Mount Sinai. The process began with the introduction of the BTF in September 2019, recording expressions of bias. Abbreviation: BTF, bias tracking form.

Figure 2

Responses to pre- and postseason surveys regarding use of the “Time-In” tool to diffuse bias at admissions committee meetings, Icahn School of Medicine at Mount Sinai. 2A. Respondents were asked to score their agreement with the statements regarding bias and responses to bias. 2B. Respondents were asked to score their agreement with the statements indicated; subgroup summaries are shown. Responses are based on a Likert scale (1–5, 1 = strongly disagree, 5 = strongly agree). A Mann–Whitney U test was used to compare Likert score averages between indicated groups. Abbreviations: URiSM, underrepresented in science and medicine; ns, not significant. ^aAsterisks indicate statistical significance: ***P < .01; **P < .02; *P < .01.

Figure 3

“Time-In” implementation scheme. Stage 1: training the committee, including unconscious bias training and how biases have historically impacted this committee’s decision making. Stage 2: reinforcing the tool’s use, regular reintroductions at each meeting, and role modeling by leadership. Stage 3: uptake and collaboration by committee members. Stage 4: tracking bias through use of the BTF. Stage 5: reviewing entries to the BTF. Stage 6: refining and planning training using examples from the BTF, leading to stage 1 of the following admissions cycle. Abbreviation: BTF, bias tracking form.