Perspectives and Preferences of Underrepresented in Emergency Medicine Resident Applicants: A Qualitative Study

Background: Increasing racial and ethnic diversity of the physician workforce has been a goal for emergency medicine (EM). Limited studies have focused on the perspective of underrepresented in medicine (URiM) trainees in this endeavor. We sought to explore the URiM trainee experiences across multiple EM residency programs regarding the EM residency application process and describe URiM perspectives, residency selection habits, and preferences creating a rank list for EM residencies. Methods: This qualitative study using a phenomenological approach was conducted at four academic EM programs in 2023. We recruited participants through both convenience and purposive sampling via e-mails and announcements at residency didactics. Self-identified URiM residents participated in individual semi-structured interviews focused on EM residency application experiences, participant preferences, and URiM recruitment efforts. Via a deductive-inductive approach, we coded deidentified transcripts with predetermined areas of interest in addition to new codes that arose after iterative review of transcripts. Two authors coded subsequent interviews with conflicts resolved through consensus discussion. The team identified and refined themes during a series of team meetings. Results: Eighteen residents from four sites participated in the study. Fourteen identified as Black, 3 as Latinx, and 1 as Latinx/Afro-Caribbean. Sixteen identified as female and two as male. Thematic saturation was reached after seven interviews, indicating adequate sample size. Three themes emerged: (1) applicants prioritized environments of identity safety, both in their identities as learners and URiM individuals, (2) applicants sought URiM representation among faculty who could be mentors and role models, and (3) while applicants noted structured programming for URiMs trainees, they valued speaking with URiM trainees in organic settings such as socials and individual conversations. Conclusions: Participants valued representation and hearing directly from other URiM trainees during the application process. Best practices should highlight opportunities to hear about the URiM experience.