Swipe right for surgical residency: Exploring the unconscious bias in resident selection

Background: Applicants provide a photo with their application through the Electronic Residency Application Service, which may introduce appearance-based bias. We evaluated whether an unconscious appearance bias exists in surgical resident selection. Methods: After the match, applicant data from the 2018 to 2019 and 2019 to 2020 application cycles were examined. Reviewers were not provided the applicant photo or self-identified race during the second cycle. Photos provided by candidates were then rated by 4 surgical subspecialty residents who had no prior exposure to applications or interview status. Photos were rated on perceived fitness level, visual appearance, and photo professionalism. An overall photo score was then calculated. Results: In the study, 422 applications were reviewed and 164 received interview invitations during the 2018 to 2019 cycle. Alpha Omega Alpha membership (odds ratio, 2.31; 95% confidence interval, 1.18–4.51), overall photo score (odds ratio, 2.29, 95% confidence interval, 1.43–3.66), research (odds ratio, 5.61, 95% confidence interval, 2.84–11.20), age (odds ratio, 0.86, 95% confidence interval, 0.76–0.99), and step 2 (odds ratio, 1.06, 95% confidence interval, 1.03–1.09) were predictors for receiving an interview. For the 2019 to 2020 cycle, 398 applications were reviewed, and 75 applicants received an invitation. Step 2 (odds ratio, 1.07, 95% confidence interval, 1.02–1.12), research (odds ratio, 2.78, 95% confidence interval, 1.40–5.55), age (odds ratio, 0.82, 95% confidence interval, 0.71–0.95), and overall photo score (odds ratio, 2.27; 95% confidence interval, 1.14–4.52) remained predictors despite reviewers being blinded to the photo during this cycle. Conclusion: Although objective metrics remain critical in determining interview invitations, overall perceived applicant appearance may influence the selection process. Although visual appearance was associated with receiving an interview, the Electronic Residency Application Service photo does not ultimately affect selection. This may suggest that appearance may influence other objective and subjective aspects of the application.