Evaluating situational judgment test use and diversity in admissions at a southern US medical school

Chelsea E. Gustafson; Crystal J. Johnson; Gary L. Beck Dallaghan; O’Rese J. Knight; Kimberly M. Malloy; Kimberley R. Nichols; Lisa Rahangdale

doi:10.1371/journal.pone.0280205

Peer Review History

Original SubmissionJune 21, 2022
1 Sep 2022 Decision Letter - Yaser Mohammed Al-Worafi, Editor PONE-D-22-17727Evaluating situational judgment test use and diversity in admissions at a southern US medical schoolPLOS ONE Dear Dr. Beck Dallaghan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript before Oct 16 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a fairly straightforward assessment of the CASPer test and whether this is a non-biased metric for minimizing bias in admissions for American medical schools. Results are important as data suggests that Black or African-American, Native American or Alaskan Native, and Hispanic applicants all had lower scores than other groups of applicants suggesting that this test may not be an accurate assessment of reducing bias in admissions. A few items should be added for clarity to the report. 1. Clarity on how this new data fits into the wholistic review of applicants is needed in the discussion. Expansion of this point is needed from what is currently in the report. 2. Is there any bias in forcing applicants to simply take the CASPer test that could have resulted in lower scores? 3. More information on the specifics of the CASper test could be added to the methods. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. 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Revision 1
15 Sep 2022 Author Response PONE-D-22-17727: Evaluating situational judgment test use and diversity in admissions at a southern US medical school Response to Reviewers Thank you for the opportunity to revise and resubmit our manuscript. We have taken all of the comments into consideration and have made revisions accordingly. Please see our detailed responses below for each one. ======== 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. >>We have made revisions to the format of the manuscript based on the template guidelines. We have also renamed the figure and supplemental file names per your instructions. 2. Please provide additional details regarding participant consent. If the need for consent was waived by the ethics committee, please include this information. >>We have revised the manuscript to indicate that consent was waived by the ethics committee in the Methods section of the manuscript. Their review of the project was deemed exempt and that consent was not required. 3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. >>A blinded supplemental file has been uploaded with our data included. In order to ensure that no identifiers were present, names, identification numbers, and other demographic variables were removed. 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. >>The ethics statement is in the Methods section. We have removed it from other spots in the manuscript. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: This is a fairly straightforward assessment of the CASPer test and whether this is a non-biased metric for minimizing bias in admissions for American medical schools. Results are important as data suggests that Black or African-American, Native American or Alaskan Native, and Hispanic applicants all had lower scores than other groups of applicants suggesting that this test may not be an accurate assessment of reducing bias in admissions. A few items should be added for clarity to the report. 1. Clarity on how this new data fits into the wholistic review of applicants is needed in the discussion. Expansion of this point is needed from what is currently in the report. >>We did mention in the Methods that CASPer was not used as a formal part of the admissions process due to this being a pilot. We have also included some additional language in the Discussion section to that effect as well. 2. Is there any bias in forcing applicants to simply take the CASPer test that could have resulted in lower scores? >>This is a good question and one that we cannot answer with the data we collected. However, we have incorporated a statement related to this as a potential limitation of the study and worthy of future study. 3. More information on the specifics of the CASper test could be added to the methods. >>Additional information about the CASPer is included in the Methods. https://doi.org/10.1371/journal.pone.0280205.r002
21 Nov 2022 Decision Letter - Yaser Mohammed Al-Worafi, Editor PONE-D-22-17727R1Evaluating situational judgment test use and diversity in admissions at a southern US medical schoolPLOS ONE Dear authors, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 05 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Yaser Mohammed Al-Worafi Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed Reviewer #4: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: The authors have appropriately addressed all reviewers’ comments. The manuscript is ready for publication. Reviewer #3: Dear authors, Thank you for addressing the previous reviews. In addition to the current revision, would it be possible to provide further information regarding CASper instrument? You mentioned that the reliability of the item is 0.66. It will be useful for the readers if you can describe further what topics/subjects covered by CASper, as well as provide the example of the items. If this has been reported elsewhere, of course the authors may also cite the report. I suggest this to be elaborated in the method section, hence the authors might be able to refer this in the discussion section. This study highlights that the CASper cannot be used as the selection instrument, despite the initial intention. I wonder what's the implication of this, whether the authors would be able to do further actions on the items or not? Reviewer #4: This manuscript reads more to me like a research letter. The authors tried an intervention to specifically broaden selection criteria that might holistically reduce racial/ethnic bias, but it’s unclear that there was any rationale that this tool might do that. If anything the authors could reframe their original hypothesis and manuscript in this manner, i.e. saying that there is no evidence to suggest it would however they sought to explore whether it would and it did not seem to. And perhaps even does the opposite in perpetuating biases. Intro: Since CASPER is new to this audience, could use a little more background in the Intro as to how it was validated. Has it previously shown bias or better been shown to not perpetuate bias and inequities in diverse samples? Was NHPI analyzed with Asian or with UIM. It should be with UIM. It’s unclear in the Methods and Results as it seems to be state both ways. I’d suggest formal Stats review. Do the CASPER results differ by race when controlling for other quantitative metrics like GPA or MCAT score? Discussion: The Discussion in general is way too short and superficial / skimpy. What did the NYU study show? Should clarify in more detail in the Discussion itself. Paragraph 2 gets to the crux of my initial question. If CASPER was introduced as a tool to mitigate bias, increase diversity, and enhance holistic review, where is the evidence that it actually does that? Especially if there are subjective components to the scoring which would be at risk of implicit and explicit biases. “applying Methods from”. This statement should be similarly elaborated. What unique recommendations did they have? ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No Reviewer #3: No Reviewer #4: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0280205.r003
Revision 2
19 Dec 2022 Author Response Reviewer #2: The authors have appropriately addressed all reviewers’ comments. The manuscript is ready for publication. >>Thank you. Reviewer #3: Dear authors, Thank you for addressing the previous reviews. In addition to the current revision, would it be possible to provide further information regarding CASper instrument? You mentioned that the reliability of the item is 0.66. It will be useful for the readers if you can describe further what topics/subjects covered by CASper, as well as provide the example of the items. If this has been reported elsewhere, of course the authors may also cite the report. I suggest this to be elaborated in the method section, hence the authors might be able to refer this in the discussion section. This study highlights that the CASper cannot be used as the selection instrument, despite the initial intention. I wonder what's the implication of this, whether the authors would be able to do further actions on the items or not? >>Thank you for this comment. We have added additional information in the introduction as well as Methods related to CASPer. Since it is a proprietary product, we would not have any ability to influence the items in the instrument. We did comment more on the fact that this instrument could be considered part of holistic review of materials, but that institutions need to do a good job of continuous quality improvement to ensure that they understand the scores for their context. Reviewer #4: This manuscript reads more to me like a research letter. The authors tried an intervention to specifically broaden selection criteria that might holistically reduce racial/ethnic bias, but it’s unclear that there was any rationale that this tool might do that. If anything the authors could reframe their original hypothesis and manuscript in this manner, i.e. saying that there is no evidence to suggest it would however they sought to explore whether it would and it did not seem to. And perhaps even does the opposite in perpetuating biases. >>We appreciate your comments. Unfortunately, little has been published about the fact that many medical schools are using CASPer now and consider it to be unbiased. NY Medical College reports these data, but others have not. Anecdotally, we thought it would provide a more unbiased measure based on the data provided by CASPer. That is the reason we wanted to explore the results and thus asked the questions we did. Intro: Since CASPER is new to this audience, could use a little more background in the Intro as to how it was validated. Has it previously shown bias or better been shown to not perpetuate bias and inequities in diverse samples? >>Thank you for this comment. Where CASPer is concerned, no such reports to our knowledge exist. There are other types of situational judgment tests that have shown bias toward ethnic groups, but not in medicine. We discuss that in the Discussion. Was NHPI analyzed with Asian or with UIM. It should be with UIM. It’s unclear in the Methods and Results as it seems to be state both ways. >>NHPI was not part of “Asian” and this was corrected in the manuscript. I’d suggest formal Stats review. >>We have an experienced statistician on our team who reviewed materials again. Do the CASPER results differ by race when controlling for other quantitative metrics like GPA or MCAT score? >>We did not incorporate GPA and MCAT in this analysis. The reason being is that those are primarily considered knowledge-based outcomes. CASPer is meant for non-cognitive abilities and therefore using interview evaluation metrics was more appropriate for an analysis. Discussion: The Discussion in general is way too short and superficial / skimpy. >>We have added to the Discussion. What did the NYU study show? Should clarify in more detail in the Discussion itself. >>We have added to the Discussion. Paragraph 2 gets to the crux of my initial question. If CASPER was introduced as a tool to mitigate bias, increase diversity, and enhance holistic review, where is the evidence that it actually does that? Especially if there are subjective components to the scoring which would be at risk of implicit and explicit biases. >>We’ve further discussed some of this as part of the expanded discussion. As we note throughout, situational judgment tests are being used in business and medical school admissions as a means of mitigating bias. However, few people have reported findings like ours. Why? We don’t know. But pointing out how different these results are based on UIM status is worth reporting because there may be issues with the grading that CASPer does. As a private business, we have no control over their process. “applying Methods from”. This statement should be similarly elaborated. What unique recommendations did they have? >>We have revised this. Attachments Attachment Submitted filename: plos1CASPer_ReviewResponseR2.docx https://doi.org/10.1371/journal.pone.0280205.r004
22 Dec 2022 Decision Letter - Yaser Mohammed Al-Worafi, Editor Evaluating situational judgment test use and diversity in admissions at a southern US medical school PONE-D-22-17727R2 Dear colleagues, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Yaser Mohammed Al-Worafi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0280205.r005
Formally Accepted
29 Dec 2022 Acceptance Letter - Yaser Mohammed Al-Worafi, Editor PONE-D-22-17727R2 Evaluating situational judgment test use and diversity in admissions at a southern US medical school Dear Dr. Beck Dallaghan: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Yaser Mohammed Al-Worafi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0280205.r006

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