Influence of Gender on Surgical Residency Applicants’ Recommendation Letters

Florence E. Turrentine · Caitlin Dreisbach · Amanda St. Ivany · John B. Hanks · Anneke T. Schroen

198 citations0/0 files storedJournal of the American College of Surgeons

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Diversity and Career in Medicine Gender Studies in Language Medical Education and Admissions

Abstract

BACKGROUND: Implicit bias has been documented in candidate selection within academic medicine. Gender bias is exposed when writers systematically use different language to describe attributes of male and female applicants. This study examined the presence of gender bias in recommendation letters for surgical residency candidates. STUDY DESIGN: Recommendation letters for 2016 to 2017 surgery resident applicants selected for interview at an academic institution were analyzed using qualitative text analysis, quantitative text mining, and topic modeling. Dedoose, QDA Miner, and RStudio analytic software were used for analysis. RESULTS: There were 332 letters of recommendation for 89 applicants (51% male) analyzed. Of 265 letter writers, 86% were male, 21% chairs, and 50% professors. Average word count was 404. Letter writers for male compared with female applicants had a significantly higher average word count (male = 421, SD 144; female = 388, SD 140, p = 0.035). Standout adjectives (eg exceptional), reference to awards, achievement, ability, hardship, leadership, scholarship, and use of applicant's name were most often applied to male applicants. Comments on positive general terms (eg delightful), grindstone words (eg hard-working), physical description, doubt raisers, and work ethic were most often applied to female applicants. Topic modeling and term frequencies revealed achievement words (performance, career, leadership, and knowledge) used more often with male applicants, while caring words (care, time, patients, and support) were used more often with female applicants. CONCLUSIONS: Gendered differences examined through language and text exist in surgical residents' recommendation letters. Implementing tools to help faculty write recommendation letters with meaningful content and editing letters for reflections of stereotypes may improve the resident selection process by reducing bias.

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References

1999Why So Slow?2009Gender and letters of recommendation for academia: Agentic and communal differences.2003Exploring the Color of Glass: Letters of Recommendation for Female and Male Medical Faculty 2016Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention 2007A Linguistic Comparison of Letters of Recommendation for Male and Female Chemistry and Biochemistry Job Applicants 2008Competent Yet Out in the Cold: Shifting Criteria for Hiring Reflect Backlash Toward Agentic Women 2016The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015 2016Gender differences in recommendation letters for postdoctoral fellowships in geoscience

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2019Gender Bias Experiences of Female Surgical Trainees 2021The unspoken reality of gender bias in surgery: A qualitative systematic review 2019Gender-based differences in letters of recommendation written for ophthalmology residency applicants 2020Race- and Gender-Based Differences in Descriptions of Applicants in the Letters of Recommendation for Orthopaedic Surgery Residency

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