Gender and Language in Letters of Recommendation for Obstetrics and Gynecology Fellowship Applications.

OBJECTIVE: To delineate the use of gender-biased language in letters of recommendation for Obstetrics and Gynecology fellowships and its impact on applicants. DESIGN: Fellowship letters of recommendation from 4 Obstetrics and Gynecology specialties at a single institution in 2020 were included. PRIMARY OUTCOME: frequency of agentic and communal language in letters of recommendation using Linguistics Inquiry Word Count software. SECONDARY OUTCOMES: letter of recommendation length and language utilization by author gender and applicant success measured by interviews and match success. Marginal models were fit to determine if language varied by applicant and writer gender and subspecialty. Modified Poisson regression models were used to determine associations between language and interview receipt. SETTING: Single academic institution (Duke University); 2020 OB/GYN fellowship application cycle. PARTICIPANTS: A total of 1216 letters of recommendation submitted by 326 unique applicants for OB/GYN subspecialty fellowships at our institution. RESULTS: Rates of gender-biased language were low (Agentic:1.3%; communal: 0.8%). Agentic term use did not vary by applicant or author gender (p = 0.78 and 0.16) Male authors utilized 19% fewer communal terms than females (p < 0.001). Each 0.25% increase in agentic language was associated with an 18% reduction in the probability of interview invitation at our institution (p = 0.004). Percentage of agentic or communal language was not associated with successful matching into any subspecialty. CONCLUSIONS: No differences in agentic vs communal language based on applicant gender were found in this cohort, though female letter writers wrote longer letters with more communal terms. Increasing agentic terms negatively impacted interview invitation but did not affect successful matching.

Gender and Racial Bias in Radiology Residency Letters of Recommendation.

OBJECTIVE: Perceptions of agency and communality vary by race and gender, which may be contributing to the persistent gender and racial inequality in radiology. The objective of this study was to determine if there are differences in the use of agentic and communal language in letters of recommendation for radiology residency programs based on the demographics of the applicant and letter writer. METHODS: We retrospectively reviewed letters of recommendation for 736 diagnostic radiology residency applicants to Duke University from the 2015 to 2016 interview season. We then used computerized text analysis software to calculate the frequency of agentic and communal terms and multilevel negative binominal regression to compare differences in count by applicant and letter writer demographics. RESULTS: We analyzed 2,624 letters of recommendation, comprising 976,489 words. The majority of applicants were male (75%, 549 of 736) and white or Asian (77%, 565 of 736). Letter writers, who were mostly male (75%, 1,979 of 2,624) and of senior rank (50%, 1,313 of 2,624), described female applicants as more agentic than men (incidence rate ratio [IRR] = 1.08, P < .05) and described blacks and Latinx applicants as less agentic than whites and Asians (IRR = 0.932, P < .05). Secondary analysis showed that female letters writers described applicants as more agentic (IRR = 1.09, P < .05) and more communal (IRR = 1.12, P < .01) than did male writers, and senior rank faculty used agentic (IRR = 0.95, P < .05) and communal (IRR = 0.88, P < .01) language less often than did junior faculty. CONCLUSION: The extent to which agentic and communal language is used in letters of recommendation for diagnostic radiology residency programs differs by applicant and letter writer demographics.