Words Used in Letters of Recommendation for Pediatric Residency Applicants: Demographic Differences and Impact on Interviews.

To describe differences in agentic (achievement) and communal (relationship) terms in letters of recommendation (LORs) for pediatric residency candidates by applicant and letter writer demographics and to examine if LOR language is associated with interview status. A random sample of applicant profiles and LORs submitted to one institution were analyzed from the 2020-21 Match. Letters of recommendation text was inputted into a customized natural language processing application which determined the frequency of agentic and communal words in each LOR. Neutral LORs were defined as having< 5% surplus of agentic or communal terms. We analyzed 2094 LORs from 573 applicants: 78% were women, 24% were under-represented in medicine (URiM), and 39% were invited to interview. Most letter writers were women (55%) and of senior academic rank (49%). Overall, 53% of LORs were agency biased, 25% communal biased, and 23% neutral. There was no difference in agency and communally biased LORs by an applicant's gender (men 53% agentic vs women 53% agentic, P = .424), race or ethnicity (non-URiM 53% agentic vs URiM 51% agentic, P = .631). Male letter writers used significantly more agentic terms (8.5%) compared to women (6.7% agentic) or writers of both genders (3.1% communal) (P = .008). Applicants invited to interview were more likely to have a neutral LOR; however, no significant association existed between language and interview status. No significant differences in language were found by applicant gender or race among pediatric residency candidates. Identifying potential biases within pediatric residency selection processes is important in creating an equitable approach to application review.

Boolchandani H ，Osborn R ，Tiyyagura G ，Sheares B ，Chen L ，Phatak UP ，Puthenpura V ，Elder RW ，Lee S ，Amster L ，Langhan ML ... -  《-》

Identifying Gender and Racial Bias in Pediatric Fellowship Letters of Recommendation: Do Word Choices Influence Interview Decisions?

To describe linguistic differences in letters of recommendation (LORs) for pediatric fellowship candidates based on applicant and letter writer demographics and to examine if these differences influenced the decision to interview a candidate for a fellowship position. LORs for applicants to 8 pediatric subspecialty fellowships at a single academic center from the 2020 Match were analyzed in this cross-sectional study. Frequency of validated agentic and communal terms in each letter were determined by a language processing web application. Bias was determined as having a >5% surplus of agentic or communal terms. We analyzed 1521 LORs from 409 applicants: 69% were women, 28% were under-represented minorities in medicine (URM), and 50% were invited to interview. Overall, 66% of LORs were agentic biased, 16% communal biased, and 19% neutral. There was no difference in bias in LORs by an applicant's gender (woman 67% agentic vs man 62% agentic; P = .058), race, or ethnicity (non-URM 65% agentic vs URM 67% agentic; P = .660). Despite a lower frequency of agentic terms in LORs for applicants invited for interviews, when accounting for other components of an application and applicant demographics, no significant association was made between language bias in LORs and fellowship interview status. The frequency of agentic and communal terms in LORs for pediatric subspecialty fellowship candidates were not found to influence the decision to invite a candidate to interview. However, raising awareness of potential areas of bias within the pediatric fellowship selection process might lead to a more equitable and holistic approach to application review.

Boolchandani H ，Chen L ，Elder RW ，Osborn R ，Phatak UP ，Puthenpura V ，Sheares BJ ，Tiyyagura G ，Amster L ，Lee S ，Langhan ML ... -  《-》

Language Patterns in Letters of Recommendation for Residency Applicants in Otolaryngology.

Assess for gender and race patterns in agentic and communal language used in letters of recommendation for Otolaryngology-Head and Neck Surgery (OHNS) residency applicants. Retrospective content analysis. Applications from OHNS applications at a single training institution for the 2019 and 2020 match cycles. A total of 2283 letters of recommendation for 611 OHNS applicants were analyzed. Applicant and letter writer gender, applicant race and ethnicity, and applicant characteristics including United States Medical Licensing Examination® Step 1 score, research productivity, and medical school rank were extracted. Agentic and communal word use from the letters of recommendation was compared across applicant and writer characteristics using multilevel negative binomial regression modeling. Letter writers use a greater rate of agentic terms when describing applicants who self-identify as Asian (incidence rate ratio [IRR] = 1.16, p < .01) or "Other/not reported" (IRR = 1.23, p < .01) as compared to white applicants. Further, standardized letters of evaluation had significantly more communal language and less agentic language. Although there was an increase in communal language in letters for female applicants compared to male applicants, these gender differences disappeared in the multivariate model. Multivariate analysis demonstrated no significant gender-based patterns in the communal or agentic language in letters of recommendation for OHNS residency applicants. However, letters for applicants identifying as Asian or "other/not reported" had more frequent use of agentic terms. Future studies should investigate other components of residency applications to assess how gender and race bias might unfairly influence an applicant's chances at a given program.

Campbell JC ，Canick JE ，Redmond R ，Lee JW ，Woodard CR ，Grimm LJ ... -  《-》

Gender and Racial Bias in Radiology Residency Letters of Recommendation.

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. 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. 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. 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.

Grimm LJ ，Redmond RA ，Campbell JC ，Rosette AS ... -  《-》

Impact of Surgeon Gender and Seniority in use of Agentic and Communal Language in Letters of Recommendation for Surgery Residency Applicants.

Differential use of communal (kindness, cooperation, morality) and agentic terms (competence, assertiveness, decisiveness) may reveal bias and has been extensively reported in letters of recommendation (LoR) for residency but letter writer factors have not been thoroughly studied. We estimate the association between use of agentic and communal language with letter writer and applicant characteristics. Retrospective review of LoR comparing 2 letters written for the same applicant. Applicant demographics and USMLE scores as well as letter writer demographics and academic/departmental rank were compared. Multilevel regression controlling for clustering of letters within applicant was performed. Single academic surgery residency program in a tertiary center. US medical students applying for categorical surgery residency. Applications of 667 US medical students (age 27.1, interquartile range [IQR] 26.2-28.6; female 340, 51%, white 337, 54.2%) were evaluated. Most commonly, letters writers were males (n = 1031, 77.3%), Full Professors (n = 660, 49.48%) and Department Chairs or Division Chiefs (n = 629, 47.151%). Overall, median bias score was 14.29 (interquartile range -4 to 33.33), indicating predominance of agentic terms. Applicant female gender (coef 3.64, 95% confidence interval [CI] 0.33-6.96) and higher Step 1 USMLE scores (coef 0.12, 95% CI 0.0026-0.24) were associated with increased use of agentic terms. For letter writer characteristics, female (coef -4.23, 95% CI -8.14 to -0.32) and fewer years in practice (coef -0.32, 95% CI -0.48 to -0.16) were independent predictors of increased use of communal traits. Comparing 2 LoR written for the same applicant, male and more senior surgeons use more agentic language in their LoR as compared to female and younger surgeons. Increased use of communal language is expected as the pool of letter writers is diversified and reflects essential characteristics of contemporary surgeons.

Storino A ，Polanco-Santana JC ，Ruiz de Somocurcio J ，Sampson R ，Gangadharan SP ，Kent TS ... -  《-》