Gendered Language in Letters of Recommendation for Applicants to Pulmonary Critical Care Fellowships

Abstract

Background Previous work has demonstrated letters of recommendation for women in academic medicine are shorter and emphasize communal traits over grindstone or agentic traits. Objective To determine if there are sex-based differences in letters of recommendation written for applicants applying to pulmonary critical care medicine fellowships and if the sex of the letter writer impacts these differences. Methods All fellowship applications submitted to a pulmonary critical care medicine fellowship program in 2020 were included in this study. The applicant demographics and self-reported accomplishments were extracted from their application. The sex of letter writers was identified through public online searches. Word count and language differences in the letters of recommendation were analyzed for each applicant using the Linguistic Inquiry and Word Count (LIWC2015) program. Multivariable linear regressions were performed controlling for applicant characteristics to identify if applicant sex was associated with total word counts and total agentic word counts. Results Of the 529 complete applications, 2,024 letters of recommendation were reviewed. A majority of the applicants (70%, n = 370/530) and letter writers (75%, n = 1,515/2,024) were male. When adjusting for applicant demographic and accomplishments, female applicants had longer letters of recommendation (30.91 words longer, 95% confidence interval [CI], 1.53–60.29; P = 0.04) and more supportive letters (3.27 words longer, 95% CI, 1.59–4.95; P < 0.01) as compared with male applicants. Female letter writers wrote longer and more supportive letters than male letter writers, and this difference was greatest for female applicants. Conclusion Female applicants received longer and more supportive letters of recommendation. Further work is needed to understand if this finding is the beginning of a change in the letters of recommendation for female applicants.

Differences in international medical graduates’ letters of recommendation by gender in pulmonary and critical care medicine: a cohort analysis

“…Historically this work was focused on the gender and URiM status of applicants, examining length of letters, discussions of research, and types of adjectives used by letter writers [ 20 , 30 ]. While more recent work suggests that the trend may be changing for women applicants to PCCM, radiation oncology, and surgery, no work has evaluated the role of letters of recommendation in exacerbating the challenges faced by IMGs as they pursue specialty training and how the language in their letters may hinder them in their pursuits [ 15 , 20 , 21 ].…”

“…These studies have shown mixed results with women applicants sometimes having longer and more supportive letters as compared to men applicants [ 15 – 17 ]. Additionally, recent studies have suggested that there may be racial disparities in letters of recommendation with URiM applicants having shorter and less supportive letters of recommendation as compared to applicants who identified as white [ 18 – 21 ]. However, these studies did not identify differences for IMGs.…”

“…To fill this gap in knowledge, we investigated if letters of recommendation for IMG applicants to a pulmonary and critical care medicine (PCCM) fellowship program differed in length or language as compared to USMGs. Furthermore, we evaluated if the sex differences found in the general applicant population persisted among IMG applicants and if the gender of the letter writer contributed to these differences [ 21 ]. We hypothesized that 1) IMG applicants would have shorter letters of recommendation compared to their U.S. counterparts, and 2) female IMG applicant letters would be longer and more supportive as compared to male IMG applicants.…”

More than Words? Looking for Gender Bias in Letters of Recommendation

“…Currently immersed in the fellowship interview season, I read with interest the article titled “Gendered Language in Letters of Recommendation for Applicants to Pulmonary Critical Care Fellowships” by Viglianti and colleagues ( 1 ). I would like to commend the authors’ efforts to provide an objective analysis of potential biases in the letters of recommendation (LoRs) written for applicants to a pulmonary and critical care medicine fellowship program at a leading university but also comment on the use of imprecise language regarding sex and gender and inquire about possible limitations of their methodology.…”

Contextualizing Word Use Differences in Letters of Recommendation for Fellowship

“…To explore these important questions, in this issue of ATS Scholar , Viglianti and colleagues ( 2 ) report on a single-center retrospective cohort study using natural language processing techniques ( 3 ) to assess for gender differences in LORs for PCCM applicants. The authors evaluated associations of applicant gender with LOR word count and a composite outcome of supportive word categories (including grindstone terms, agentic terms, research terms, ability terms, and standout terms).…”