Background Letters of recommendation are considered one of the most important factors for whether an applicant is selected for an interview for orthopaedic surgery residency programs. Language differences in letters describing men versus women candidates may create differential perceptions by gender. Given the gender imbalance in orthopaedic surgery, we sought to determine whether there are differences in the language of letters of recommendation by applicant gender. Questions/purposes (1) Are there differences in word count and word categories in letters of recommendation describing women and men applicants, regardless of author gender? (2) Is author gender associated with word category differences in letters of recommendation? (3) Do authors of different academic rank use different words to describe women versus men applicants? Methods Using a linguistic analysis in a retrospective study, we analyzed all letters of recommendation (2834 letters) written for all 738 applicants with completed Electronic Residency Application Service applications submitted to the Johns Hopkins Orthopaedic Surgery Residency program during the 2018 to 2019 cycle to determine differences in word category use among applicants by gender, authors by gender, and authors by academic rank. Thirty nine validated word categories from the Linguistic Inquiry and Word Count dictionary along with seven additional word categories from previous publications were used in this analysis. The occurrence of words in each word category was divided by the number of words in the letter to obtain a word frequency for each letter. We calculated the mean word category frequency across all letters and analyzed means using non-parametric tests. For comparison of two groups, a p value threshold of 0.05 was used. For comparison of multiple groups, the Bonferroni correction was used to calculate an adjusted p value (p = 0.00058). Results Letters of recommendation for women applicants were slightly longer compared with those for men applicants (366 ± 188 versus 339 ± 199 words; p = 0.003). When comparing word category differences by applicant gender, letters for women applicants had slightly more “achieve” words (0.036 ± 0.015 versus 0.035 ± 0.018; p < 0.0001). Letters for men had more use of their first name (0.016 ± 0.013 versus 0.014 ± 0.009; p < 0.0001), and more “young” words (0.001 ± 0.003 versus 0.000 ± 0.001; p < 0.0001) than letters for women applicants. These differences were very small as each 0.001 difference in mean word frequency was equivalent to one more additional word from the word category appearing when comparing three letters for women to three letters for men. For differences in letters by author gender, there were no word category differences between men and women authors. Finally, when looking at author academic rank, letters for men applicants written by professors had slightly more “research” terms (0.011 ± 0.010) than letters written by associate professors (0.010 ± 0.010) or faculty of other rank (0.009 ± 0.011; p < 0.0001), a finding not observed in letters written for women. Conclusions Although there were some minor differences favoring women, language in letters of recommendation to an academic orthopaedic surgery residency program were overall similar between men and women applicants. Clinical Relevance Given the similarity in language between men and women applicants, increasing women applicants may be a more important factor in addressing the gender gap in orthopaedics.

Background. The Sustaining Technical and Analytical Resources (STAR) project seeks to invest in and expand the capacity of diverse senior global public health professionals. STAR builds on traditional work-based fellowships by partnering with universities in order to curate (or develop) and deliver high-quality, tailored learning across a set of required “core competency domains” as well as elective skills- or content-based competency domains. Pedagogy. In a rapidly changing global health context, ongoing learning is essential but often gets sidelined by other pressures; STAR’s approach aims to respond to these challenges by developing a learning curriculum tailored to the needs of our participants and their roles in global health. STAR’s pedagogy utilizes individualized learning plans, a deliberate practice approach, and a hybrid mentorship model to support project participants to achieve their learning objectives as well as broader project goals. Next Steps. The STAR project is in its first year of implementation. Furthermore, our future work will focus on developing a monitoring and evaluation plan that seeks to track the progress of our participants, guide project improvements, measure the impact of learning activities, and inform the pedagogy of future global health training initiatives.

Research has shown that women have leadership ability equal to or better than that of their male counterparts, yet proportionally fewer women than men achieve leadership positions and promotion in medicine. The Women’s Empowerment and Leadership Initiative (WELI) was founded within the Society for Pediatric Anesthesia (SPA) in 2018 as a multidimensional program to help address the significant career development, leadership, and promotion gender gap between men and women in anesthesiology. Herein, we describe WELI’s development and implementation with an early assessment of effectiveness at 2 years. Members received an anonymous, voluntary survey by e-mail to assess whether they believed WELI was beneficial in several broad domains: career development, networking, project implementation and completion, goal setting, mentorship, well-being, and promotion and leadership. The response rate was 60.5% (92 of 152). The majority ranked several aspects of WELI to be very or extremely valuable, including the protégé-advisor dyads, workshops, nomination to join WELI, and virtual facilitated networking. For most members, WELI helped to improve optimism about their professional future. Most also reported that WELI somewhat or absolutely contributed to project improvement or completion, finding new collaborators, and obtaining invitations to be visiting speakers. Among those who applied for promotion or leadership positions, 51% found WELI to be somewhat or absolutely valuable to their application process, and 42% found the same in applying for leadership positions. Qualitative analysis of free-text survey responses identified 5 main themes: (1) feelings of empowerment and confidence, (2) acquisition of new skills in mentoring, coaching, career development, and project implementation, (3) clarification and focus on goal setting, (4) creating meaningful connections through networking, and (5) challenges from coronavirus disease 2019 (COVID-19) and the inability to sustain the advisor-protégé connection. We conclude that after 2 years, the WELI program has successfully supported career development for the majority of protégés and advisors. Continued assessment of whether WELI can meaningfully contribute to attainment of promotion and leadership positions will require study across a longer period. WELI could serve as a programmatic example to support women’s career development in other subspecialties.

Background Sitting at the bedside may strengthen physician–patient communication and improve patient experience. Yet despite the potential benefits of sitting, hospital physicians, including resident physicians, may not regularly sit down while speaking with patients. Objective To examine the frequency of sitting by internal medicine residents (including first post-graduate year [PGY-1] and supervising [PGY-2/3] residents) during inpatient encounters and to assess the association between patient-reported sitting at the bedside and patients’ perceptions of other physician communication behaviors. We also assessed residents’ attitudes towards sitting. Design In-person survey of patients and email survey of internal medicine residents between August 2019 and January 2020. Participants Patients admitted to general medicine teaching services and internal medicine residents at The Johns Hopkins Hospital. Main Measures Patient-reported frequency of sitting at the bedside, patients’ perceptions of other communication behaviors (e.g., checking for understanding); residents’ attitudes regarding sitting. Key Results Of 334 eligible patients, 256 (76%) completed a survey. Among these 256 respondents, 198 (77%) and 166 (65%) reported recognizing the PGY-1 and PGY-2/3 on their care team, respectively, for a total of 364 completed surveys. On most surveys (203/364, 56%), patients responded that residents “never” sat. Frequent sitting at the bedside (“every single time” or “most of the time,” together 48/364, 13%) was correlated with other positive behaviors, including spending enough time at the bedside, checking for understanding, and not seeming to be in a rush ( p < 0.01 for all). Of 151 residents, 77 (51%) completed the resident survey; 28 of the 77 (36%) reported sitting frequently. The most commonly cited barrier to sitting was that chairs were not available (38 respondents, 49%). Conclusions Patients perceived that residents sit infrequently. However, sitting was associated with other positive communication behaviors; this is compatible with the hypothesis that promoting sitting could improve overall patient perceptions of provider communication. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07231-4.