The Role of Gender in Neurosurgical Residency Applicants’ Letters of Recommendation

Abstract

BACKGROUND Letters of recommendation (LORs) are one of the most important components of the neurosurgical residency application. Studies in other fields and surgical subspecialties have found gender bias. OBJECTIVE To determine whether neurosurgical LORs contain significant linguistic gendered differences. METHODS We performed a retrospective review and linguistic analysis of all LORs submitted on behalf of applicants offered an interview invitation to a single neurosurgical residency program at an academic medical center between 2015-2016 and 2018-2019. RESULTS A total of 599 letters from 156 applicants (120 males and 36 females) were included. Background demographics, including United States Medical Licensing Examination (USMLE) Step 1 score and publications, were not significantly different between applicants. Male faculty authored 93% of all letters. Female faculty were more likely to write letters for female applicants than male applicants (12.1% vs 5.5%, P < .001). Letters for women were significantly longer (334 words vs 277 words, P < .001). Overall, 1754 agentic terms and 854 communal terms were coded. Letters for men contained significantly fewer agentic terms (10.7 vs 13.1, per applicant, P < .01) and communal terms (5.2 vs 6.4, P < .034). This difference, however, is nonsignificant when word count was used as a covariate. Female applicants were more significantly likely to be labeled “Outstanding” (2.4 vs 1.6 mentions per applicant). CONCLUSION Overall, there are more similarities than differences between genders in LORs for neurosurgical applicants. This finding is at odds with what has previously been reported in most other surgical specialties.

Gender bias in postgraduate year one pharmacy letters of recommendation

“…8,12 Field et al found no linguistic differences in LORs based on gender for neurosurgical residents. 15 Other research has been conducted for urology, radiation oncology, orthopedic surgery, and ophthalmology residencies and transplant surgery fellowships. [9][10][11]13,14 There appears to be only one study of this nature for pharmacy residency programs by Rice et al, conducted at a single center for one application cycle, which found that women candidates' LORs contained more gendered, solitary/ reserved, and desire words than men candidates.…”

“…6,7 Gender bias in LORs has been studied in various medical residency and fellowship programs with mixed results. [8][9][10][11][12][13][14][15] In postgraduate pharmacy residencies, there is one single-center study that evaluated pharmacy residents' LOR for gender bias. 16 Besides lacking additional studies for gender bias in LORs, there are also no studies that tried to determine if gender bias might impact residency offers to interview, the next step in the process of obtaining a residency.…”

Commentary: An Examination of Standardized Letters of Recommendation Rating Scales Among Neurosurgical Residency Candidates During the 2020 to 2021 Application Cycle

“…Additionally, it is critical to be aware of unconscious biases that can disadvantage highly qualified applicants, such as using "softer" rather than "standout" praise words, gender or ethnic stereotypic traits, or writing shorter letters for applicants who differ in gender, ethnicity, or orientation from the evaluator. [10][11][12] While neurosurgery is better at this than most specialties, 13 it is still important to recognize potential pitfalls. This is an important manuscript and we agree with their findings.…”

Commentary: The Role of Gender in Neurosurgical Residency Applicants’ Letters of Recommendation

“…T he authors of the article "The Role of Gender in Neurosurgical Residency Applicants' Letters of Recommendation" performed a retrospective review of letters of recommendation (LOR) submitted for applicants who were offered an interview at their institution. 1 They report that within their cohort, there were more similarities among LOR for female and male applicants than there were differences. Their specific findings include that LOR for female applicants were more likely to have been written by female faculty, were longer, and were more likely to have the candidate described as "outstanding."…”