Letters of recommendation (LORs) function as an indicator of competence and future potential for a trainee. Our purpose was to evaluate gender bias in hand surgery fellowship applicant LORs.
This was a retrospective study of all LORs submitted to a hand surgery fellowship program between 2015 and 2020. Demographic data about applicants and letter writers were collected. Linguistic analysis was performed using a text analysis software, and results were evaluated with nonparametric tests, multiple linear regression models, and a mixed effects regression model.
Letters of recommendation were analyzed; 720 letters for 188 (23.4%) female applicants and 2,337 letters for 616 (76.6%) male applicants. Compared with LORs written for men, those written for women had more references to categories of anxiety (eg, worried and fearful) and affiliation (eg, ally and friend). Letters for women had more “clout.” In subgroup analysis, letters for female plastic surgery applicants had more words signaling power, whereas recommendations for female applicants from orthopedic residencies had more words related to anxiety, achievement, work, and leisure.
Letters of recommendation written for female residents applying to hand fellowship had more references to anxiety but were written with higher clout and more words of affiliation. Subgroup analysis looking at orthopedic and plastic surgery applicants separately found a mixed picture. Overall, these LORs written for applicants to hand fellowship had no notable specific patterns of gender bias in our analyses.
Because programs look to train the next generation of hand surgeons, alerting letter readers to trends in implicit bias may help in the selection of qualified applicants. Bringing topics of implicit bias forward may help writers think more critically about word choice and topics.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- An evaluation of plastic surgery resident selection factors.J Surg Educ. 2015; 72: 8-15
- Integrated plastic surgery applicant review: important factors and selection criteria.Plast Reconstr Surg Glob Open. 2020; 8e2892
- Assessing implicit gender bias in medical student performance evaluations.Eval Health Prof. 2010; 33: 365-385
- Gender bias in reference letters for residency and academic medicine: a systematic review.Postgrad Med J. 2021; (Paper presented at: Canadian Conference for Medical Education (CCME); 2019)
- Influence of gender on surgical residency applicants’ recommendation letters.J Am Coll Surg. 2019; 228: 356-365.e3
- The development and psychometric properties of LIWC2015.University of Texas at Austin, 2015
- LIWC. Interpreting LIWC Output.https://www.liwc.app/help/liwc#Interpreting-OutputDate accessed: November 16, 2021
- Racial and gender discrimination in hand surgery letters of recommendation.J Hand Surg Am. 2021; 46: 998-1005.e2
- Current orthopaedic residency letters of recommendation are not biased by gender of applicant.JBJS Open Access. 2021; 6e20.00134
- Are there gender-based differences in language in letters of recommendation to an orthopaedic surgery residency program?.Clin Orthop Relat Res. 2020; 478: 1400-1408
- Gendered differences in letters of recommendation for transplant surgery fellowship applicants.J Surg Educ. 2019; 76: 427-432
- Exploring the gender gap: letters of recommendation to pediatric surgery fellowship.Am J Surg. 2020; 219: 932-936
- Evolution of characteristics from letters of recommendation in general surgery residency applications.J Surg Educ. 2018; 75: e23-e30
- Severe anxiety among female oral-maxillofacial surgery residents: can gender discrimination be a cause?.J Oral Maxillofac Surg. 2018; 76: 2248
- Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination. National Bureau of Economic Research.https://www.nber.org/system/files/working_papers/w9873/w9873.pdfDate accessed: September 8, 2022
Published online: February 12, 2023
Accepted: January 11, 2023
Received: January 27, 2022
Publication stageIn Press Corrected Proof
No benefits in any form have been received or will be received related directly to this article.
© 2023 by the American Society for Surgery of the Hand. All rights reserved.