Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical relevance
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.
Key words
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Article info
Publication history
Published online: February 12, 2023
Accepted:
January 11,
2023
Received:
January 27,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly to this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
