The Journal of Thoracic and Cardiovascular Surgery
Thoracic: EducationGender differences in cardiothoracic surgery letters of recommendation
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Methods
The Institutional Review Board (IRB) or equivalent ethics committee of Temple University approved the study protocol and publication of data. Applicant written consent for the publication of the study data was waived by the IRB. When applying for fellowship via the Electronic Residency Application Service, applicants agree on submission to have their application data used in research per the Association of American Medical Colleges policies.14 Thus, informed consent was not obtained from each
Applicant Characteristics
A total of 739 LORs were obtained from 196 applicants. Among the 196 applicants included in this study, 135 (68.9%) were men and 61 (31.1%) were women (Table 1). Men and women applicants were overall similar in age, race, mean USMLE Step 2 and 3 scores, Alpha Omega Alpha membership, number of publications and presentations, and number of LORs submitted. Applicants who are men attained higher USMLE Step 1 scores (P = .003) and American Board of Surgery In-Service Training Exam (ABSITE) scores (P
Discussion
The lack of gender diversity in cardiothoracic surgery is multifactorial. One potential mechanism is inherent gendered differences in narrative recommendation letters required during the application process. Recommendation letters remain among the most important criteria for selection and entry into the field of not only cardiothoracic surgery but the vast majority of medical specialties,8 and thus have a pivotal role in determining the workforce.
Our study is the first to examine how gender
Conclusions
Linguistic analysis of letters of recommendation for cardiothoracic surgery demonstrate differences based on gender. Letters for women applicants were more likely to discuss activities outside of surgery, social connections, and emphasize the letter writer's clout. In cardiothoracic surgery, our reported gender differences in letters of recommendation may have unintended consequences during the fellowship selection process. All letter writers must be aware of potential gender bias in writing
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Commentary: The importance of equity in letters of recommendation in residency and fellowship applications
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2023, AEM Education and Training
Partially supported by Temple University/Fox Chase Cancer Center and Hunter College (TUFCCC/HC) Regional Comprehensive Cancer Health Disparity Partnership, award No. U54 CA221704(5) from the National Cancer Institute of National Institutes of Health (NCI/NIH). Ms Deng is supported under NIC/NIH award No. P30CA006927. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI/NIH.
IRB protocol: #28673 12-Aug-2021.
Informed Consent Statement: The Institutional Review Board (IRB) or equivalent ethics committee of Temple University approved the study protocol and publication of data. Patient written consent for the publication of the study data was waived by the IRB. When applying for fellowship via the Electronic Residency Application Service, applicants agree on submission to have their application data used in research per the Association of American Medical Colleges policies. Thus, informed consent was not obtained from each subject.