Thoracic: Education
Gender differences in cardiothoracic surgery letters of recommendation

Read at the 103rd Annual Meeting of The American Association for Thoracic Surgery, Los Angeles, California, May 6-9, 2023.
https://doi.org/10.1016/j.jtcvs.2023.03.027Get rights and content

Abstract

Objective

To investigate whether or not gender influences letters of recommendation for cardiothoracic surgery fellowship.

Methods

From applications to an Accreditation Council Graduate Medical Education cardiothoracic surgery fellowship program between 2016 and 2021, applicant and author characteristics were examined with descriptive statistics, analysis of variance, and Pearson χ2 tests. Linguistic software was used to assess communication differences in letters of recommendation, stratified by author and applicant gender. An additional higher-level analysis was then performed using a generalized estimating equations model to examine linguistic differences among author-applicant gender pairs.

Results

Seven hundred thirty-nine recommendation letters extracted from 196 individual applications were analyzed; 90% (n = 665) of authors were men and 55.8% (n = 412) of authors were cardiothoracic surgeons. Compared with women authors, authors who are men wrote more authentic (P = .01) and informal (P = .03) recommendation letters. When writing for women applicants, authors who are men were more likely to display their own leadership and status (P = .03) and discuss women applicants' social affiliations (P = .01), like occupation of applicant's father or husband. Women authors wrote longer letters (P = .03) and discussed applicants' work (P = .01) more often than authors who are men. They also mentioned leisure activities (P = .03) more often when writing for women applicants.

Conclusions

Our work identifies gender-specific differences in letters of recommendation. Women applicants may be disadvantaged because their recommendation letters are significantly more likely to focus on their social ties, leisure activities, and the status of the letter writer. Author and reviewer awareness of gender-biased use of language will aid in improvements to the candidate selection process.

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Linguistic analysis of gender differences in cardiothoracic surgery fellowship letters of recommendation. ACGME, Accreditation Council for Graduate Medical Education.

Section snippets

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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  • 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.

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