The Role of Gender in Neurosurgical Residency Applicants' Letters of Recommendation.

Abstract

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. To determine whether neurosurgical LORs contain significant linguistic gendered differences. 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. 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 (10.7vs 13.1, per applicant, P <.01) and communal terms (5.2vs 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" (2.4vs 1.6 mentions per applicant). 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.