<h3>Study Objective</h3> Various surgical specialties have reported gender bias in letters of recommendations (LORs). Currently, no studies have evaluated this phenomenon in Gynecological sub-specialties. We aimed to determine if linguistic differences exist in LORs for female and male physicians applying to Minimally Invasive Gynecologic Surgery (MIGS) fellowship. <h3>Design</h3> Retrospective cohort study including application cycles 2019 and 2020. <h3>Setting</h3> Academic university hospital. <h3>Patients or Participants</h3> MIGS fellowship applicants. <h3>Interventions</h3> Not applicable. <h3>Measurements and Main Results</h3> Abstracted applicant demographic data included age, race, gender, geographical region of residency training, Step 1 and 2 scores, number of research and volunteer activities, Alpha Omega Alpha (AOA) status and number of LORs, as well as the gender and academic rank of the letter writer. We utilized the Linguistic Inquiry and Word Count (LIWC) software, a validated text analysis program, to characterize LORs linguistic content by frequency of words in predetermined categories. A total of 118 applications, including 391 letters, were analyzed. Seventy-six (64.4%) of applicants were female and 42 (35.6%) were male. A majority of female applicants were white (46% versus 36%, p=0.04), had AOA status (13% vs. 0%), higher Step 2 scores (239.7 vs. 230.4, p <0.01), and more service activities (7.7 versus 4.7, p<0.01), compared to male applicants. Male applicants were more likely to graduate from international residency programs (45% vs. 16%, p <0.01). Female authors wrote 159 LORs, and male authors wrote 232. Following multivariable analysis controlling for race, Step 1 score and letter writer gender, no significant differences in average LOR word count for female and male applicants (406.7 ± 24.2 words vs. 340.1 ± 35.4 words), or differences in LIWC linguistic categories existed. <h3>Conclusion</h3> Although demographic differences were noted between female and male MIGS applicants, no differences in LOR length or linguistic categories were noted. These results likely reflect a shift towards a female-dominated field and increased efforts to address gender bias.
Read full abstract