Letter Length Research Articles

Cracking the code: interpreting content and phrases used in maternal-fetal medicine fellowship letters of recommendation

BackgroundLetters of recommendation for Maternal-Fetal Medicine(MFM) fellowship are a critical part of the applicant selection process. However, data regarding best practices for how to write LOR for MFM is limited. Similarly, within letters of recommendation, differences in the “code” or meaning of summative words/phrases used at the end of letters of recommendation are seen between surgery, pediatrics, and medicine. However, data regarding code MFM Letters of recommendation are quite limited. ObjectiveWe sought to describe what Maternal-Fetal Medicine program directors value in letters of recommendation for fellowship applicants and how PDs interpret commonly used summative words/phrases. Study DesignAfter IRB exemption, subject matter experts developed an e-survey querying the importance of various letters of recommendation “best practices” described by other specialties. Content and face validation were performed prior to dissemination. This cross-sectional survey was administered to MFM program directors in February 2023. The primary outcome was the relative importance of letters of recommendation content areas. Secondary outcomes included the strength of each summative “code” phrase. Descriptive analysis was performed and principal component analysis (PCA) was then used to reduce the list of phrases to their underlying dimensions. Statistical analysis was performed by SPSS 29.0. ResultsOf 104 MFM program directors sent the survey, 70 (67%) responded. MFM program directors reviewed an average of 78 applications (SD, 30) with 60% writing ≥3 letters/year. Ninety-one percent of respondents noted that letters of recommendation are important/very important in shaping impressions of an applicant. Respondents reported the depth of interaction with an applicant, the applicant's specific behavior traits, the applicant's abilities and a summative statement including strength of the recommendation as important content for MFM fellowship letters of recommendation. Letter length, use of bold/italics, and restating the applicant's curriculum vitae were considered not important. Following PCA with varimax rotation, 14 specific phrases used in letters of recommendation were reduced to 5 themes: high qualitative assessments, average qualitative assessments, objective metrics, exceeding expectations and grit. These themes accounted for 64.6% of the variance in the model (KMO 0.7, Bartlett's Test of Sphericity p<.01). Phrases that respondents considered positive included: “Top 5%,” “Want to keep,” and “highest recommendation,” (all mean score≥4.5/5), while “expected level,” “showed improvement,” and “2nd quartile” were negatively associated code words (all mean score <2.5/5). ConclusionMFM program directors reported that descriptions of an applicant's abilities, behavior traits, and depth of the writer's interactions with the applicant were all important components of an MFM fellowship letters of recommendation. Letter length, bold/italics, and highlights from the CV were not important. A clear “code” emerged regarding summative phrases included in letters of recommendation. Dissemination of these data might help less experienced letter writers send a clearer message and ensure all letter writers have a shared mental model.

Decoding the Reference Letter: Strategies to Reduce Unintentional Gender Bias in Letters of Recommendation.

There is a growing body of literature on gender bias in letters of recommendation (LORs) in academic medicine and the negative effect of bias on promotion and career advancement. Thus, increasing knowledge about gender bias and developing skills to mitigate it is important for advancing gender equity in medicine. This workshop aims to provide participants with knowledge about linguistic bias (focused on gender), how to recognize it, and strategies to apply to mitigate it when writing LORs. We developed an interactive 60-minute workshop for faculty and graduate medical education program directors consisting of didactics, reflection exercises, and group activities. We used a postworkshop survey to evaluate the effectiveness of the workshop. Descriptive statistics were used to analyze Likert-scale questions and a thematic content analysis for open-ended prompts. We presented the workshop four times (two local and two national conferences) with one in-person and one virtual format for each. There were 50 participants who completed a postworkshop survey out of 74 total participants (68% response rate). Ninety-nine percent of participants felt the workshop met its educational objectives, and 100% felt it was a valuable use of their time. Major themes described for intended behavior change included utilization of the gender bias calculator, mindful use and balance of agentic versus communal traits, closer attention to letter length, and dissemination of this knowledge to colleagues. This workshop was an effective method for helping participants recognize gender bias when writing LORs and learn strategies to mitigate it.

Gender bias in colorectal surgery fellowship letters of recommendation

BackgroundAs leaders strive to create equitable surgical pipelines, one process under scrutiny is letters of recommendation (LORs). We sought to review the Colon and Rectal Surgery (CRS) Resident Candidate Assessment questionnaire and LORs for gendered differences. MethodsThis retrospective observational study of letters of recommendation to CRS fellowship during the 2018–2019 application cycle utilized linguistic Inquiry and Word Count (LIWC2015) software to assess letter length and themes comparing differences by applicant and referee gender. Results103 applicants (35 ​% women) with 363 LORs (16 ​% written by women) were included. Short answer responses were longer for women applicants, while LORs were longer for men applicants (368 vs 325 words p ​= ​0.03). Men applicants' strengths had more technical skill descriptors, while women applicants’ strengths had more emotional language and cognitive and perceptual words. ConclusionsThis study found significant differences between LORs written for CRS fellowship applicants based on gender.

Gender Bias in Letters of Recommendation for Cardiothoracic Surgery Applicants

BackgroundBias in letters of recommendation may have an impact on assessment of the cardiothoracic surgical applicant. Letters written for fellowship candidates might differ on the basis of the applicant's gender, although prior investigations have not explored this population. We aimed to evaluate gender differences in letters of recommendation written for cardiothoracic surgery applicants. MethodsLetters of recommendation written for applicants between 2015 and 2020 to a large, 2-year academic cardiothoracic surgical training program were reviewed. Data regarding applicants and letter writers were captured. A library of terms to describe applicants was created. Natural language processing was employed to detect differences in use of these terms in letters written for men vs letters written for women. Letter content was compared across applicant and writer characteristics by Kruskal-Wallis and t-tests. ResultsThere were 1707 letters of recommendation for 553 applicants analyzed: 430 letters for 147 (26.6%) women and 1277 letters for 406 (73.4%) men. Mean letter length was 498.4 (SD 209.3) words. Letters for men were longer (518.2 vs 491.7 words; P = .022). Men were more often described with terms of humility (P < .01), professionalism (P < .01), and integrity/honesty (P < .01), whereas women were more frequently described by terms of family (P < .01) and leadership (P < .01). Men writers described men applicants more often with gendered language (P < .01) and terms of humility (P < .01), personality (P < .01), and integrity/honesty (P < .01). ConclusionsWe identified gender-based differences in letters of recommendation for cardiothoracic surgery applicants as well as differences based on the writer's gender. These findings are critical to consider in the assessment of applicants as efforts are needed to minimize bias and to support a diverse future of our specialty’s workforce.

Music and Patronage in Light of letters of Dedication: Wacław of Szamotuły, Valentin Bakfark and King Sigismund II Augustus

In contemporary discourses of patronage in art, literature, theatre or music, the motives for becoming involved in patronage are a continuing subject of research interest. Although the area of motivation still remains unclear today, it is undoubtedly the case that the patrons’ initiatives were always linked to using the potential of art for political and propaganda purposes. With the arrival of music printing previous patronage practices took on a new shape. Printed editions, through their previously unachievable extent of distribution, now became a far-reaching instrument of representing high-born personages. The most common way of achieving this were dedication letters, produced with the intention of introducing a given work into broad social circulation. Among the few extant Polish music prints from the sixteenth century, the editions of works by Wacław of Szamotuły (1533) and Valentin Bakwark (1565) are of exceptional significance. This article investigates the paratexts included in this editions and examine both cases from the point of view of patronage practices. Paratexts in the two editions demonstrate the diversity of Renaissance patronage practices and provide examples of the rhetoric involved in the client-patron relationship. Wacław’s poem is exceptional not only against the background of Polish but also European music publishing. It does not contain a request for financial support but is a statement by someone deeply involved in the political life of the country and concerned about the fate of his homeland. Wacław’s poem should therefore be read in the political context and psychological climate of the Commonwealth at that time. It constitute an extension of diplomacy, introducing important accents into the policies of Sigismund Augustus. Bakwark’s dedication letter has a totally different character. It strikes the reader not only by its refined phraseology but also by the plethora of allusions from antique literature and the Bible. The most interesting aspect of the letter is the reference to the figure of Pope Leo X. Bakwark describes him as the perfect model of a Renaissance patron, to whom the world owed the development of art on a scale previously unknown. The letter contains also commentary on the style of Bakwark’s works and the characteristics of his compositional craft. The fact that the both dedications were written by the composers themselves, as well as the considerable length of both letters, point to the significance attached at that time to the paratexts. They indicated the importance of the achievements and activities of clients, at the same time building the prestige of the patron. But, above all, these paratexts demonstrate the different ways of exploiting the potential of art: in Wacław’s case, serving the aims of politics and propaganda; in the case of Bakwark, serving to create an image of the monarch as someone enlightened, sensitive and supportive of the art of music.

Effect of filters on the accommodation and colour discrimination

AbstractPurpose: To evaluate the effect of coloured filters on the accommodative response and colour discrimination in young subjects.Methods: Two long pass filters (LED light reduction and 511 nm filter), two selective absorption filters (ML41 and emerald filter), and no filter condition were evaluated. The photorefractor PowerRef3 (PlusOptix) was used to measure the objective refraction at 3 different distances (40, 100, and 400 cm). The measurement obtained at 400 cm was used as a reference to calculate the accommodative response. The fixation target consisted of five letter length words (size corresponding to 6/12 Snellen) that were presented in black font over white background. Words changed with a frequency of 2 Hz according to the rapid serial visual presentation paradigm. The Cambridge Colour Test (Metropsis) was used to measure the discrimination threshold in a 10‐vector ellipse at a 3 m viewing distance. The measurement was repeated twice, and it was performed monocularly. In total, 20 healthy volunteers with no accommodation problems or colour blindness were included.Results: On average, the accommodative response with no filter condition was larger compared to the measurements with filters for 40 and 100 cm. The differences were in all cases lower than 0.25D, and differences were not statistically significant (p &gt; 0.05). For the colour discrimination thresholds, the ML41 and 511 filters showed statistically significant different values compared to the other two conditions for most of the vectors. The filter 511 had the highest impact on the colour vision, as the results resemble to a Tritan defect.Conclusions: The accommodative response in healthy young adults was not significantly different than the no filter condition. The colour discrimination thresholds with the filter ML41 and 511 were significantly different compared to the no filter condition.

Effects of Acute Ashwagandha Ingestion on Cognitive Function.

Background: Ashwagandha (Withania somnifera) has been reported to decrease perceptions of stress, enhance mood, and improve cognitive function. However, it is currently unknown whether acute ashwagandha supplementation affects memory and cognitive function. This study evaluated the effects of acute ashwagandha extract ingestion on executive function. Materials and Methods: 13 healthy volunteers were administered the Berg–Wisconsin Card Sorting (BCST), Go/No-Go (GNG), Sternberg Task (STT), and Psychomotor Vigilance Task (PVTT) tests. Participants then ingested in a double-blind, placebo-controlled, and crossover manner 400 mg of a placebo (PLA) or ashwagandha (ASH) extract (NooGandha®, Specnova Inc., Boca Raton, FL, USA). Participants then performed cognitive function tests every hour for 6 h. After a 4-day washout period, volunteers repeated the experiment while receiving the remaining supplement. Data were analyzed by repeated measures General Linear Model multivariate and univariate statistics with body weight as a covariate. Results: Acute ASH supplementation increased STT-determined working memory as demonstrated by an improvement in 6 letter length, Present Reaction Time at 3 and 6 h. PVTT analysis revealed that ASH sustained attention by helping maintain reaction times, preventing mental fatigue, and remaining vigilant. Conversely, reaction times (at task 20, hour 6; overall, hour 3) increased with PLA. In the BCST, there was evidence that ASH increased the ability to recognize and ‘shift’ to a new rule compared with baseline. However, this was not seen when evaluating changes from baseline, suggesting that differences in baseline values influence results. In the GNG test, ASH ingestion promoted faster response times to respond correctly than PLA, indicating less metal fatigue. However, ASH did not affect accuracy compared to PLA, as both treatments decreased the percentage of correct answers. Conclusions: Acute supplementation with 400 mg of ashwagandha improved selected measures of executive function, helped sustain attention, and increased short-term/working memory.

Linguistic Differences by Gender in Letters of Recommendation for Female Pelvic Medicine and Reconstructive Surgery Fellowship Applicants From 2010 to 2020.

Linguistic differences suggestive of gender bias have been detected in letters of recommendation (LOR) for female and male residency and fellowship program applicants within multiple medical specialties. The aim of the study was to determine whether linguistic differences exist in LOR for female and male physicians applying to female pelvic medicine and reconstructive surgery (FPMRS) fellowship. A retrospective analysis of FPMRS fellowship applications submitted to a university-affiliated academic center from 2010 to 2020 was performed. Linguistic Inquiry and Word Count, a text analysis software, was used to characterize the linguistic content of letters. Multivariable analysis was used to compare letter characteristics with applicant and letter writer demographics. Of 306 applications reviewed, 221 (72.2%) applicants were female and 85 (27.8%) were male. Of the 1,062 letters analyzed, 457 (43.0%) were written by female letter writers, 586 (55.2%) by males, and 19 (1.8%) were a combination. Multivariable analysis controlling for race, Step 1 score, and letter writer gender demonstrated more frequent use of affiliation words for female applicants compared with males (3.1% ± 0.3 vs. 2.9% ± 0.3, P = 0.02). No additional differences were noted in average letter length or all other linguistic categories analyzed. Multiple differences were detected between writing styles of female and male letter writers, including average letter length, use of multiple word categories, and use of communal (relationship-oriented) language. Data were stratified into 2-year periods and no longitudinal trends in linguistic differences were detected. No linguistic differences, suggestive of gender bias, were found between female and male applicants to FPMRS fellowship.

Graphemes are used when reading: Evidence from Monte Carlo simulation using word norms from mega-studies.

Recently, Chetail (Journal of Memory and Language, 2020) has claimed there is no strong evidence that multi-letter graphemes are used in reading tasks with proficient adult readers, with most studies being statistically weak or having confounds in the stimuli used. Here, I used Monte Carlo simulation with data from reading mega-studies to examine the extent to which the number of multi-letter graphemes matters in words when letter length is held constant. This was done by simulating thousands of experiments using different sets of items for each of a small number of comparisons (e.g., words with only single-letter graphemes versus words with one multi-letter grapheme). The results showed that words with two multi-letter graphemes tended to cause slower reaction times than words with one or no multi-letter graphemes, with effects found in both naming and lexical decision tasks. Interestingly, when words with no multi-letter graphemes were compared with words with one multi-letter grapheme, the differences were much weaker. Simulations of naming results using two computer models, the connectionist dual-process (CDP) model and the dual-route cascaded (DRC) model, showed only CDP predicted this pattern. Since CDP learns simple associations between graphemes and phonemes whereas DRC uses a set of grapheme-phoneme rules, this suggests that the results may have been caused by simple associations between spelling and sound being relatively easy to learn with words with one compared with two multi-letter graphemes. More generally, the results suggest that graphemes are used when reading, but they often produce relatively weak effects and thus differences in some studies may not have been found due to a lack of power.

The Influence of Orthographic Units Across Korean Children of Different Ages in Hangul Reading

Using the dual-route reading model as a framework, this study investigated the following research questions on Hangul reading: Which orthographic units (e.g., letters, syllable blocks, and words) influence the reading performance of Korean-speaking children? In addition, do the influential units change as the children grow up? To answer these questions, we tested the effects of age, frequency, lexicality, and two types of length—the numbers of letters (letter length) and syllable blocks (syllable block length)—and the interactions of these factors in the reading performance of Korean-speaking preschool and primary school children from first to third grade. Regarding reading latencies, there was a significant three-way interaction of age × lexicality × length regardless of the type of length. This interaction indicated that, for words only, the interaction between age and length was significant. Accordingly, the length effect decreased as children’s age increased. When reading latencies for words were analyzed with a mixed-effect model consisting of three factors—age, frequency, and length—neither a main effect of syllable block length nor an interaction of syllable block length with age was significant. In contrast, the interaction of age × letter length in word reading latencies remained significant. The length effect was smaller as children’s age increased. In addition, the frequency effect was significant and interacted significantly with age. The frequency effect increased as children’s age increased. In conclusion, significant frequency effects indicate that Korean-speaking children use the lexical process in addition to the non-lexical process when reading Hangul words. Importantly, as children grow up, a larger orthographic unit, that is, words, is more strongly related to reading performance, whereas the influence of the smaller orthographic unit, that is, letters, decreases.

The impact of disclosure characteristics of application texts on the Science and Technology Innovation Board listed companies

This paper studies the impact of disclosure characteristics of the application texts on the successful listing of companies on the Science and Technology Innovation Board. The application texts include registration statements, inquiry letters, and response letters. The disclosure length, fog index, and redundancy are the disclosure characteristics of these three types of application texts. In the empirical analysis, we select 273 companies that have applied for listing on the Science and Technology Innovation Board from June 19, 2019, to January 31, 2021, as the research sample. Among them, 214 companies were successfully listed, and 59 companies failed to go public. By extracting the disclosure characteristics of three types of application texts, we established a logistics regression model to study the impact of disclosure characteristics of the application texts on the successful listing of companies on the Science and Technology Innovation Board. The empirical results show that the fog index of both registration statement and response letter has no significant impact on the companies’ successful listing. The disclosure length and redundancy of the registration statement are positively related to the company’s successful listing, while the number of questions of the inquiry letter and the disclosure length and redundancy of the response letter are negatively related.

Japanese orthographic complexity and speech duration in a reading task.

The number of letters in a word's orthographic form can affect speech duration. Previous research in this area has been limited to studies of languages with alphabets. The current study expands upon this previous research by investigating effects on speech duration from units of orthographic complexity potentially analogous to letter length in Japanese, a language with a logography. In a modified version of a reading task used in one of the prior studies, native Japanese-speaking participants were audio-recorded reading pairs of homophonous words that varied by: 1) number of pen strokes in a single character; or 2) number of whole characters in their orthographic forms. Two-character words were produced significantly longer than one-character words. No significant effect was found from pen strokes on speech duration. These results are presented as evidence that the orthographic duration effect observed in previous studies is not limited to languages with alphabetic writing systems.

Teaching plain language to medical students: improving communication with disadvantaged patients

BackgroundLow health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce.ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose.MethodsStudents, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students’ ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students).ResultsStudents scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool’s reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient’s medical condition.ConclusionsPlain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.

Exploring parents’ perceptions of the value of pediatric genetic counseling patient letters: A qualitative study presenting lessons learned

Genetic counseling patient letters are a valuable supplement to genetic counseling practice. As the demand for genetic services increases, improving efficiency in daily tasks such as letter writing could improve genetic counselor workflow. Additionally, understanding the value recipients place on the content of these letters prior to creating efficiencies is essential toward ensuring that the utility of these letters is not lost. To better understand parents' perceptions of the letter's value in the pediatric genetic counseling setting, we employed a qualitative design involving thirteen parents of children who received a patient letter following their diagnosis. Parents participated in a semi-structured focus group, interview, or phone interview, and the data were analyzed using thematic analysis. In addition to gathering perceptions of their child's letter, we sought to learn preferences for letter length, formatting, and level of detail by asking for verbal and written feedback on three different letter formats created for a fictional patient. We used self-determination theory (SDT) framework to create the sample letters, which states that an individual's experience of autonomy, competence, and relatedness can impact their ability to engage in activities. This includes caring for a child with special medical needs. While the findings from this work reinforced the importance of written communication for patients as seen in previous research, this work uncovered three major themes about the letter's value: (a) elements such as readability and content impact parent feelings of autonomy and improve competence moving forward with their child's care; (b) parents value written acknowledgment of the emotional impact of the diagnosis; and (c) parents use the letter as a tool to communicate their child's diagnosis with others. These results can be used for creating comprehensible patient letters that support autonomy, competence, and relatedness.

Kajian Dampak Ekonomi Hutan Desa Terhadap Pendapatan Petani Kampung Merabu (Kabupaten Berau, Provinsi Kalimantan Timur)

The purpose of this study is to answer the prior problems of analyzing the extent to which the effect of the duration of the decision letter is accepted, the size of the land, the number of labor, the transportation costs, the input costs, the partnership pattern, the knowledge of the status of the village forest, the participation of planning and implementation participation, and the participation of monev on farmer income in Merabu. The research method used in this research is explorative and analytical descriptive. In general, there is an increase in production, income and employment. Regression analysis proves that the length of the decision letter is accepted and the amount of labour has a positive effect on income significantly. Meanwhile, labour is a dominant variable affecting the income of Merabu. Since the status of village forests is published in 2014, farmers are beginning to transform to manage and utilize forest land. The number of workers had increased quite drastically from before and after the village forest decree received.

The Standardized Letter of Evaluation Narrative: Differences in Language Use by Gender.

IntroductionPrior research demonstrates gender differences in language used in letters of recommendation. The emergency medicine (EM) Standardized Letter of Evaluation (SLOE) format limits word count and provides detailed instructions for writers. The objective of this study is to examine differences in language used to describe men and women applicants within the SLOE narrative.MethodsAll applicants to a four-year academic EM residency program within a single application year with a first rotation SLOE available were included in the sample. We used the Linguistic Inquiry and Word Count (LIWC) program to analyze word frequency within 16 categories. Descriptive statistics, chi-squared, and t-tests were used to describe the sample; gender differences in word frequency were tested for using Mann-Whitney U tests.ResultsOf 1117 applicants to the residency program, 822 (82%) first-rotation SLOEs were available; 64% were men, and 36% were women. We did not find a difference in baseline characteristics including age (mean 27 years), top 25 schools (22.5%), Alpha Omega Alpha Honor Medical Society rates (13%), and having earned advanced degrees (10%). The median word count per SLOE narrative for men was 171 and for women was 180 (p = 0.15). After adjusting for letter length, word frequency differences between genders were only present in two categories: social words (women: 23 words/letter; men: 21 words/letter, p = 0.02) and ability words (women: 2 words/letter; men: 1 word/letter, p = 0.04). We were unable to detect a statistical difference between men and women applicants in the remaining categories, including words representing communal traits, agentic traits, standout adjectives, grindstone traits, teaching words, and research words.ConclusionThe small wording differences between genders noted in two categories were statistically significant, but of unclear real-world significance. Future work is planned to evaluate how the SLOE format may contribute to this relative lack of bias compared to other fields and formats.

An Investigation of the Impact of Data Breach Severity on the Readability of Mandatory Data Breach Notification Letters: Evidence From U.S. Firms

The aim of this article is to investigate the impact of data breach severity on the readability of mandatory data breach notification letters. Using a content analysis approach to determine data breach severity attributes (measured by the total number of breached records, type of data accessed, the source of the data breach, and how the data were used), in conjunction with readability measures (reading complexity, numerical intensity, length of letter, word size, and unique words), 512 data breach incidents from 281 U.S. firms across the 2012–2015 period were examined. The results indicate that data breach severity has a positive impact on reading complexity, length of letter, word size, and unique words, and a negative impact on numerical terms. Interpreting the results collectively through the lens of impression management, it can be inferred that business managers may be attempting to obfuscate bad news associated with high data breach severity incidents by manipulating syntactical features of the data breach notification letters in a way that makes the message difficult for individuals to comprehend. The study contributes to the information studies and impression management behavior literatures by analyzing linguistic cues in notifications following a data breach incident.

Developmental changes in the spelling of derivational suffixes by typically developing Greek children: effects of transparency, lexicality, letter length and frequency

The study aimed to investigate developmental changes in the spelling performance of derivational suffixes by 188 Greek school children (ages: 7–14 ½) of typical development, along with effects of t...

Gender and Letters of Recommendation: A Linguistic Comparison of the Impact of Gender on General Surgery Residency Applicants✰

We investigated letters of recommendation for general surgery residency applicants to determine if any gender-based disparities exist. A dictionary of over 400 terms describing applicants and 24 unique categories into which these terms were classified was created. Word count and language comparisons were performed using linguistic analysis software to assess for differences in applicant characterization, letter length, and writing style between male and female applicants and letter writers. A large, Midwest, academic general surgery residency program. Five hundred and fifty-nine letters of recommendation received during the 2015 and 2016 interview cycles were selected for analysis. Average word count was approximately equal for male and female applicants (503 vs 508, respectively). Female writers wrote longer letters (mean word count 545.5 vs 497.1, p = 0.028). "Standout" terms were more likely to be used to describe female applicants. Otherwise no statistically significant differences in applicant characterization were discovered. Letters of recommendation for general surgery are written using similar descriptive terms and lengths for male and female applicants. This suggests that there is no specific gender disadvantage with regard to letters of recommendation when applying for general surgery residency.

74 Sex Differences in Language of Standardized Letter of Evaluation Narrative for Emergency Medicine Residency Applicants

Sex differences in language for letters of recommendation have been identified in many professional fields. Our prior study evaluated the narrative portion of the emergency medicine Standardized Letter of Evaluation (SLOE) for all applicants invited to interview during a single residency application cycle. In this prior study, we found that letters of recommendation for women applicants had more frequent words related to “affiliation,” and contrary to prior research, “ability” words appeared with greater frequency for women applicants. We now aim to examine the differences in language used to describe men and women applicants within the SLOE narrative for all applicants in one application cycle, rather than only the invited applicants. All applicants to a 4-year urban, academic EM residency program within a single application year were included in the sample. Only SLOEs from the applicants’ first EM rotation were included. Exclusion criteria were: SLOE of applicants from non-Liaison Committee on Medical Education (LCME) schools or first rotation SLOE not available for download. Data was collected on applicant sex, age, Alpha Omega Alpha (AOA) designation, and medical school rank. The previously validated Linguistic Inquiry and Word Count (LIWC) program was used to analyze frequency of words within categories relevant to letters of recommendation. We assessed for differences by sex in 16 word categories (9 defined by the LIWC and 7 defined by word lists created by previous studies in the field). Descriptive statistics, chi-squared and t-tests were used to describe the sample, and Mann-Whitney U tests were used to compare the word counts by sex. Of 1001 applicants in the 2016 application cycle to our institution, 822 (82%) had a first rotation SLOE available for analysis. 64% were men and 36% were women; there were no differences between sex for baseline characteristics including: age (mean 27 years), top 25 schools (22.5%), AOA rates (12.7%), and having earned advanced degrees (10%). The median word count per SLOE narrative for men was 170 and for women was 180, which was not statistically different (p=0.15). Within the 16 word categories, after adjusting for letter length, word frequency differences between sex were only present in 2 categories: social words (women: 23 words/letter; men: 21 words/letter, p=0.05) and ability words (women: 2 words/letter; men: 1 word/letter, p=0.04).The remaining categories, including words representing communal or agentic traits and “standout” adjectives, “grindstone” traits, and teaching and research words were also not statistically different between men and women applicants. Building upon prior research in this expanded study population, our results indicate that there are minimal language differences by sex in SLOEs for EM applicants. The wording differences noted in 2 categories were statistically significant, but of unclear real-world significance with only a 1-2 word difference between sex. Future work could evaluate how the SLOE format may contribute to this relative lack of bias compared to other fields and formats.