Gender bias in colorectal surgery fellowship letters of recommendation

Background: As 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. Methods: This 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. Results: 103 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 1/4 0.03). Men applicants' strengths had more technical skill descriptors, while women applicants' strengths had more emotional language and cognitive and perceptual words. Conclusions: This study found significant differences between LORs written for CRS fellowship applicants based on gender.