Language Patterns in Letters of Recommendation for Residency Applicants in Otolaryngology

Objective: Assess for gender and race patterns in agentic and communal language used in letters of recommendation for Otolaryngology-Head and Neck Surgery (OHNS) residency applicants.Study design: Retrospective content analysis.Setting: Applications from OHNS applications at a single training institution for the 2019 and 2020 match cycles.Methods: A total of 2283 letters of recommendation for 611 OHNS applicants were analyzed. Applicant and letter writer gender, applicant race and ethnicity, and applicant characteristics including United States Medical Licensing Examination (R) Step 1 score, research productivity, and medical school rank were extracted. Agentic and communal word use from the letters of recommendation was compared across applicant and writer characteristics using multilevel negative binomial regression modeling.Results: Letter writers use a greater rate of agentic terms when describing applicants who self-identify as Asian (incidence rate ratio [IRR] = 1.16, p < .01) or "Other/not reported" (IRR = 1.23, p < .01) as compared to white applicants. Further, standardized letters of evaluation had significantly more communal language and less agentic language. Although there was an increase in communal language in letters for female applicants compared to male applicants, these gender differences disappeared in the multivariate model.Conclusion: Multivariate analysis demonstrated no significant gender-based patterns in the communal or agentic language in letters of recommendation for OHNS residency applicants. However, letters for applicants identifying as Asian or "other/not reported" had more frequent use of agentic terms. Future studies should investigate other components of residency applications to assess how gender and race bias might unfairly influence an applicant's chances at a given program.