Gender Bias in Letters of Recommendation for Cardiothoracic Surgery Applicants

Bias 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.

Letters 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.

There 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).

We 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.