Gendered Language in Letters of Recommendation for Interventional Pulmonology Fellowship Candidates

Sex-based disparities persist in procedural subspecialties, including interventional pulmonology (IP). Letters of recommendation (LORs) are critical in fellowship applications, and prior research suggests sex-based bias in LORs for female candidates.

To evaluate gendered language and structural differences in LORs for IP fellowship candidates by applicant and letter writer sex.

This study analyzed 461 LORs from IP fellowship applications during the 2022 and 2023 cycles. LORs were deidentified and analyzed using the Linguistic Inquiry and Word Count program, supplemented by a custom dictionary capturing agentic, communal, and family terms. Statistical analyses assessed differences by applicant and letter writer sex, practice type, and academic rank.

A total of 461 LORs were reviewed. No significant differences were found in LOR length by applicant or writer sex. The frequency of agentic and communal terms was similar across groups. However, female letter writers used significantly more family-related terms than male letter writers did (0.16 vs. 0.09; P = 0.002). Secondary analyses revealed no consistent meaningful differences by letter writer age, practice type, or rank.

This study found limited evidence of sex-based bias in LORs for IP fellowship candidates. The results underscore the need for continued awareness and training to promote equity in the application process.