Gender and Language in Letters of Recommendation for Obstetrics and Gynecology Fellowship Applications

Objective: To delineate the use of gender-biased language in letters of recommendation for Obstetrics and Gynecology fellowships and its impact on applicants.

Design: Fellowship letters of recommendation from 4 Obstetrics and Gynecology specialties at a single institution in 2020 were included.

Primary outcome: frequency of agentic and communal language in letters of recommendation using Linguistics Inquiry Word Count software.

Secondary outcomes: letter of recommendation length and language utilization by author gender and applicant success measured by interviews and match success. Marginal models were fit to determine if language varied by applicant and writer gender and subspecialty. Modified Poisson regression models were used to determine associations between language and interview receipt.

Setting: Single academic institution (Duke University); 2020 OB/GYN fellowship application cycle.

Participants: A total of 1216 letters of recommendation submitted by 326 unique applicants for OB/GYN subspecialty fellowships at our institution.

Results: Rates of gender-biased language were low (Agentic:1.3%; communal: 0.8%). Agentic term use did not vary by applicant or author gender (p = 0.78 and 0.16) Male authors utilized 19% fewer communal terms than females (p < 0.001). Each 0.25% increase in agentic language was associated with an 18% reduction in the probability of interview invitation at our institution (p = 0.004). Percentage of agentic or communal language was not associated with successful matching into any subspecialty.

Conclusions: No differences in agentic vs communal language based on applicant gender were found in this cohort, though female letter writers wrote longer letters with more communal terms. Increasing agentic terms negatively impacted interview invitation but did not affect successful matching.