Words Used in Letters of Recommendation for Pediatric Residency Applicants: Demographic differences and impact on interviews

Program directors (PDs) receive numerous residency applications. Although the process of screening and selecting applicants is varied, among the standardized submission materials, PDs frequently cite letters of recommendation (LORs) as an important consideration in the decision to interview.1 While LORs are valuable and used in decision-making, the language within LORs may differ by applicant demographics. Psychosocial research has described two language domains reflecting individuals’ aims and characteristics: agency and communion.2 Agentic terms, such as ‘efficient,’ ‘assertive,’ and ‘confident,’ center on achievement. Communal terms focus on relationship building, such as ‘empathetic,’ ‘understanding,’ and ‘reliable.’2 Men and individuals who identify as White or Asian are more likely to be described using agentic terms, whereas women and individuals who identify as Black or Latinx are more likely to be described using communal terms.3, 4, 5 Agentic traits are perceived as important for success in science,6 and thus differences in descriptive terms and known stereotypes may impact hiring and promotions.7, 8, 9, 10

Gender or racial stereotypes may lead to the use of certain words in LORs. For residency positions, women and applicants from underrepresented in medicine (URiM) backgrounds were more likely to be described using communal terms in general surgery, urology, and emergency medicine,11, 12, 13 but not obstetrics and gynecology.14 No data exist for pediatric applicant LORs and associations between LOR language and applicant selection for interviews is unknown. The primary objectives of our study were to determine if the use of agentic and communal terms in LORs to one pediatric residency program differed by applicant gender, race, ethnicity, letter writer gender and/or rank. We also sought to determine if there was an association between the use of agentic and communal terms in LORs and an interview invitation.

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