Linguistic Differences by Gender in Letters of Recommendation for Female Pelvic Medicine and Reconstructive Surgery Fellowship Applicants From 2010 to 2020

Importance Linguistic differences suggestive of gender bias have been detected in letters of recommendation (LOR) for female and male residency and fellowship program applicants within multiple medical specialties. Objective The aim of the study was to determine whether linguistic differences exist in LOR for female and male physicians applying to female pelvic medicine and reconstructive surgery (FPMRS) fellowship. Study Design A retrospective analysis of FPMRS fellowship applications submitted to a university-affiliated academic center from 2010 to 2020 was performed. Linguistic Inquiry and Word Count, a text analysis software, was used to characterize the linguistic content of letters. Multivariable analysis was used to compare letter characteristics with applicant and letter writer demographics. Results Of 306 applications reviewed, 221 (72.2%) applicants were female and 85 (27.8%) were male. Of the 1,062 letters analyzed, 457 (43.0%) were written by female letter writers, 586 (55.2%) by males, and 19 (1.8%) were a combination. Multivariable analysis controlling for race, Step 1 score, and letter writer gender demonstrated more frequent use of affiliation words for female applicants compared with males (3.1% +/- 0.3 vs. 2.9% +/- 0.3, P = 0.02). No additional differences were noted in average letter length or all other linguistic categories analyzed. Multiple differences were detected between writing styles of female and male letter writers, including average letter length, use of multiple word categories, and use of communal (relationship-oriented) language. Data were stratified into 2-year periods and no longitudinal trends in linguistic differences were detected. Conclusions No linguistic differences, suggestive of gender bias, were found between female and male applicants to FPMRS fellowship.