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

OBJECTIVE: To describe differences in agentic (achievement) and communal (relationship) terms in letters of recommendation (LORs) for pediatric residency candidates by applicant and letter writer demographics and to examine if LOR language is associated with interview status.

METHODS: A random sample of applicant profiles and LORs submitted to one institution were analyzed from the 2020-21 Match. LOR text was inputted into a customized natural language processing application which determined the frequency of agentic and communal words in each LOR. Neutral LORs were defined as having <5% surplus of agentic or communal terms.

RESULTS: We analyzed 2,094 LORs from 573 applicants: 78% were women, 24% under-represented in medicine (URiM), and 39% invited to interview. Most letter writers were women (55%) and of senior academic rank (49%). Overall, 53% of LORs were agency biased, 25% communal biased, and 23% neutral. There was no difference in agency and communally biased LORs by an applicant's gender (Men 53% agentic vs. Women 53% agentic, p=.424), race or ethnicity (Non-URiM 53% agentic vs. URiM 51% agentic, p=.631). Male letter writers used significantly more agentic terms (8.5%) compared to women (6.7% agentic) or writers of both genders (3.1% communal) (p=0.008). Applicants invited to interview were more likely to have a neutral LOR, however, no significant association existed between language and interview status.

CONCLUSIONS: No significant differences in language were found by applicant gender or race among pediatric residency candidates. Identifying potential biases within pediatric residency selection processes is important in creating an equitable approach to application review.