Linguistic Differences in Letters of Recommendation for Maternal Fetal Medicine Fellowship Applicants

INTRODUCTION: Multiple medical specialties have previously reported on gender bias in letters of recommendation (LORs). We aimed to determine if linguistic differences exist in LORs for male and female applicants to a maternal fetal medicine (MFM) fellowship at an academic institution. METHODS: This was an institutional review board (IRB)-approved retrospective single-site cohort study conducted from 2019-2021. Data collected included applicant’s age, race, self-reported gender, geographic region of residency, Step 1 and 2 scores, scholarly and volunteer activities, and number of LORs. The Linguistic Inquiry and Word Count (LIWC) software, a validated text analysis program, was used to characterize LORs’ linguistic content. Multivariable analysis was used to compare letter characteristics to applicant demographics. RESULTS: A total of 212 applications were reviewed, including 808 LORs. Women comprised 76.9% of applicants and men 23.1%. Most applicants identified as non-Hispanic White (52.8%). Men were more likely to be international medical graduates (20% vs. 6%, P =<.01), and women reported more volunteer activities (7.1 ± 5.1 vs. 5.5 ± 4.3, P =.04). There were no significant differences in Step scores, number of research projects, or number of LORs. Multivariable analysis controlling for applicant race, Step 1 score, and gender of the letter writer revealed that letters written for males contained significantly more references to the word category cognitive processes (7.4 ± 0.2 vs. 7.1 ± 0.1, P =.046), specifically in reference to the subcategories of certainty and differentiation. CONCLUSION: We identified linguistic differences in LORs written for MFM applicants, suggesting potential bias in the style of writing for male and female physicians applying to this field.