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 recommenda-tion (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. Letters of recommendation 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 2094 LORs from 573 applicants: 78% were women, 24% were under-represented in medicine (URiM), and 39% were 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 sig-nificantly more agentic terms (8.5%) compared to women (6.7% agentic) or writers of both genders (3.1% communal) (P = .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 re-sidency selection processes is important in creating an equi-table approach to application review.