American Society for Peripheral Nerve

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Letters of Recommendation for Integrated Plastic Surgery Residency Highlight Unconscious Gender Bias
Byrd Nichols, BS; Anna Pavlov, MD; Tara Rao, MS; Alex Fanning, BA; Lloyd Edwards, PhD; Michelle Roughton, MD
University of North Carolina, Chapel Hill, NC

Introduction: Letters of recommendation may be the most important component of a residency application. We hypothesize that letters of recommendation are significantly affected by unconscious gender bias.

Methods: A retrospective, IRB-exempt review of standardized letters of recommendation (SLOR) for all medical student applicants to our integrated plastic surgery residency program for the last two years, 2014-2015 (n=177) and 2015-2016 (n=182) was performed. Synonymous strengths and weaknesses were combined, and their use was recorded for each applicant.

Results: Female medical students comprise 37% (134/359) of applicants to our integrated plastic surgery residency program. Only 9.5% (128/1346) of letters were written by women. Women were nearly twice as likely (OR 1.8, 1.2-2.8) to be described as quiet, reserved, or shy and more than three times as likely to be described as a pleasure to teach (OR 3.2, 1.3-7.8). However, women were only half as likely as their male counterparts to be praised for their knowledge base (OR 0.6, 0.3-0.97). Some adjectives were exclusively used to describe female applicants, such as "strikingly beautiful," "chatty," and "enjoyable." Terminology aside, women were slightly more likely to successfully match than their male counterparts.

Conclusions: Letters of recommendation are powerful tools in resident selection. Understanding subtle biases in how letter writers describe male and female applicants will help to more fairly and successfully promote and recruit resident physicians.

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