I read your Fall 2020 issue on Women and Diversity with great interest. Drs. Kamilla Esfahani and Allison Bechtel highlighted leadership development seminars at the University of Virginia titled, Women in Anesthesia and Women in Surgery, conducted in early 2020. Among the featured topics, the role of language in reflecting, and likely furthering, our gender biases.
My own research into gendered language in letters of recommendation for surgery residency demonstrated that letters for male applicants are longer, more likely to contain references to leadership and achievement, and a greater use of superlatives.
Letters for women more frequently included references to work ethic and featured grindstone adjectives and positive but general terms.1 I cannot conclude from this work whether these differences in letter content correlate with different outcomes in the Match.
My bigger concern, however, is that gender biases reflected in the word choices of the letter writers have longer term effects for a new generation at the start of their careers. Do these biases influence: Whom and how we mentor others? Whom and what we sponsor? What opportunities we make available and how readily we offer them?
When I started this work, I was convinced I did not write recommendation letters that were different by applicant gender. And if others did write with gender differences, I would have noticed after more than 15 years of reading these recommendation letters.
Of course, I did not notice. I did not even pick up on a pattern of letter lengths. My results showed that gendered language was present in letters from both men and women writers. Finally, this work did not begin to uncover how the biases of the letter readers come into play.
Reducing inequity will not happen naturally over time, or at least not at an acceptable pace – studies have already confirmed this.2,3 Achieving equity, and thereby full inclusion, requires intention and design, awareness and engagement, and leadership and action.
By all of us taking stock of our biases, then, we can and must address lingering inequities in advancements, pay, and leadership opportunities in medicine. Therefore, I am grateful that you chose to highlight efforts and viewpoints directed at creating a more inclusive work environment for all in your recent issue.
Anneke Schroen, MD, MPH
Associate Professor, Surgery
University of Virginia
- Turrentine FE, Dreisbach CN, St Ivany AR, Hanks JB, Schroen AT. Influence of gender on surgical residency applicants’ recommendation letters. J Am Coll Surg 2019;228:356-67.
- Abelson JS, Chartrand G, Moo T, Moore M, Yeo H. The climb to breast the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg 2016;212:566-72.