Study explores gender, racial bias in radiology residency letters of recommendation

Applicant and author demographics shape the language found in letters of recommendation for radiology residency programs, according to new research published by the Journal of the American College of Radiology.

“The communal stereotypes ascribed to women and the incompetent stereotypes (eg, inept, lazy) attributed to racial minorities are frequently perceived as incompatible with agentic characteristics that tend to define professional roles and are deemed valuable in radiology,” wrote Lars J. Grimm, MD, MHS, department of radiology at Duke University Medical Center in Durham, North Carolina, and colleagues. “Given that the field of radiology is dominated by whites and men, it is conceivable to reason that differing racial and gendered perceptions may play a role when applicants seek positions as radiologists.”

Grimm et al. studied data from 736 diagnostic radiology residency applications submitted through the Electronic Residency Application Service in the 2015 and 2016 application years. The text of each letter of recommendation—more than 2,600 letters overall—was analyzed using specific software that quantifies key language metrics.

One of the team’s primary areas of focus was agentic and communal content. Language associated with racial minorities were also tracked closely.

“We hypothesize that agentic and communal language in letters of recommendation will conform with traditional gender and racial stereotypes of applicants,” the authors wrote.

While 75% of the applicants were male, 77% were white or Asian. Also, 75% of the letter authors were male; the letters were written by male letter authors for male applicants 56% of the time.

Overall, letter authors described female applicants as more agentic than men and described black and Latinx applicants as less agentic than white or Asian applicants. Female letter authors described the applicants as agentic and more communal than male authors. Senior faculty members, who made up half of the letter authors, used agentic and communal language less than junior faculty members.

“Our results show that letter writers used agentic language more frequently to describe female applicants than male applicants,” the authors wrote. “At first glance, this result may seem surprising because perceptions of agency seem in conflict with traditional feminine stereotype. However, these findings are consistent with recent research demonstrating that women are sometimes perceived as possessing more rather than less agency when specific types of agency (ie, competence) are under consideration.”

The researchers also noted that letter authors used “a more inclusive set of agentic descriptors, like work ethic, confidence and leader potential” when talking about white and Asian applicants compared to underrepresented minorities (URMS).

“This suggests URMs may be perceived to differ from whites and Asians on more types of agency than women are perceived to differ from men,” the authors wrote. “Although racial differences in the field of radiology have not been well studied, these findings are in line with generally favorable biases toward whites and negative perceptions that have been shown to persist toward racial minorities in social science research and in the limited research that has considered race in medical school admissions.”

Grimm and colleagues concluded that medical schools and residency selection committees should keep these findings in mind. Medical schools could look at implementing training programs aimed at faculty members who may be asked to write letters of recommendation. Selection committees, meanwhile, should keep remember these differences when making their decisions.