Research: Study finds gender-based differences in letters of recommendation written for general surgery residency candidates

By Suzanne Boles

A new study led by clinician-researchers at Schulich Medicine & Dentistry reveals differences in the letters of recommendation written for male versus female candidates of general surgery residency programs, which may affect residency selection committees' perceptions and rankings of the applicants.

The study, conducted by Drs. Jennifer Koichopolos, Michael Ott, Allison Maciver and Julie Ann Van Koughnett, assessed 215 reference letters written for 51 general surgery applicants through the Canadian Resident Matching Service (CarMS). The researchers looked for systematic differences in the descriptors used for male and female applicants, as well as differences based on male and female authorship.

A list of attributes describing male and female applicantsVan Koughnett, Associate Professor with the Divisions of General Surgery and Surgical Oncology, notes that there is existing, published data showing differences in how applicants are described in various specialties, as well as some gender-based differences in opportunities between female and male surgical residents and what sub-specialties they choose to pursue.

Koichopolos, MD’16, a critical care fellow at the School, says the new study, published in the Canadian Journal of Surgery, showed a notable difference in the number of letters written by female authors for female applicants (30 per cent) versus female authors for male applicants (15 per cent).

Other differences included the use of adjectives and some subtle distinctions that become apparent to the critical eye.

"Some of the patterns we saw were that male applicants were more often described by their achievements, such as their scholarly work and extracurricular activities. Female applicants were more likely described by their attributes, such as being a good communicator, or being kind and keen to help and responsive to feedback," said Van Koughnett.

The study focused on acknowledging the distinctions that exist, but both Koichopolos and Van Koughnett agree that the most obvious question to address next is what these differences mean.

"How the applicants are perceived by the program and interviewers and if that impacts how they're ranked when applying to programs are very difficult questions to answer," said Van Koughnett, adding that the differences are very subtle and likely unconscious.

"After starting to work on this project, I talked to many general surgeons and there was a lot of disbelief that there would be any differences between genders in reference letters,” said Koichopolos. “I think a lot of the bias is subconscious or unconsciously done, and this study is shedding light on the issue.”

Looking ahead, possible resolutions may include using blinded gender letters of reference, removing names and gender pronouns, or standardizing letters of recommendation, which has been adopted by some Canadian residency programs in different specialties.

"It's great to see that the gender distribution in medical school is equal and that general surgery programs in Canada are basically equal," said Van Koughnett. "But it's important to look at whether there are additional barriers that one gender has to overcome over another gender. That's hard to capture, but it's something we should continue to study."