Letters of Recommendation to an Otolaryngology/Head and Neck Surgery Residency Program: Their Function and the Role of Gender

Objectives/Hypothesis: To ascertain common features and gender differences in letters of recommendation (LORs) for applicants to an otolaryngology/head and neck surgery (OHNS) residency program. Study Design: Retrospective review. Methods: Seven hundred sixty-three LORs submitted to one OHNS residency program in 2006 were reviewed. Results: All 763 letters "recommended" the applicant for OHNS residency. Ninety-one percent of letters were written by men, 68.4% by male otolaryngologists (OTOs), 4.2% by female OTOs, and 33% by OHNS department chairs or division chiefs (100% men). A comparison of female and male letter writers revealed five categories with significant differences: female letter writers were more likely to call an applicant a "team player" (P = .000), "compassionate," (P = .001) and use strings of adjectives (P = .024). In contrast, they were less likely when compared with male letter writers, to mention an applicant's Personal life (P = .003), or write "letters of minimal assurance" (P = .035). Evaluation of the letters by applicant gender revealed two findings: letter writers were more likely to use a gender term in letters for male applicants make reference to a female candidate's physical appearance (P = .040). Conclusions: LORs for OHNS residency universally advocate for the applicant. The letters are written predominately by the highest-ranking male OTOs in academic medicine. In the LORs, male and female applicants are described similarly. Male and female letter writers, however, often describe applicants in different ways regardless of applicant gender.