Gender and Racial Bias in Radiology Residency Letters of Recommendation

Objective: Perceptions of agency and communality vary by race and gender, which may be contributing to the persistent gender and racial inequality in radiology. The objective of this study was to determine if there are differences in the use of agentic and communal language in letters of recommendation for radiology residency programs based on the demographics of the applicant and letter writer. Methods: We retrospectively reviewed letters of recommendation for 736 diagnostic radiology residency applicants to Duke University from the 2015 to 2016 interview season. We then used computerized text analysis software to calculate the frequency of agentic and communal terms and multilevel negative binominal regression to compare differences in count by applicant and letter writer demographics. Results: We analyzed 2,624 letters of recommendation, comprising 976,489 words. The majority of applicants were male (75%, 549 of 736) and white or Asian (77%, 565 of 736). Letter writers, who were mostly male (75%, 1,979 of 2,624) and of senior rank (50%, 1,313 of 2,624), described female applicants as more agentic than men (incidence rate ratio [IRR] = 1.08, P < .05) and described blacks and Latinx applicants as less agentic than whites and Asians (IRR = 0.932, P < .05). Secondary analysis showed that female letters writers described applicants as more agentic (IRR = 1.09, P < .05) and more communal (IRR = 1.12, P < .01) than did male writers, and senior rank faculty used agentic (IRR = 0.95, P < .05) and communal (IRR = 0.88, P < .01) language less often than did junior faculty. Conclusion: The extent to which agentic and communal language is used in letters of recommendation for diagnostic radiology residency programs differs by applicant and letter writer demographics.