Gender and the Council of Emergency Medicine Residency directors standardized letter of recommendation

Objectives: Until 2002, the Council of Emergency Medicine Residency Directors standardized letter of recommendation (SLOR) prompted authors to predict how an applicant would rank on their match list. A ranking of guaranteed match (GM) was identified as the least common superlative response on the SLOR. That knowledge allowed precise identification of the best SLORs. The authors correlated GM with every possible author/applicant gender combination. Methods: This was a retrospective, observational study of 835 SLORs submitted in the 1998-1999 and 1999-2000 application cycles to one emergency medicine residency program. A standardized data collection instrument was used. Author/applicant gender combinations (M/M, M/F, F/F, F/M, M/M + F/F, and M/F + F/M) were analyzed with respect to GM by chi-square test, odds ratios with 95% confidence intervals, and logistic regression. Results: There was a statistically significant association between a female-authored/female-applicant SLOR and GM, with a female applicant two times more likely to get a GM from a female author than any other author/applicant gender combination (odds ratio, 2.0; 95% confidence interval = 1.1 to 3.8; p = 0.023). No other combination was significantly associated with GM. Conclusions: Female applicants to the authors' emergency residency program had a two times better chance of receiving a GM recommendation on a SLOR written by a female faculty member compared with any other possible gender combination of applicants and letter authors. Although the choice of GM has now been eliminated from the SLOR, the role of gender in relation to the SLOR merits further study.