University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Postgrad Med J. 2023 May 22;99(1170):272-278. doi: 10.1136/postgradmedj-2021-140045.
Reference letters play an important role for both postgraduate residency applications and medical faculty hiring processes. This study seeks to characterise the ways in which gender bias may manifest in the language of reference letters in academic medicine. In particular, we conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Embase, MEDLINE and PsycINFO from database inception to July 2020 for original studies that assessed gendered language in medical reference letters for residency applications and medical faculty hiring. A total of 16 studies, involving 12 738 letters of recommendation written for 7074 applicants, were included. A total of 32% of applicants were women. There were significant differences in how women were described in reference letters. A total of 64% (7/11) studies found a significant difference in gendered adjectives between men and women. Among the 7 studies, a total of 86% (6/7) noted that women applicants were more likely to be described using communal adjectives, such as "delightful" or "compassionate", while men applicants were more likely to be described using agentic adjectives, such as "leader" or "exceptional". Several studies noted that reference letters for women applicants had more frequent use of doubt raisers and mentions of applicant personal life and/or physical appearance. Only one study assessed the outcome of gendered language on application success, noting a higher residency match rate for men applicants. Reference letters within medicine and medical education exhibit language discrepancies between men and women applicants, which may contribute to gender bias against women in medicine.
推荐信对于研究生住院医师申请和医学教师招聘过程都很重要。本研究旨在描述性别偏见在学术医学推荐信中的语言表达上可能表现出的方式。具体来说，我们根据系统评价和荟萃分析的首选报告项目进行了系统回顾。我们从数据库建立到 2020 年 7 月在 Embase、MEDLINE 和 PsycINFO 中搜索了评估住院医师申请和医学教师招聘中推荐信的性别语言的原始研究。共纳入 16 项研究，涉及 7074 名申请人的 12738 封推荐信。申请人中共有 32%为女性。推荐信中对女性的描述存在显著差异。共有 64%（7/11）的研究发现男性和女性之间推荐信中的性别形容词存在显著差异。在这 7 项研究中，共有 86%（6/7）指出女性申请人更有可能被描述为具有集体形容词，如“令人愉快”或“富有同情心”，而男性申请人更有可能被描述为具有代理形容词，如“领导者”或“杰出”。一些研究指出，女性申请人的推荐信更频繁地使用疑问词、提及申请人的个人生活和/或外貌。只有一项研究评估了性别语言对申请成功的影响，指出男性申请人的住院医师匹配率更高。医学和医学教育中的推荐信存在男女申请人之间的语言差异，这可能导致医学领域对女性的性别偏见。
