Rostmeyer Kaleb, Yong Valeda, Deng Mengying, Chin Kristine, Lutzow Lynde, Erkmen Kadir, Erkmen Cherie P
Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
Department of Surgery, Temple University Hospital, Philadelphia, Pa.
J Thorac Cardiovasc Surg. 2025 Mar;169(3):718-726.e1. doi: 10.1016/j.jtcvs.2024.09.037. Epub 2024 Sep 26.
Cardiothoracic surgery lacks racial diversity. Attracting the best candidates requires valuing diversity and advancing a recruitment process that minimizes racial bias. Implicit bias in recommendation letters has been identified as an influential mechanism for lack of diversity in cardiothoracic surgery. We aim to investigate how applicant race impacts language used in cardiothoracic surgery fellowship recommendation letters.
We examined applications to an accredited cardiothoracic surgery fellowship program between 2017 and 2021. Recommendation letter authors were categorized as cardiothoracic and noncardiothoracic surgeons. Applicant self-reported race was dichotomized as White and non-White. Applicant characteristics were described using standard descriptive statistics and compared between applicant race. Recommendation letters were examined with linguistic analysis software and higher-level analysis to assess language associations between applicant race and author specialty.
A total of 597 recommendation letters were analyzed from 158 individual applications. Cardiothoracic surgeons composed 334 (55.9%) recommendation letters. A total of 95 applicants (60.1%) were categorized as White. White applicants were described as more driven (P = .03), whereas letters for non-White applicants were more authentic (P = .02) and highlighted past experiences (P = .05). Cardiothoracic surgeons wrote longer letters (P = .04) with standout adjectives (P = .03) more frequently for White applicants and emphasized perceptiveness (P = .02) more often when writing for non-White applicants.
We demonstrate that authors' recommendation letters are influenced by applicant race. Letters written for White candidates are significantly longer and more descriptive of drive and outstanding characteristics than letters written for non-White candidates, particularly when written by cardiothoracic surgeons. Addressing this bias is crucial for recruiting the best candidates for cardiothoracic surgery.
心胸外科领域缺乏种族多样性。吸引最优秀的候选人需要重视多样性，并推进一个能将种族偏见降至最低的招聘流程。推荐信中的隐性偏见已被确认为是心胸外科缺乏多样性的一个影响因素。我们旨在研究申请人的种族如何影响心胸外科住院医师培训推荐信中使用的语言。
我们审查了2017年至2021年间一个经认可的心胸外科住院医师培训项目的申请。推荐信作者分为心胸外科医生和非心胸外科医生。申请人自我报告的种族分为白人及非白人。使用标准描述性统计方法描述申请人特征，并在不同种族申请人之间进行比较。使用语言分析软件和高级分析方法审查推荐信，以评估申请人种族与作者专业之间的语言关联。
共分析了来自158份个人申请的597封推荐信。心胸外科医生撰写了334封（55.9%）推荐信。共有95名申请人（60.1%）被归类为白人。白人申请人被描述为更有动力（P = 0.03），而非白人申请人的推荐信更真实（P = 0.02）且突出过往经历（P = 0.05）。心胸外科医生为白人申请人撰写的推荐信更长（P = 0.04），更频繁地使用突出形容词（P = 0.03），而为非白人申请人撰写推荐信时更常强调洞察力（P = 0.02）。
我们证明了作者的推荐信会受到申请人种族的影响。为白人候选人撰写的推荐信明显比为非白人候选人撰写的更长，且对动力和突出特征的描述更多，尤其是由心胸外科医生撰写时。解决这种偏见对于招募心胸外科最优秀的候选人至关重要。
