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Article / Publication Details

Received: December 02, 2022
Accepted: January 27, 2023
Published online: April 11, 2023

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3

ISSN: 0301-1569 (Print)
eISSN: 1423-0275 (Online)

For additional information: https://www.karger.com/ORL

Abstract

Introduction: The persistent lack of racial and ethnic diversity within the field of otolaryngology calls for an analysis of potential bias within the residency application system. Letters of recommendation (LORs) and personal statements (PSs) are the most important subjective application constituents. This subjectivity predisposes these components to implicit bias. In applications to various surgical subspecialties, prior linguistic studies assessing bias in reviews of LOR show race-based differences. Thus far, racial and ethnic linguistic differences in LORs for otolaryngology applicants have not been analyzed in the literature. Methods: LORs and PSs were abstracted from otolaryngology – head and neck surgery applications in the Electronic Residency Application Service for the 2019–20 and 2020–21 application cycles. Linguistic Inquiry and Word Count 2015 was used for quantitative analysis of emotional, cognitive, and structural components of written text. Results: Race-pair analysis of the 2019–2021 application cycles revealed higher mean “teaching” scores for LORs for Asian, black, Hispanic, and white applicants when compared to applicants who self-identified as Other. White applicants had lower scores for the terms “research” and “analytic” when compared to Asian and black applicants, respectively. Analysis of PSs revealed greater scores for an “authentic” writing style for white versus Asian applicants. White applicants were found to have higher scores for “tone” compared to black applicants. Conclusion: Minor racial and ethnic language differences exist in both LORs and PSs. A statistically significant difference was observed among LORs, with the “teaching” term used more frequently for Asian, black, Hispanic, and white applicants compared to self-identified Other individuals. For PSs, statistically significant differences were observed among white applicants, who wrote about themselves using more “authentic” language when compared with Asian applicants and who also had higher scores for “tone” compared to black applicants. Although these differences were statistically significant, the practical impact of the variances is likely small.

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References Hucko L, Al-Khersan H, Lopez Dominguez J, Cavuoto KM, Scott NL, Williams BKJr, et al. Racial and ethnic diversity of U.S. Residency programs, 2011-2019. N Engl J Med. 2022;386(22):2152–3. Kirby JB, Taliaferro G, Zuvekas SH. Explaining racial and ethnic disparities in health care. Med Care. May 2006;44(5 Suppl l):I64–72. Elster A, Jarosik J, VanGeest J, Fleming M. Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. Arch Pediatr Adolesc Med. 2003;157(9):867–74. Penner LA, Hagiwara N, Eggly S, Gaertner SL, Albrecht TL, Dovidio JF. Racial healthcare disparities: a social psychological analysis. Eur Rev Soc Psychol. 2013;24(1):70–122. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8. Rabinowitz HK, Diamond JJ, Veloski JJ, Gayle JA. The impact of multiple predictors on generalist physicians’ care of underserved population. Am J Public Health. 2000;90(8):1225–8. Shen MJ, Peterson EB, Costas-Muniz R, Hernandez MH, Jewell ST, Matsoukas K, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5(1):117–40. Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from oakland. Am Econ Rev. 2019;109(12):4071–111. Jetty A, Jabbarpour Y, Pollack J, Huerto R, Woo S, Petterson S. Patient-physician racial concordance associated with improved healthcare use and lower healthcare expenditures in minority populations. J Racial Ethn Health Disparities. 2022;9(1):68–81. Landon BE, Onnela JP, Meneades L, O’Malley AJ, Keating NL. Assessment of racial disparities in primary care physician specialty referrals. JAMA Netw Open. 2021;4(1):e2029238. Collins JC, Rocco TS. Disparities in healthcare for racial, ethnic, and sexual minorities. New Dir Adult Continuing Education. 2014;2014:5–14. Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care?J Health Soc Behav. 2002;43(3):296–306. Wilbur K, Snyder C, Essary AC, Reddy S, Will KK, Mary S. Developing workforce diversity in the health professions: a social justice perspective. Health Professions Education. 2020;6(2):222–9. AAMC. Underrepresented in medicine definition. 2004. Tusty M, Flores B, Victor R, Fassiotto M, Maldonado Y, Howard J, et al. The long “race” to diversity in otolaryngology. Otolaryngol Head Neck Surg. 2021;164(1):6–8. Acosta D, Poll-Hunter N, Eliason J. Trends in racial and ethnic minority applicants and matriculants to U.S. Medical schools. Association of American Medical Colleges; 1980. Vol. 17. AAMC. Fall applicant, Matriculant, and Enrollment Data Tables December. 2021. Nieblas-Bedolla E, Williams JR, Christophers B, Kweon CY, Williams EJ, Jimenez N. Trends in race/ethnicity among applicants and matriculants to US surgical specialties, 2010–2018. JAMA Netw Open. 2020;3(11):e2023509. Nguemeni Tiako MJ, Johnson S, Muhammad M, Osman NY, Solomon SR. Association between racial and ethnic diversity in medical specialties and residency application rates. JAMA Netw Open. 2022;5(11):e2240817. AAMC. 2021 report on residents. Table B5. Number of active MD residents, by race/ethnicity (alone or in combination) and GME specialty. Washington (DC); 2021. Lopez EM, Farzal Z, Ebert CSJr, Shah RN, Buckmire RA, Zanation AM. Recent trends in female and racial/ethnic minority groups in U.S. Otolaryngology residency programs. Laryngoscope. Feb 2021;131(2):277–81. Smith JB, Chiu AG, Sykes KJ, Eck LP, Hierl AN, Villwock JA. Diversity in academic otolaryngology: an update and recommendations for moving from words to action. Ear Nose Throat J. 2021;100(10):702–9. Choinski K, Lipsitz E, Indes J, Phair J, Gao Q, Denesopolis J, et al. Trends in sex and racial/ethnic diversity in applicants to surgery residency and fellowship programs. JAMA Surg. 2020;155(8):778–81. National Resident Matching Program. Data release and research committee: results of the 2020 NRMP program director survey. Washington (DC): National Resident Matching Program; 2020. Bradford PS, Akyeampong D, Fleming MA2nd, Dacus AR, Chhabra AB, DeGeorge BRJr. Racial and gender discrimination in hand surgery letters of recommendation. J Hand Surg Am. 2021;46(11):998–1005.e2. Grimm LJ, Redmond RA, Campbell JC, Rosette AS. Gender and racial bias in radiology residency letters of recommendation. J Am Coll Radiol. 2020;17(1 Pt A):64–71. Chapman BV. Rooney MK, Ludmir EB, De La Cruz D, Salcedo A, Pinnix CC, et al. Linguistic biases in letters of recommendation for radiation oncology residency applicants from 2015 to 2019. J Cancer Educ. 2022;37(4):965–972. Powers A, Gerull KM, Rothman R, Klein SA, Wright RW, Dy CJ. Race- and gender-based differences in descriptions of applicants in the letters of recommendation for orthopaedic surgery residency. JB JS Open Access. 2020;5(3):e20.0002. Jarman BT, Kallies KJ, Joshi ART, Smink DS, Sarosi GA, Chang L, et al. Underrepresented minorities are underrepresented among general surgery applicants selected to interview. J Surg Educ. 2019;76(6):e15–e23. Dream S, Olivet MM, Tanner L, Chen H. Do male chairs of surgery have implicit gender bias in the residency application process?Am J Surg. 2021;221(4):697–700. Tausczik YR, Pennebaker JW. The psychological meaning of words: LIWC and computerized text analysis methods. J Lang Soc Psychol. 2010;29(1):24–54. Trix F, Psenka C. Exploring the color of glass: letters of recommendation for female and male medical faculty. Discourse Soc. 2003;14(2):191–220. Pennebaker JW, Boyd RL, Jordan K, Blackburn K. The development and psychometric properties of LIWC 2015. Austin (TX): University of Texas at Austin; 2015. N. R. M. Program. “2020 Main Residency Match”. 2020. N. R. M. Program. “2021 Main Residency Match”. 2021. Article / Publication Details

Received: December 02, 2022
Accepted: January 27, 2023
Published online: April 11, 2023

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3

ISSN: 0301-1569 (Print)
eISSN: 1423-0275 (Online)

For additional information: https://www.karger.com/ORL

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