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Calley DQ, Fu S, Hamilton MD, Kalla AW, Lee CK, Rasmussen VA, Hollman JH, Liu H. Assessment of Gender Differences in Letters of Recommendation for Physical Therapy Residency Applications. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00105. [PMID: 38640081 DOI: 10.1097/jte.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/27/2023] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Letters of recommendation (LOR) are an integral component of physical therapy residency applications. Identifying the influence of applicant and writer gender in LOR will help identify whether potential implicit gender bias exists in physical therapy residency application processes. REVIEW OF LITERATURE Several medical and surgical residency education programs have reported positive, neutral, or negative LOR female gender bias among applicants and writers. Little research exists on gender differences in LOR to physical therapy education programs or physical therapy residency programs. SUBJECTS Seven hundred sixty-eight LOR were analyzed from 256 applications to 3 physical therapy residency programs (neurologic, orthopaedic, sports) at one institution from 2014 to 2020. METHODS Thematic categories were developed to identify themes in a sample of LOR. Associations between writer and applicant gender were analyzed using summary statistics, word counts, thematic and psycholinguistic extraction, and rule-based and deep learning Natural Language Processing . RESULTS No significant difference in LOR word counts were found based on writer or applicant gender. Increased word counts were seen in sports residency LOR compared with the orthopaedic residency. Thematic analysis showed LOR gender differences with male applicants receiving more positive generalized recommendations and female applicants receiving more comments regarding interpersonal relationship skills. No thematic or psycholinguistic gender differences were seen by LOR writer. Male applicants were 1.9 times more likely to select all male LOR writers, whereas female applicants were 2.1 times more likely to choose all female LOR writers. DISCUSSION AND CONCLUSION Gender differences in LORs for physical therapy residencies were found using a comprehensive Natural Language Processing approach that identified both a positive recommendation male applicant gender bias and a positive interpersonal relationship skill female applicant gender bias. Applicants were not harmed nor helped by selecting LOR writers of the opposite gender. Admissions committees and LOR writers should be mindful of potential implicit gender biases in LOR submitted to physical therapy residency programs.
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Affiliation(s)
- Darren Q Calley
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - Sunyang Fu
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - Marissa D Hamilton
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - Austin W Kalla
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - Christopher K Lee
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - Veronica A Rasmussen
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - John H Hollman
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
| | - Hongfang Liu
- Darren Q. Calley is the residency director for the Mayo Clinic Physical Therapy Neurologic, Orthopaedic, & Sports Residency Programs in the Mayo Clinic School of Health Sciences, and is an assistant professor of Physical Therapy at the Mayo Clinic College of Medicine and Science, and is a faculty member in the Physical Therapy Doctoral Education Program at the Mayo Clinic, Siebens 7-57, 200 First Street SW, Rochester, MN, 55905 . Please address all correspondence to Darren Calley
- Sunyang Fu is an assistant professor of Biomedical Informatics, and is an associate director of Team Science at the Center for Translational AI Excellence and Applications in Medicine (TEAM-AI) at the University of Texas Health Science Center
- Marissa D. Hamilton is a physical therapist at Mayo Clinic
- Austin W. Kalla is a physical therapist graduate at Mayo Clinic
- Christopher K. Lee is a physical therapist at Mayo Clinic
- Veronica A. Rasmussen is a physical therapist at the Hennepin County Medical Center
- John H. Hollman is the program director of the Physical Therapy Doctoral Education Program, and is an associate dean for Academic Affairs in the Mayo Clinic School of Health Sciences, and is a professor of Physical Therapy in the Mayo Clinic College of Medicine and Science
- Hongfang Liu is a professor in the Biomedical Informatics, and is a director of Translational AI Excellence and Applications in Medicine (TEAM-AI), University of Texas Health Science Center
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Ramprasad A, Casubhoy I, Bachar A, Meister M, Bethman B, Sutkin G. Language in the Teaching Operating Room: Expressing Confidence Versus Community. JOURNAL OF SURGICAL EDUCATION 2024; 81:556-563. [PMID: 38383237 DOI: 10.1016/j.jsurg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/18/2023] [Accepted: 12/17/2023] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Previous work has analyzed residency letters of recommendation for agentic and communal language, but this has not been applied to spoken language. Our objective was to analyze intraoperative spoken language by attending and resident surgeons for the use of agentic and communal language. DESIGN We completed a linguistic inquiry and word count (LIWC) analysis on 16 operating room transcripts (total time 615 minutes) between attendings and resident surgeons for categories associated with agentic and communal speech. Wilcoxon signed rank and Mann-Whitney U tests were used to compare attending versus resident and male versus female speech patterns for word count; "I," clout, and power (agentic categories); and "we," authentic, social (communal categories). SETTING Midwestern academic university teaching hospital. PARTICIPANTS Sixteen male (9 attendings, 7 residents) and 16 female (7 attendings, 9 residents) surgeons, from 6 surgical specialties, most commonly from General Surgery. RESULTS Attending surgeons used more words per minute than residents (40.01 vs 16.92, p < 0.01), were less likely to use "I" (3.18 vs 5.53, p < 0.01), and spoke more language of "clout" (75.82 vs 55.47, p < 0.01). There were no significant differences between attendings and residents in use of analytic speech (23.72 vs 24.67, p = 0.32), "causation" (1.20 vs 1.08, p = 0.72), or "cognitive processing" (10.20 vs 10.54, p = 0.74). Residents used more speech with "emotional tone" (92.91 vs 79.92, p = 0.03), "positive emotion" (4.98 vs 3.86, p = 0.04), more "assent" language (4.89 vs 3.09, p < 0.01), and more "informal" language (9.27 vs 6.77, p < 0.01). There were no gender differences, except for male residents speaking with greater certainty than female residents, although by less than 1% of the total word count. CONCLUSIONS In the operating room, attending surgeons were more likely to use agentic language compared to resident surgeons based on LIWC analysis. These differences did not depend on gender and likely relate to surgeon experience and confidence, learning versus teaching, and power dynamics.
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Affiliation(s)
- Aarya Ramprasad
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Imaima Casubhoy
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Austin Bachar
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Melanie Meister
- Urogynecology and Reconstructive Pelvic Surgery, University of Kansas, Kansas City, Kansas
| | - Brenda Bethman
- Department of Race, Ethnic and Gender Studies, School of Humanities and Social Sciences, University of Missouri Kansas City, Kansas City, Missouri
| | - Gary Sutkin
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
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Chen JH, Costa P, Gardner AK. Maximizing Standardization While Ensuring Equity: Exploring the Role of Applicant Experiences, Attributes, and Metrics on Performance of a Surgery-Specific Situational Judgment Test. JOURNAL OF SURGICAL EDUCATION 2023; 80:1703-1710. [PMID: 37365117 DOI: 10.1016/j.jsurg.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Situational judgment tests (SJT) are hypothetical but realistic scenario-based assessments that allow residency programs to measure judgment and decision-making among future trainees. A surgery-specific SJT was created to identify highly valued competencies among residency applicants. We aim to demonstrate a stepwise process for validation of this assessment for applicant screening through exploration of two often-overlooked sources of validity evidence - relations with other variables and consequences. METHODS This was a prospective multi-institutional study involving 7 general surgery residency programs. All applicants completed the SurgSJT, a 32-item test aimed to measure 10 core competencies: adaptability, attention to detail, communication, dependability, feedback receptivity, integrity, professionalism, resilience, self-directed learning, and team orientation. Performance on the SJT was compared to application data, including race, ethnicity, gender, medical school, and USMLE scores. Medical school rankings were determined based on the 2022 U.S. News & World Report rankings. RESULTS In total, 1491 applicants across seven residency programs were invited to complete the SJT. Of these, 1454 (97.5%) candidates completed the assessment. Applicants were predominantly White (57.5%), Asian (21.6%), Hispanic (9.7%), Black (7.3%), and 52% female. A total of 208 medical schools were represented, majority were allopathic (87.1%) and located in United States (98.7%). Less than a quarter of applicants (22.8%; N=337) were from a top 25 school based on U.S. News & World Report rankings for primary care, surgery, or research. Average USMLE Step 1 score was 235 (SD 37) and Step 2 score was 250 (SD 29). Sex, race, ethnicity, and medical school ranking did not significantly impact performance on the SJT. There was no relationship between SJT score and USMLE scores and medical school rankings. CONCLUSIONS We demonstrate the process of validity testing and importance of two specific sources of evidence-consequences and relations with other variables, in implementing future educational assessments.
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Affiliation(s)
- Jennifer H Chen
- Department of Surgery, Baylor College of Medicine, Houston, Texas.
| | - Paula Costa
- SurgWise Consulting, Houston, Texas; ICF International, Fairfax, Virginia
| | - Aimee K Gardner
- Department of Surgery, Baylor College of Medicine, Houston, Texas; SurgWise Consulting, Houston, Texas
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Moran CJ, Dzara K, Frey-Vogel AS, Flaherty M, Hall D, Nelson BA, Sparger K, Stanley T, Yager P, Scott-Vernaglia S. Confidence of Faculty in Writing Letters of Recommendation for Pediatric Fellowship Applicants. Cureus 2023; 15:e49750. [PMID: 38161882 PMCID: PMC10757671 DOI: 10.7759/cureus.49750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The assessment of pediatric residents applying to subspecialty fellowship programs relies on faculty letters of recommendation (LOR). However, it is unclear if pediatric faculty are confident that their LOR are effective. OBJECTIVE This study aims to assess the confidence of pediatric faculty in writing an effective LOR for pediatric residents applying to subspecialty fellowship programs. METHODS Survey development was conducted using evidence-based best practices. Surveys were distributed via email in 2021 to all full-time pediatric faculty members who taught pediatric residents in a large academic medical center. Categorical values were compared by chi-square test. RESULTS Eighty-five out of 150 (57%) faculty members completed the survey. Forty-one percent of participants were very confident that their LOR provided adequate content to assess residents during the application process. Confidence was associated with higher academic rank (p=0.02), frequent contact with residents (p=0.01), and writing >2 LOR in the last five years (p=0.0002). Confident LOR writers were more likely to describe their own background, details about the resident's scholarly activity, and the resident's ability to work as part of a team. Thirty-five percent of respondents reported never considering gender bias when writing LOR, whereas 28% reported always considering gender bias. Eighty-seven percent of respondents reported an interest in receiving LOR writing guidelines. CONCLUSION Half of the faculty respondents were not very confident in their ability to write an effective LOR for pediatric residents applying for a fellowship. Faculty development and standardized instructions on writing effective LOR may be helpful both at the institutional and national levels, including the importance of considering gender bias when writing LOR.
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Affiliation(s)
- Christopher J Moran
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Kristina Dzara
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, USA
- Center for Educator Development, Advancement, and Research, Saint Louis University School of Medicine, Saint Louis, USA
| | - Ariel S Frey-Vogel
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Division of General Pediatrics, Mass General for Children, Boston, USA
| | - Michael Flaherty
- Division of Pediatric Critical Care Medicine, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Daniel Hall
- Division of General Pediatrics, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Benjamin A Nelson
- Division of Pediatric Pulmonology, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Katherine Sparger
- Division of Neonatology, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Takara Stanley
- Division of Pediatric Endocrinology, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Phoebe Yager
- Division of Pediatric Critical Care Medicine, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Shannon Scott-Vernaglia
- Division of General Pediatrics, Mass General for Children, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
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