By Kate Madden Yee, AuntMinnie.com staff writer

September 9, 2019 -- Racial bias continues to dog radiology, particularly in letters of recommendation for medical students applying to residency programs, according to a study published online September 6 in the Journal of the American College of Radiology.

The findings have implications for residency programs because letters of recommendation can influence who gets invited for interviews, lead author Dr. Lars Grimm of Duke University Medical Center in Durham, NC, told AuntMinnie.com.

"There is no real training for letter writers and only recently have efforts been put forth to standardize letters of recommendation," he said. "The implicit or explicit biases of letter writers might bleed through into their work and influence an applicant's chances of success."

It's no secret that racial imbalance in radiology exists, Grimm and colleagues noted. One of the ways it is expressed is in language with terms that communicate agency (i.e., competence, aggressiveness, independence) or communality (kindness, helpfulness, sympathy). For people of color, there's often an "incongruity between agentic [agency] traits and stereotypes," Grimm and colleagues wrote.

"The incompetent stereotypes (e.g., inept, lazy) attributed to racial minorities are frequently perceived as incompatible with agentic characteristics that tend to define professional roles and are deemed valuable in radiology," the group wrote.

Grimm's team hypothesized that agentic and communal language in letters of recommendation would match racial stereotypes of applicants. The study included 2,624 letters of recommendation for 736 diagnostic radiology residency applications in the year 2015 to 2016. The researchers used text analysis software to assess the frequency of agency and communal terms, and compared differences in use of these terms by applicant and letter writer characteristics.

In all, 75% of both the applicants and letter writers were male; of the applicants, 77% were white or Asian. Fifty percent of the letter writers were of senior rank.

Overall, letter writers described black and Latinx applicants as less agentic than whites and Asians. Senior faculty used agentic and communal language less often than did junior faculty.

Agentic and communal terms by applicant and letter writer characteristics
  Agency Communality
Characteristic Mean % of terms per letter Mean % of terms per letter
Applicant
White or Asian 0.98% 0.38%
Underrepresented minority 0.93% 0.41%
Letter writer
Female 1% 0.42%
Male 0.95% 0.37%
Junior 1% 0.41%
Senior 0.93% 0.34%

"When considering race, letter writers were more inclined to use agency when describing white and Asian applicants rather than black and Latinx applicants," the team wrote. "Furthermore ... letter writers used a more inclusive set of agentic descriptors, like work ethic, confidence, and leader potential, to distinguish whites and Asians from underrepresented minorities."

The study findings show that letter writer demographics do influence language, and it may be necessary to institute training programs to raise awareness of this, according to Grimm and colleagues.

"Further work is justified to understand the implications of agentic and communal language on applicant match success and to develop better practice guidelines or educational interventions for letter writers," they concluded.


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