Gender-based linguistic differences in letters of recommendation for rhinology fellowship over time: A dual-institutional follow-up study using natural language processing and deep learning.

KEY POINTS: This follow-up dual-institutional and longitudinal study further evaluated for underlying gender biases in LORs for rhinology fellowship. Explicit and implicit linguistic gender bias was found, heavily favoring male applicants.

Nature in Seclusion. The Monastic Republic of Letters in Southern Germany.

Monasteries were famous for their extensive libraries and richly decorated churches. Less well known are their observatories and their mathematical-physical collections with telescopes, air pumps, and friction machines. But how did the way of life in the monastery and scientific practices influence each other? This paper examines the interaction of scientific practices and religious way of life using the example of southern German monasteries in the second half of the eighteenth century. It shows how the monks pragmatically linked monastic life and research practice, thereby forming their own specific scientific culture. This closes an important gap in the understanding of scholarship in the eighteenth century by foregrounding the monasteries as places of knowledge production, which have so far received little attention alongside universities and academies.

Development of Dynamic Contrast Sensitivity Chart.

Background: Dynamic visual acuity (DVA) is a complex visual function that requires the observer to detect a moving target, to visually acquire it by eye movements, and to resolve critical details contained in it, in a relatively brief time exposure. Dynamic contrast sensitivity (DCS) functions are determined over a range of angular velocities to complement the traditional contrast sensitivity (CS) functions (obtained with stationary targets). Methodology: A new chart is constructed to assess DCS by chosen 5×5 grid and Sloan letters (D, H, N, U, V, R, Z, S, K, O, C). Letters are constructed at a constant visual acuity of six lines having the contrast varied at each interval of the line. Each line has six letters and each line subtends different contrast (0.20 logCS-1.70 logCS). The chart has a motor of 45 revolutions per minute (rpm) and 30 rpm and measured among the normal population of the age group of 17 to 30. Results: Results shows that CS declines once the target stimulus is in motion. There was a statistically significant difference (p < 0.05) between the stimulus speeds of 30 rpm and 45 rpm. Dynamic contrast sensitivity values increased for lower target velocity indicating that as speed of the target stimulus increases, CS decreases. Conclusion: This study concludes that the DCS decreases as the velocity increases. Consequently, incorporating the DCS chart into comprehensive eye examinations provides a holistic understanding of an individual's visual function.

Enhancing Clarity and Patient Safety: Evaluating the Inclusion of Laterality in Orthopaedic Outpatient Correspondence in Galway, Ireland.

Background In medical documentation, accurate mention of laterality, whether a condition or treatment pertains to the left or the right side of the body, is critical for avoiding errors like wrong-site surgeries, which can have severe repercussions. This study aims to assess compliance regarding the mention of laterality in outpatient clinic letters at Galway University Hospital. Methods An analytical cross-sectional study was conducted at Galway University Hospital from February to August. We reviewed outpatient letters in the Orthopaedic Department. The Fisher exact and Chi-square tests were employed to observe the association between the levels of practitioners and laterality. Results A total of 278 outpatient letters from 37 practitioners in one week were analyzed. The overall laterality rate was 65.1%. It was observed that there was a male predominance in the workforce (31; 83.8%). Conclusion In conclusion, our study revealed satisfactory improvement in the prevalence of mentioning laterality among healthcare providers. It is recommended that educational sessions and re-auditing be carried out to enhance the quality of care.

Can artificial intelligence make elective hand clinic letters easier for patients to understand?

We investigated whether ChatGPT was able to increase the Flesch reading ease and the Flesch-Kincaid reading level of elective clinic letters written by hand surgeons. ChatGPT could not reliably simplify the hand clinic letters any further.

Machine Learning for Predictive Analysis of Otolaryngology Residency Letters of Recommendation.

INTRODUCTION: Letters of recommendation (LORs) are a highly influential yet subjective and often enigmatic aspect of the residency application process. This study hypothesizes that LORs do contain valuable insights into applicants and can be used to predict outcomes. This pilot study utilizes natural language processing and machine learning (ML) models using LOR text to predict interview invitations for otolaryngology residency applicants. METHODS: A total of 1642 LORs from the 2022-2023 application cycle were retrospectively retrieved from a single institution. LORs were preprocessed and vectorized using three different techniques to represent the text in a way that an ML model can understand written prose: CountVectorizer (CV), Term Frequency-Inverse Document Frequency (TF-IDF), and Word2Vec (WV). Then, the LORs were trained and tested on five ML models: Logistic Regression (LR), Naive Bayes (NB), Decision Tree (DT), Random Forest (RF), and Support Vector Machine (SVM). RESULTS: Of the 337 applicants, 67 were interviewed and 270 were not interviewed. In total, 1642 LORs (26.7% interviewed) were analyzed. The two best-performing ML models in predicting interview invitations were the TF-IDF vectorized DT and CV vectorized DT models. CONCLUSION: This preliminary study revealed that ML models and vectorization combinations can provide better-than-chance predictions for interview invitations for otolaryngology residency applicants. The high-performing ML models were able to classify meaningful information from the LORs to predict applicant interview invitation. The potential of an automated process to help predict an applicant's likelihood of obtaining an interview invitation could be a valuable tool for training programs in the future. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Health budget cuts will be paid for by the most vulnerable.

No abstract available.

Pearls and pitfalls in letters of recommendation for neurology residency applications.

Letters of recommendation are a cornerstone of residency applications. Variability and bias in letters exists across specialties, neurology being no exception. Studies done in other specialty fields assessing nuanced language uncovered key attention points for improvement and mitigation of bias, lessons from which should be applied in the field of neurology. We review common pearls and pitfalls in the letter solicitation, writing and reading process, with suggested best-practices for residency applicants, letter writers, and program faculty reviewers. We advocate for the thoughtful selection of writers, emphasis on highlighting professional skills, and attention to implicit bias. This discussion focuses on recommendations for US advanced or categorical neurology programs, but elements of this guidance may apply more broadly to fellowship and faculty promotion letters as well.

Program Directors' Perspectives on Residency Applications in the Post‒United States Medical Licensing Examination Step 1 Era: A Case for Standardized Letters of Recommendation?

INTRODUCTION: The United States Medical Licensing Examination (USMLE) Step 1 test evolved into a key metric utilized by program directors (PDs) in assessing candidates for residency. The transition to a USMLE Step 1 binary pass/fail scoring system has resulted in a loss of an important objective assessment. With national movements toward pass/fail systems for clerkship grading and trends toward abandonment of class ranking, assessing residency applications has become increasingly challenging. METHODS: The Society of Academic Urologists convened a task force to, in part, assess the perspectives of urology PDs regarding the importance of various aspects of a residency application for predicting clinical performance. An anonymous survey was disseminated to all urology PDs in the US. Perspectives on 11 potential application predictors of clinical performance and demographics were recorded. Descriptive statistics characterized PD responses. Friedman test and pairwise Wilcoxon tests were used to evaluate the relative ranks assigned to application elements by PDs. RESULTS: There was a 60.5% response rate (89/147). Letters of recommendation (LORs) were ranked as the most important predictor, with a mean rank of 2.39, median of 2 (IQR 1-3). Clerkship grades and USMLE Step 1 were comparable and ranked second. Medical school reputation ranked the lowest. There was significant subjective heterogeneity among categories; however, this was less so for LORs, which predominated as the most important factor among application elements (P < .001). CONCLUSIONS: To our knowledge, this is the largest sample size assessing PD perspectives on application factors that predict clinical performance. The second (clerkship grades) and third (USLME Step 1) most important factors moving toward binary pass/fail systems create an opportunity for actionable change to improve assessment objectivity. Our data demonstrate LORs to be the most important factor of residency applications, making a compelling argument for moving toward a standardized LOR to maximize this tool, mitigate bias, and improve interreviewer reliability.

"Letter to my future self" as a device for assessing health education effectiveness.

OBJECTIVE: To examine whether a "letter to my future self" analyzed using structural topic modeling (STM) represents a useful technique in revealing how participants integrate educational content into planned future behaviors. METHODS: 453 club-sports athletes in a concussion-education randomized control study wrote two-paragraph letters describing what they hoped to remember after viewing one of three randomly assigned educational interventions. RESULTS: A six-topic solution revealed three topics related to the content of the education and three topics related to the participant behavioral takeaways. The content-related topics reflected the educational content viewed. The behavioral takeaway topics indicated that the Consequence-based education was more likely to generate the Concussion Seriousness[CS:23%] topic while Traditional(24%) and Consequence-based(20%) interventions were more likely to generate the Responsibility for Brain Health[BH] topic. Traditional(21%) and Revised-symptom(17%) interventions were more likely to generate the Awareness and Action topics. CONCLUSION: Unstructured user-generated data in the form of a "letter to my future self" analyzed using structural topic modeling provides a novel evaluation of the present and likely future impact of educational interventions. PRACTICE IMPLICATIONS: Patient educators can enhance the effectiveness of education through the application of these methods to the evaluation of and innovation in programs.

What's in a Name? Experimental Evidence of Gender Bias in Recommendation Letters Generated by ChatGPT.

BACKGROUND: Artificial intelligence chatbots such as ChatGPT (OpenAI) have garnered excitement about their potential for delegating writing tasks ordinarily performed by humans. Many of these tasks (eg, writing recommendation letters) have social and professional ramifications, making the potential social biases in ChatGPT's underlying language model a serious concern. OBJECTIVE: Three preregistered studies used the text analysis program Linguistic Inquiry and Word Count to investigate gender bias in recommendation letters written by ChatGPT in human-use sessions (N=1400 total letters). METHODS: We conducted analyses using 22 existing Linguistic Inquiry and Word Count dictionaries, as well as 6 newly created dictionaries based on systematic reviews of gender bias in recommendation letters, to compare recommendation letters generated for the 200 most historically popular "male" and "female" names in the United States. Study 1 used 3 different letter-writing prompts intended to accentuate professional accomplishments associated with male stereotypes, female stereotypes, or neither. Study 2 examined whether lengthening each of the 3 prompts while holding the between-prompt word count constant modified the extent of bias. Study 3 examined the variability within letters generated for the same name and prompts. We hypothesized that when prompted with gender-stereotyped professional accomplishments, ChatGPT would evidence gender-based language differences replicating those found in systematic reviews of human-written recommendation letters (eg, more affiliative, social, and communal language for female names; more agentic and skill-based language for male names). RESULTS: Significant differences in language between letters generated for female versus male names were observed across all prompts, including the prompt hypothesized to be neutral, and across nearly all language categories tested. Historically female names received significantly more social referents (5/6, 83% of prompts), communal or doubt-raising language (4/6, 67% of prompts), personal pronouns (4/6, 67% of prompts), and clout language (5/6, 83% of prompts). Contradicting the study hypotheses, some gender differences (eg, achievement language and agentic language) were significant in both the hypothesized and nonhypothesized directions, depending on the prompt. Heteroscedasticity between male and female names was observed in multiple linguistic categories, with greater variance for historically female names than for historically male names. CONCLUSIONS: ChatGPT reproduces many gender-based language biases that have been reliably identified in investigations of human-written reference letters, although these differences vary across prompts and language categories. Caution should be taken when using ChatGPT for tasks that have social consequences, such as reference letter writing. The methods developed in this study may be useful for ongoing bias testing among progressive generations of chatbots across a range of real-world scenarios. TRIAL REGISTRATION: OSF Registries osf.io/ztv96; https://osf.io/ztv96.

Do certain phrases in letters of recommendation predict success in fellowship performance?

BACKGROUND: Letters of recommendation (LORs) are a valued, yet imperfect tool. Program directors (PDs) score phrases such as give my highest recommendation and top 5 to 10% of students as positive. Although positive phrases are valued by PDs, there is no evidence that these phrases predict performance. We attempt to identify whether 12 specific phrases found in letters of recommendation predict future performance of fellows. METHODS: LORs were evaluated for 12 select phrases and statements. Alpha Omega Alpha (AOA) status, Step 2 Clinical Knowledge (CK) score, and whether the letter writer was personally known to our admission's committee were also categorized. Logistic regressions were performed to evaluate the relationship of the independent variables with fellow performance. RESULTS: Using multivariate logistic regression, one of the best residents (OR = 4.02, 95% CI (1.0, 15.9), p < 0.05), exceeds expectations (OR = 4.74, 95% CI (1.4, 16.3), p = 0.01), and give my highest recommendation (OR = 3.87, 95% CI (1.3, 11.7), p = 0.02) predicted positive performance. Highly recommend (OR = 0.31, 95% CI (0.1, 1.0), p < 0.05) and top 5 to 10% (OR = 0.05, 95% CI (0.0, 0.6), p = 0.02) predicted negative performance. The remaining phrases did not correlate to fellowship performance. CONCLUSION: The current LOR evaluation process may place undo importance on phrases that have limited bearing on a candidate's success in training. Training both letter readers and writers to avoid using coded language or avoid assigning improper importance to select phrases may help improve the candidate selection process.

Writing effective letters of recommendation in physiology.

A letter of recommendation is a statement of support for a person that has been requested by some individual or organization. In physiology, the purpose of the letter may be to support admission to an academic program, funding of a fellowship grant proposal, consideration for a trainee position in a research laboratory, an award from a professional society, or an application for a job. The goal of the letter should be to provide personalized insight into the suitability of the candidate for the position or award that cannot be easily obtained from other materials in an application or nomination process. Despite the importance of writing effective letters of recommendation, most physiologists receive no formal training in this requisite professional skill. In this Perspective, I first discuss the responsibilities and challenges of writing letters of recommendation, for whom you should consider writing a letter, the pros and cons of asking the candidate to create an initial draft, and the information required for you to write a letter. I then describe a helpful structure to follow when writing a letter of recommendation, including the opening paragraph (introduction), main body, and summary sections. Next, I share 10 insider tips for writing effective letters of recommendation. I complete the commentary by discussing special circumstances, including writing letters for solid but not highly ranking candidates and acting as a "substitute" for a primary mentor. It is hoped that this perspective will provide guidance for early career physiologists in this essential skill of the profession.NEW & NOTEWORTHY This Perspective provides essential background, a step-by-step guide, and key insider tips for writing an effective letter of recommendation aimed at helping early career physiologists with this important professional task.

Nurses engaging with referral letters and discharge summaries: A qualitative study.

AIMS: To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice. DESIGN: This study comprised a qualitative, case-study design within a constructivist paradigm using convenience sampling. METHODS: Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus-group sessions. The data were transcribed and analysed inductively. RESULTS: In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. CONCLUSION: Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans. IMPACT: Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing. REPORTING METHOD: We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives.

Purpose: Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care. Methods: We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively. Results: We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals. Conclusion: A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.

Gender bias in colorectal surgery fellowship letters of recommendation.

BACKGROUND: As leaders strive to create equitable surgical pipelines, one process under scrutiny is letters of recommendation (LORs). We sought to review the Colon and Rectal Surgery (CRS) Resident Candidate Assessment questionnaire and LORs for gendered differences. METHODS: This retrospective observational study of letters of recommendation to CRS fellowship during the 2018-2019 application cycle utilized linguistic Inquiry and Word Count (LIWC2015) software to assess letter length and themes comparing differences by applicant and referee gender. RESULTS: 103 applicants (35 â€‹% women) with 363 LORs (16 â€‹% written by women) were included. Short answer responses were longer for women applicants, while LORs were longer for men applicants (368 vs 325 words p â€‹= â€‹0.03). Men applicants' strengths had more technical skill descriptors, while women applicants' strengths had more emotional language and cognitive and perceptual words. CONCLUSIONS: This study found significant differences between LORs written for CRS fellowship applicants based on gender.

[«Our whole family does not get out of the common cold¼: an ear, throat and nose disease in the conditions of S.P. Botkin]. / «Vse nashe semeistvo ne vykhodit iz nasmorka¼: zabolevaniya ukha, gorla i nosa v okruzhenii S.P. Botkina.

The article presents an epistolary insight into the history of otorhinolaringology in Russia. It shows pathology of ear, nose and throat, which S.P. Botkin faced: cases of diseases of empress Maria Aleksandrovna, grand duke Vyacheslav Konstantinovich, poet N.A. Nekrasov, publisher A.A. Kraevsky, Sergey Petrovich himself, his relatives and loved ones. The biographical singularity of the famous doctor's patients is noted. On the materials of family letters of 1855-1889 yrs., service diaries of 1872-1889 yrs. and S.P. Botkin's clinical lectures it is shown how daily cases and casuistry of otorhinolaryngology pathology formed scientific innovative ideas.

Interdependency in lateralization of written word and face processing in right-handed individuals.

It has been suggested that the right hemisphere lateralization typically observed for face processing may depend on lateralization of written word processing to the left hemisphere; a pattern referred to as the causal complementary principle of lateralization. According to a strong version of this principle, a correlation should be found between the degree of left and right hemisphere lateralization for word and face processing respectively. This has been observed in two studies, but only for left-handed individuals. The present study tested whether a similar lateralization pattern could be found in a relatively large sample of right-handed individuals (N = 210) using behavioral measures (divided visual field paradigms). It was also tested whether the degree of right hemisphere lateralization for face and global shape processing would correlate positively, as predicted by a strong version of the input asymmetry principle of lateralization. This was tested in a subsample (n = 189). Bayesian analyses found no evidence for lateralization interdependency as the observed data were 4-17 times more likely under the null hypothesis. Unfortunately, the reliabilities of the lateralization measures were found to be poor. While this dampens the firmness of the conclusions that can be drawn, it is argued that at present there is no positive evidence for strong interdependency between written word and face processing in right-handed individuals.

Navon letters and composite faces: same or different processing mechanisms?

Navon letters and composite faces are two fascinating demonstrations of hierarchical organization in perception. Many researchers believe that the two types of stimuli and their associated tasks gauge comparable holistic mechanisms. This belief is so common that the two paradigms are now being applied in tandem to measure impaired holistic processing in prosopagnosic patients. But are Navon letters and composite faces processed in a similar fashion? In the present study we take a closer look at their apparent affinity. We gain novel insights into their underlying mechanisms by fitting parameters of the linear ballistic accumulator (LBA) model to empirical correct and incorrect response times (RTs). The results reveal major differences in processing between the two tasks. We conclude that despite the presence of a compelling surface similarity, Navon compound letters and composite faces tap into separate psychological processes.