Skip to main content
Northwestern University Feinberg School of Medicine
MD Education

Bias-Free Letters of Recommendation

Letters of recommendation are an important component of the residency application process. Similar to other narrative-based documents in medicine such as the Medical Student Performance Evaluation (MSPE), studies have found that letters of recommendation demonstrate gender and racial bias. We all hold unconscious bias, and while we try to avoid it, sometimes those biases can enter our writing and be reflected in the letters of recommendation that we write. Please review the information below provided to help you fairly and accurately describe student’s performance and avoid potential bias in the letters you write.

  • Use observations not inference. Give specific examples of behaviors based on direct observation of the student.
  • Do not mention age, race/ethnicity, marital status, children, physical characteristics or other personal attributes. If you believe this is an important factor in demonstrating the applicant’s performance and potential, ask the student if they want that information included in the letter.

Avoid Potentially Biased Language

Research shows:

  • Men are more likely to be described using standout adjective or references to awards and scholarship.
  • Women are more likely to be described using vague personality descriptors (i.e., delightful) or grindstone words.
  • Students from groups underrepresented in medicine are less likely to be described using terms that confer agency — such as descriptions of leadership or achievement.

Adjectives to Limit*

  • Caring
  • Compassionate
  • Hard-working
  • Conscientious
  • Dependable
  • Diligent
  • Dedicated
  • Tactful
  • Interpersonal
  • Warm
  • Helpful

Adjectives to Increase

  • Successful
  • Excellent
  • Accomplished
  • Outstanding
  • Skilled
  • Knowledgeable
  • Insightful
  • Resourceful
  • Confident
  • Ambitious
  • Independent

*Adapted from UCSF and the University of Arizona

Interested in testing your letter of recommendation to see if it is gender-biased? Check out the gender bias calculator.

References

  1. Rojek A, Khanna R,  Yim J, Gardner R, Lisker S, Hauer Lucey C, Sarkar U.  Differences in Narrative Language in Evaluations of Medical Students by Gender and Under-represented Minority Status. Journal of General Internal Medicine. 34. 10.1007/s11606-019-04889-9.
  2. Ross D, Boatright D,Nunez-Smith M, Jordan A, Chekroud A, Moore E. (2017). Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations. PLoS ONE. 12. 10.1371/journal.pone.0181659.
  3. csw.arizona.edu/sites/default/files/avoiding_gender_bias_in_letter_of_reference_writing.pdf
  1. Turrentine FE, Dreisbach CN, St Ivany AR, Hanks JB, Schroen AT. Influence of Gender on Surgical Residency Applicants' Recommendation Letters. J Am Coll Surg. 2019;228(4):356‐365.e3. doi:10.1016/j.jamcollsurg.2018.12.020
  2. 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. doi:10.1016/j.jacr.2019.08.008
  3. Filippou P, Mahajan S, Deal A, et al. The Presence of Gender Bias in Letters of Recommendations Written for Urology Residency Applicants. Urology. 2019;134:56‐61. doi:10.1016/j.urology.2019.05.065