Writing Letters of Recommendation

As a clinical educator, you may be asked by students to write letters of recommendation.
You may ask the clerkship coordinator for the assessment you completed on the student when the student rotated with you. Your assessment will help your letter be more accurate!


An Academic Medicine article details how Pediatric, Surgery, and Internal Medicine residency Program Directors (PDs) interpret phrases written in letters of recommendation. The tables are especially useful.
Some striking takeaways:

  1. PDs from all three specialties considered “exceeded expectations” a positive phrase, “I recommend” a neutral phrase, and “showed improvement,” “performed at expected level,” and “overcame personal setbacks” negative phrases.
  2. PDs in all three specialties rated a letter describing the depth of interaction with the applicant among the most important letter features.
  3. Pediatric and Internal Medicine PDs preferred a description of an applicant’s involvement in community service and their compassion compared to surgery PDs, while surgery PDs indicated a description of an applicant’s resilience was more important.

A JAMA article poses ways to improve the residency application process in light of the COVID-19 pandemic. One recommendation is to "Improve the quality of information programs receive," particularly information "regarding an applicant’s integrity, reliability and dependability, motivation, initiative, teamwork, and professionalism." Including details or student interactions that demonstrate these characteristics would be useful to program directors.

Another important consideration when writing letters of recommendation is gender bias. Research shows that letters written for women were more often shorter, lacking of basic features of quality letters of recommendation, lacking status terms, and included more doubt raisers. Letters often reinforced gender biases such as portraying women as teachers and students and men as researchers and professionals. This article, by the Daily Muse, provides concrete strategies to use to avoid gender bias when writing assessment comments or letters of recommendation, such as avoid doubt raisers, focus on accomplishments and impact, tie soft skills to the role, understand the biases, counteract ingrained behaviors, and talk to the person you’re recommending.

FIU's STRIDE training uses these two slides to show how gender bias comes across in letters of recommendation. The take home message here is to be aware of these gender biases so that you can mitigate them.