Writing a Letter of Recommendation Without Bias

Letters of recommendation (LORs) play a pivotal role in the highly competitive orthopaedic surgery residency and fellowship applications, with increasing influence amid evolving evaluation metrics. LORs are crucial in providing nuanced insights into applicants' clinical competencies, personal qualities, and potential fit within programs, complementing standardized test scores and academic achievements. However, despite their importance, LORs are susceptible to implicit biases, particularly affecting women and underrepresented minorities. Research underscores disparities in language use, with gender and racial stereotypes influencing adjectival choices and narrative emphasis. Strategies to mitigate bias include adopting a consistent outline, emphasizing agentic and standout adjectives over communal and grindstone traits, and using precise language and specific examples. We advocate for LORs that are detailed, specific, equitable, and avoid stereotypes, aiming to support fair evaluation practices and promote diversity within orthopaedics. By examining current biases and proposing best practices, this review contributes to ongoing efforts to enhance equity in the residency and fellowship selection process.