Linguistic Biases in Letters of Recommendation for Radiation Oncology Residency Applicants from 2015 to 2019

Bhavana V. Chapman, Michael K. Rooney, Ethan B. Ludmir, Denise De La Cruz, Abigail Salcedo, Chelsea C. Pinnix, Prajnan Das, Reshma Jagsi, Charles R. Thomas, Emma B. Holliday

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


We aimed to investigate whether implicit linguistic biases exist in letters of recommendation (LORs) for applicants to radiation oncology (RO) residency. LORs (n = 487) written for applicants (n = 125) invited to interview at a single RO residency program from the 2015 to 2019 application cycles were included for analysis. Linguistic Inquiry and Word Count (LIWC) software was used to evaluate LORs for length and a dictionary of predetermined themes. Language was evaluated for gender bias using a publicly available gender bias calculator. Non-parametric tests were used to compare linguistic domain scores. The median number of the LORs per applicant was 4 (range 3–5). No significant differences by applicant gender were detected in LIWC score domains or gender bias calculator (P > 0.05). However, LORs for applicants from racial/ethnic backgrounds underrepresented in medicine were less likely to include standout descriptors (P = 0.008). Male writers were less likely to describe applicant characteristics related to patient care (P < 0.0001) and agentic personality (P = 0.006). LORs written by RO were shorter (P < 0.0001) and included fewer standout descriptors (P = 0.014) but were also more likely to include statements regarding applicant desirability (P = 0.045) and research (P = 0.008). While language was globally male-biased, assistant professors were less likely than associate professors (P = 0.0064) and full professors (P = 0.023) to use male-biased language. Significant linguistic differences were observed in RO residency LORs, suggesting that implicit biases related to both applicants and letter writers may exist. Recognition, and ideally eradication, of such biases are crucial for fair and equitable evaluation of a diverse applicant pool of RO residency candidates.

Original languageEnglish (US)
Pages (from-to)965-972
Number of pages8
JournalJournal of Cancer Education
Issue number4
StatePublished - Aug 2022
Externally publishedYes


  • Bias
  • Ethnicity
  • Gender
  • Graduate medical education
  • Race
  • Residency
  • Underrepresented in medicine
  • Women in medicine

ASJC Scopus subject areas

  • Oncology
  • Public Health, Environmental and Occupational Health


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