15 Furthermore, extreme variability appears to be at odds with the MSPE Task Force's stated goals to “achieve a level of standardization and transparency that facilitates the residency selection process.” 3 Currently, program directors are expected to read and interpret nearly 150 different versions of the MSPE. 14 Similarly, business literature has suggested that readability variability on annual reports results in obfuscation. Turning to clinical literature, consistency in reporting is considered necessary for interpretation. This is compounded by variations in visual display, making readability challenging. The vast majority (88.7%) of schools include the grade distribution however, there are numerous variations in grade type (eg, honors type vs numerical). While 81.6% of schools report on the assessments that contribute to clerkship grades, the actual components vary from school to school. The clerkship grades, while consistently reported by most schools, is an area ripe for misinterpretation and creates barriers in making comparisons across schools due to the variations in content. Among the “others” were the dean, career advisors, academic advisors, and select faculty. Lastly, more than half of MSPEs (58.0%, 83 of 143) were signed by a dean of student affairs, leaving 42.0% (60 of 143) signed by other faculty. Beyond the descriptor term, 60.8% (87 of 143) provided a narrative describing the student in the summary paragraph. Representative examples are provided in the Box. About two-thirds (69.2%, 99 of 143) included an overall descriptor of comparative performance (ie, adjective) in the final paragraph, and 92.9% (92 of 99) provided detail on what components contributed to the comparative performance. In addition, there were numerous variations in grade type (eg, honors type vs numerical). The visual display of this data varied greatly among schools with no clear standard identified. Almost all schools (98.6%, 141 of 143) included clerkship grades in the academic progress section, 81.6% (115 of 141) included what determines clerkship grades, and 88.7% (125 of 141) included a grade distribution. About half (51.7%, 74 of 143) referenced performance in the fourth year, including electives, acting internships, or both. About one-third (30.8%, 44 of 143) of MSPEs included a narrative of student performance in the preclinical curriculum, while the remaining 69.2% (99 of 143) either omitted data or reported passing all coursework. 2, 4– 11Ī total of 143 MSPEs were reviewed from schools across the United States (Northeast 24.5%, Midwest 24.5%, South 38.5%, and West 12.5% Table).
3 Historically, program directors and other end users have found the MSPE difficult to decipher, widely variable among schools, and lacking in transparency. The MSPE is intended to provide an honest and objective summary of a student's personal attributes, experiences, and academic accomplishments.
NOTEWORTHY CHARACTERISTICS MSPE EXAMPLES PLUS
2 An essential element of undergraduate medical education (UME) to graduate medical education (GME) communication, the MSPE is a comprehensive summary of a medical student's performance across 3 plus years of medical school. With the change in USMLE Step 1 to pass/fail reporting in the near future, the MSPE may become an even more important component of the residency application. In the 2018 NRMP Program Director Survey, 1 the MSPE ranked third in terms of importance in the residency application process, with 81% of respondents citing it as a factor behind only USMLE Step 1 and letters of recommendation in the specialty. The Medical Student Performance Evaluation (MSPE), formerly known as the “Dean's letter,” is a key application component for residency program directors.
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