As the Match becomes increasingly competitive, student affairs deans are taking extra precautions to increase their students’ chances of matching. In some cases, this means they are providing residency program directors with detailed accounts of students, sometimes up to 19 pages, in the Medical Student Performance Evaluation (MSPE).
A significant component of residency applications, the MSPE summarizes a student’s performance throughout medical school, including an assessment of key characteristics, such as professionalism. The AAMC Council of Deans Administrative Board recently endorsed recommended revisions to the MSPE. As part of the AAMC Optimizing GME initiative, the revised MSPE is designed to ease the transition to residency with a standardized template that will increase transparency and make it easier for program directors to evaluate applicants holistically.
“Anything we can do to help program directors understand applicants will help them invite applicants who are most mission-aligned with their residency program. Highlighting additional strengths beyond USMLE scores allows applicants to be interviewed,” said Daniel Giang, MD, associate dean and director of graduate medical education at Loma Linda University Medical Center.
An MSPE taskforce, convened by the AAMC in January 2015, developed the new format after meeting with stakeholders and reviewing current MSPE guidelines, relevant literature, and survey data. The taskforce included members from several AAMC groups and other stakeholders, including the AAMC Council of Deans and the AAMC Organization of Resident Representatives.
The AAMC is encouraging medical schools to use the revised MSPE in spring 2017. Residency directors will receive letters in the new format during the 2017–2018 cycle for the Electronic Residency Application Service™ (ERAS®).
Inconsistency in MSPEs points to need for revision
As student affairs deans have begun writing longer MSPEs, the result has been widespread inconsistency, with evaluations that range from two to 19 pages and include different types of information in various formats. With such variations, some program directors have reported they don’t always read MSPEs because inconsistencies make it difficult to assess applicants equally. But this means directors might miss out on information that presents a holistic view of students—for example, how a student overcame obstacles or concerns about performance.
“We hope [the revised MSPE] will offer a more holistic, well-rounded view that will benefit students. I think anytime there is a good match between the program and the student, it helps the [student’s] transition.”
Angela Nuzzarello, MD, MHPE
Oakland University William Beaumont School of Medicine
Authors of a study published online in Academic Medicine in 2015 reviewed MSPEs submitted by 117 medical schools and found significant variation in key words—terms used to describe overall performance. The study also found that 49 percent of the schools provided incomplete information about key words that describe applicants, clerkship grades, or both.
“The inability of the program directors to gain useful information from our MSPEs in a time-efficient manner is forcing them to use something else as a proxy for holistic review,” said Donna Elliott, MD, EdD, senior associate dean for student and educational affairs at Keck School of Medicine of USC. “If program directors are unable to understand our students and learn who they are, that puts students at a disadvantage.”
If student affairs officers want to ensure program directors have this information, it needs to be presented in “a way that is digestible and reasonable,” added Elliott, who was not part of the taskforce.
“From a student affairs perspective, in our effort to present students in the best light possible, we added more information, but more information isn’t necessarily better,” said Angela Nuzzarello, MD, MHPE, associate dean for student affairs at Oakland University William Beaumont School of Medicine and a taskforce member.
Revised MSPE addresses concerns from both sides
Taskforce members faced a challenge in revising the MSPE to reflect desires of both student affairs deans and program directors. On one side, student affairs officers want students to have the best chance of matching. On the other side, program directors might receive 1,000 applications for a few slots and need to make quick decisions about which students to interview.
“We addressed some of those tensions by really making sure people understood that the MSPE was one part of the application,” said taskforce member Lee Jones, MD, associate dean for students at the University of California, San Francisco, School of Medicine.
The revised MSPE addresses this issue with a standard five-page template. A uniform format will help program directors find the information they need, while ensuring transparency and fairness. The taskforce recommended that the evaluations not include information that is available in other parts of the ERAS application, such as transcripts or USMLE scores.
The Noteworthy Characteristics section strengthens the opportunity for holistic review by asking student affairs deans to describe three things about the student they want to convey. Giang, who served on the taskforce, gave an example of a student who received a low USMLE Step 1 score but took the exam following the death of a parent. The student affairs dean could clarify the reason for the low score and note that the student did well on USMLE Step 2. If a student affairs dean explains that a student has difficulty in intensive care settings, for example, but performs well in other environments, that information can provide important details for residency directors.
For student affairs deans who might be concerned that the new format doesn’t provide enough information, improved clarity with standardization will “enable programs to get a feel for what’s important to the student and hopefully help the student get a better match,” Jones said.
“We hope [the revised MSPE] will offer a more holistic, well-rounded view that will benefit students. I think anytime there is a good match between the program and the student, it helps the [student’s] transition,” Nuzzarello said.
While members of the taskforce believe they reached a balance, they stressed that the work is not over. They hope future revisions based on stakeholder feedback will lead to continuous improvement, with the ultimate goal of helping students find the best match.
“We would like to see an evolutionary movement toward transparency … and the ability to transfer information more efficiently from undergraduate medical education to graduate medical education. We don’t think this is the end result,” Giang said.