Issues with Medical Student Performance Evaluation (MSPE) Letter

Between your undergraduate degree and your time in medical school, you've put in seven years of hard work—blood, sweat, and tears—on your way to becoming a health professional. The journey isn't over yet, but you're finally ready to prepare your residency applications. This is a huge moment. Savor it, but don't let up now. Your applications will need just as much blood, sweat, and tears as you've given to everything else up to this point.

The Medical Student Performance Evaluation (MSPE) letter is a critical component of these applications. How important? According to the 2018 NRMP Program Director Survey Results, 81% of programs cited the Medical Student Performance Evaluation as a factor in selecting applicants to interview for the program. Residency programs rated the MSPE's importance at 4.0 out of 5.

Unfortunately, these letters do sometimes include mistakes. It is rare but not unheard of for letter writers to try and deliberately tank an application. When it comes to matching, you can't afford anything to go wrong. A low grade in a course, or a negative word about your clinicals, could throw your career completely off-track.

Make sure you know exactly what needs to go into your MSPE and how to make sure it's all in there. Find out as well all you can about how to make corrections to your letter if there are problems. This is far too important a moment to leave anything to chance.

What is an MSPE, and How is it Used?

Your MSPE is an important part of your complete residency application package. Your total package should include,

  • Your C.V. or application
  • Letters of recommendation
  • A personal statement
  • Medical School Performance Evaluation (MSPE)
  • Medical school transcripts
  • Licensing Exam transcripts

You are responsible for assembling the first three of these documents. Your medical school will take care of the others, including the MSPE. In some cases, the school will give these materials to you to include in your application. More often, though, schools upload them directly to the Electronic Residency Application Service (ERAS). That doesn't mean, though, that you don't have some say over the other documents, especially the MSPE.

What is the MSPE, though? It used to be known as the “Dean's Letter,” and the AAMC refers to it as a “summary letter of evaluation.” However, it isn't a letter of recommendation, and it is important you understand that it doesn't count as one. You still need at least three letters in addition to your MSPE.

You might think of the MSPE as an expanded version of your transcript, though it includes far more than just your grades. It also differs from your transcript because it's written in narrative form; the MSPE is the “story” of your time in medical school. Ultimately, the goal of the MSPE is to offer fellowship and residency programs an honest and complete evaluation of your entire medical school performance. No wonder, then, that it's a crucial component in these programs' final decisions.

Again, you aren't responsible for producing your MSPE. Typically, your school's dean's office assigns a faculty member or administrator to write it, though they may write it themselves. You should be involved, though. At a minimum, you will meet with this person and talk through what materials will be included in the letter and what the writer intends to say about you. You'll likely be asked about your background, your career plans, and what residency programs you're planning to apply to. In addition, your writer will discuss your grades and your clinical experience. If there are issues such as a leave of absence or a low score in a course, this is your chance to explain.

In fact, you may be given even more say in how your letter is written. Some schools, for example, actually encourage students to create a first draft of the letter themselves, so the actual writer has an idea of what the student would like them to say.

In any case, it's a good idea to make your request to meet with your letter writer no later than July. Between this initial meeting and the due date for your application materials—usually the last day of September or the first day of October—you should regularly monitor your writer's progress on completing the MSPE. If possible, it's a good idea to meet with your writer several times, just to make sure the letter is shaping up the way you expect it to.

Finally, you should request to see a copy of the final letter before it's sent to ERAS. This is standard practice, and your writer will probably give you regular updates as they work anyway. We all know administrators and instructors, though, who have eccentricities, and anyone working at a medical school is pressed for time. It is perfectly acceptable to offer a gentle reminder as the due dates draw near.

A month of lead time is best, which means having the letter in your hands by the beginning of September. This will give you plenty of time to go over the MSPE with a fine-toothed comb and make sure it is complete, accurate, and represents you in the best possible light. If you'd like revisions or if you notice mistakes, this will also give you time to request your writer make the necessary changes.

Once they are submitted to residency programs—that is, after the application deadline in the fall—MSPEs cannot be revised. Your school can make changes, but only as addenda to the original document. This means it is essential that everything in it be in order well before it is submitted.

What Does an MSPE Look Like?

It is important to know what is included in an MSPE letter. That information can help you draft the document if you're asked to. More importantly, it will give you a clear sense of what to look for when you're reviewing what's been written about you.

An MSPE is meant to be comprehensive, to summarize three years' worth of work. As such, the information inside it is usually quite detailed. Fellowship and residency programs don't mandate a specific format for the letter. However, in its “Recommendations for Revising the Medical Student Performance Evaluation,” published in 2015, the Association of American Medical Colleges (AAMC) suggests an MSPE include six separate sections:

  • Identifying information: Basic factual information about you, like your full name and your school's name and location
  • Noteworthy characteristics: Describes three characteristics your evaluator thinks best represent you; provides your evaluator with a chance to talk about you as more than the sum of your grades and test scores.
  • Academic history: Includes very specific information, such as
    • The date of your initial medical school matriculation
    • Your expected date of graduation from medical school
    • Explanations about any gaps or leaves of absence
    • Information about any coursework you had to repeat
    • Information about any disciplinary sanctions you were given
  • · Academic progress: A statement about the professionalism and pre-clinical coursework you have completed as well as information about all of your clerkships, including
    • The grades you received
    • Exact comments from your clerkship evaluations
  • Summary: A final statement about what your work as a med student says about you and your ability to succeed in a residency program
  • Medical school information: Provides a brief overview of your school, such as its emphases, its mission, and any special characteristics; provides the residency program with context about your education

Where Can Things Go Wrong in an MSPE?

As the list above suggests, there are a number of areas of an MPSE to worry about. When you have an opportunity to examine the final letter, you will want to consider each of these carefully.

  • Factual inaccuracies: While these are usually easy to resolve, factual inaccuracies in your MSPE can cause all sorts of headaches with your residency application. Make sure to check the narrative portions of the MSPE as well to ensure your writer didn't get a fact about you wrong.
  • Low grades: To make yourself as appealing a candidate as you can, you want your grades to be as high as possible. If your transcript isn't as strong as it could be, you might consider appealing any problem grades. You may also want your writer to provide reasonable explanations for why a grade might have been low.
  • Poor clerkship evaluations: Obviously, you should monitor these as they come in during your third year and fourth year. In fact, some schools only allow three months for evaluation revision, so it is important to be vigilant and proactive. Here again, if any of the comments from your evaluators are low, you should first try to appeal the original decision. Failing this, you want your writer to include an explanation of anything negative.
  • Disciplinary problems: No residency program wants to accept someone they think might be unprofessional. If you are accused of any disciplinary infraction during your time in medical school, you should challenge it immediately. If your MSPE includes a mark against you, work on appealing the original decision.
  • Style/ Tone problems: You want your MSPE to impress anyone who reads it. A factual document that says nothing about who you are as a person will do nothing to move your candidacy forward. Writers are limited to seven, single-spaced pages. That means they must be succinct. However, there's always room for personalized comments about you. Make sure your writer includes some details. They shouldn't simply list your accomplishments, but rather provide concrete specifics—narrative stories—about your experience. Nothing should be unsupported: if they say you are a “leader,” they need to explain exactly why they think so. Finally, writers should look to talk about aspects of your career that don't show up on your transcript or in your test scores, since anyone looking at your application can find that information elsewhere. It's not a bad idea to talk about you beyond your role as a med student. What are your hobbies and interests, for instance, and how have these shaped who you are?

An MSPE letter isn't merely about the facts and statistics that describe you. It's about the feeling the writer conveys to the committee members who read it. When you get a copy of the final letter, read it through several times. Read it out loud so you can get a feel for the language and any emotion it conveys. Don't limit yourself to suggesting factual revisions. If you think a word or a phrase could be changed to add better emphasis, don't be afraid to ask for the change.

How Can an Attorney Help With an MSEP?

Any time you're working with an official document, an attorney can offer valuable perspective. That's especially true if you are dealing with a document that's about you but not written by you. Those who evaluate you have a responsibility to assess you honestly. In addition, they have an obligation to treat you fairly. An attorney can help you decide if they've done that. If a reviewer hasn't, an attorney can help make sure they do.

An attorney can help in two other important ways as well. First, they can help you file formal appeals to address problems with your MSPE. Second, they can negotiate with faculty and administrators to come up with informal solutions that can improve your MSPE.

You have the right to appeal any decision your medical school makes about you, whether that decision is academic, professional, or personal. The Liaison Committee on Medical Education (LCM), a medical school accrediting organization, insists accredited programs ensure:

“[T]there is a fair and formal process for taking any action that may affect the status of a medical student, including timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the medical student to respond, and an opportunity to appeal any adverse decision related to advancement, graduation, or dismissal.”

This statement doesn't specify the areas where students may make appeals. This means you can potentially appeal a disciplinary decision, a grade, a clerkship evaluation. You even have the right to appeal your school's decision about who is writing your letter. If you believe your writer has a conflict of interest, you should ask that someone else be assigned to complete your MSPE.

Appeals can take many forms. If you've been accused of sexual misconduct, for example, you will likely be investigated and adjudicated under very specific Title IX procedures outlined by the federal government. The process for appealing a grade, on the other hand, may be far simpler.

Typically, there are two strong reasons why a school might grant a request for an appeal. First, you might appeal on the grounds that the school itself or one of its representatives committed some sort of improper conduct. Maybe an instructor marked your exam wrong. It could be you were dismissed from a course without being given due process rights. If the school made a mistake, you are entitled to insist they correct it.

A second common ground for appeal is extenuating circumstances. That is, there may be a reasonable explanation for your lack of academic progress or your unsatisfactory behavior. Family crises do come up. All of us, even medical students, can suffer from medical and psychological problems. These might impact your performance during a given semester.

If your school should deny your formal appeal, an attorney might also be able to approach them to negotiate an alternative settlement, one that will do less harm to your MSPE. A clerkship evaluator, for instance, might not be willing to change your grade, but if your extenuating circumstances are explained to them, they might be willing to modify their comments.

Contact the Lento Law Firm

If you're having issues with your MSPE, or if you're just a little anxious about it as you go through the process, a qualified attorney can help. They can look over the document for you, suggest ways it might be revised, and help you convince your school to make the revisions.

Not every lawyer can provide these services effectively, though. You need a lawyer who has training and experience in representing medical students.

The Lento Law Firm has defended hundreds of medical students across the United States and in the Caribbean with academic and related concerns. He knows the law and how to use it effectively in educational settings. More importantly, attorney Joseph D. Lento is comfortable in those settings. He built his career helping medical students. Attorney Lento can represent you at hearings; he can write letters on your behalf; he can call and negotiate informal settlements. If all else fails, he can help you file suit to force your school to treat you fairly. Whatever you need to move your medical career forward, attorney Joseph D. Lento is ready to stand beside you and do whatever it takes.

Let us help you remedy your Medical Student Performance Evaluation Letter. Call the Lento Law Firm today at 888-535-3686 or contact us through our website.

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If you, or your student, are facing any kind of disciplinary action, or other negative academic sanction, and are having feelings of uncertainty and anxiety for what the future may hold, contact the Lento Law Firm today, and let us help secure your academic career.

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