Hi everyone,
Late last night, I made it through the “O’s”—Oakland, Ohio, Oregon—before ending a day spent sifting through Medical Student Performance Evaluations (MSPEs) and letters of recommendation.
The tiny font strained my eyes, but the true strain was on my brain as I worked to untangle webs of grades, milestones, and half-filtered quotes meant to describe performance. Ideally, all schools would post standardized, objective, structured MSPEs, but few do. It would also be ideal if all internal medicine departments wrote structured evaluative letters (SLEs), but adherence is poor.
We need MSPEs to tell us if students are ready for internship. Have they acquired core knowledge? Can they write notes? Can they reason and communicate? The least useful MSPEs copy and paste random quotes linked to Pass/Fail grades, leaving me to navigate a sea of inscrutable descriptors. Should I be reassured by a student’s “growth mindset” or worry that they have too much growing to do? If a student’s major strengths are enthusiasm and compassion, does that mean they’re weak in knowledge and patient care?
Kudos to departments that tell us if students have mastered milestones, but what should we make of letters that withhold this information? How should we interpret letters that claim all their students are “outstanding?” How should we compare applicants from departments that place 95% of their students in the top tier while other departments rank theirs as “top five,” “top 25%,” or “top half?”
Referee letters are a free for all. Some writers can’t muster more than a generic paragraph or two, while others compose lengthy testimonials, punctuated by bold font to highlight heroic deeds. Some writers apparently understand the hierarchy of adjectives (exceptional > outstanding > excellent > very good) while others don’t realize they may hurt a candidate by calling them “excellent.” Some writers are extremely precise (top 1%, 2%, 3%, etc.), while others forgo quantification entirely—a sign that they recognize the futility of numbers or that they don’t want to undermine a student with honesty. Finally, some referees return every year with a new protege they call the “best ever,” supplanting last year’s “best ever” and the one from the year before (as if I don’t remember).
I’ve been reading residency applications in bulk for sixteen years, and, some day, I will publish an interpretive glossary: “good” means “bad,” “strong” means “weak,” “prepared” means “watch out.” Until then, if you write these letters, or plan to write them, please take pity on me and my fellow program directors: take the time to write detailed, objective, honest evaluations that help applicants and programs find the perfect match.
Enjoy your Sunday, everyone. After a bike ride, I’ll be wading back into the pool, starting with the P’s.
Mark
P.S. What I’m reading and listening to:
- What the MSPE Can Learn From Dungeons and Dragons By Nicole M. Deiorio, Richard Moberly, and Benjamin Schneider
- Standardization in the MSPE: Key Tensions for Learners, Schools, and Residency Programs By Karen E Hauer et al.
- I Consulted With Christa Pike’s Death Row Team. I Knew This Could Happen. By Joel Zivot
- A Terrible Way to Die, a Terrifying Way to Survive By Elizabeth Bruenig
- I’m a College Professor. Writing Isn’t as Important as We Think. By Joe Cruz
- Bill Gates’s Blunt Warning on A.I. On The Ezra Klein Show
- The Id, the Ego and the Superintelligence By Simon Critchley
- Will A.I. Make Your Brain Lazy? Here’s What the New Research Actually Shows. By Juliana Castro Varón and Dylan Freedman
- People Say They Want to Die at Home. I Think About It Differently. By Daniela J. Lamas