During the 2010 AAMC annual meeting, the Group on Student Affairs hosted a “Hot Topic” session related to who should write the medical student performance evaluation (MSPE), also known as the “dean's letter.” This session was stimulated because of my concerns as cosecretary of the Liaison Committee on Medical Education (LCME) that a student might be inhibited from seeking access to sensitive health services made available through student affairs if the dean for student affairs writes the MSPE. The various perspectives were presented by a five-person panel; each panelist was given three minutes to present his or her point, leaving ample time for audience participation. I sat on the dais listening to the lively, sometimes passionate audience comments, including those of a long line of student affairs deans who came to the microphone to defend their right to write the MSPE.
At first, I was assured that by raising the question, this dedicated group of faculty would find ways to make sure that students would not be blocked or inhibited from seeking help for health issues. But as I listened more closely I realized that their statements were contradictory. Describing the MSPE as an objective evaluative document and, in the same sentence, arguing that it was best written by a student advocate was disconcerting. The danger that this advocacy could be expressed in the MSPE in an unconscious or conscious manner, thus undermining the desired objectivity of the MSPE, is more than a little worrisome. This called to mind the recent study by Kiefer et al1 reporting that students who were rated “good” in the MSPE were invariably below average. I would understand that a student in the bottom half of a medical school accredited by the LCME would still most likely be a “good” student. However, the intent of the Kiefer report was not so forgiving and implied a kind of cover-up of the facts.
If we are to continue the progress in the direction of making the MSPE more objective and useful to residency directors that began with the 1989 AAMC publication guidelines for the dean's letter,2 then we must reconsider who creates it. Our colleagues in Canada, to a school, believe that while the student affairs office should be the office of support and advocacy, student affairs officers should never be the writers of the Canadian version of the MSPE, the medical student performance report (MSPR). While there are differences across the border in the overall structure of the deans' offices, it is notable that all 17 Canadian schools depend on the academic side of the dean's office to create the MSPR. The Canadian deans are surprised when they learn about the U.S. situation.
The calls in the literature for improvements in objectivity continue,3 and I believe it is now time to review who should write this evaluation. If we examine all potentials for bias, then we would need to conclude that, with the pressures on each medical school to “have a good match,” perhaps no one in the dean's office should write the MSPE and that perhaps it should be left to a group that is knowledgeable but independent of the dean's office. While reassured that schools will work on systems to ensure access to sensitive health issues, I walked away from that Hot Topic session convinced that the writer should not be a member of the group whose charge it is to be the student's advocate.
1 Kiefer CS, Colletti JE, Bellolio MF, et al. The “good” dean's letter. Acad Med. 2010;85:1705–1708.
2 A Guide to the Preparation of the Medical School Dean's Letter. Report of the Ad Hoc Committee on Dean's Letters. Washington, DC: Association of American Medical Colleges; 1989. https://www.aamc.org/download/139542/data/mspe.pdf
. Accessed July 13, 2011.
3 Green M, Zick A, Thomas JX. Commentary: Accurate medical student performance evaluation and professionalism assessment: “Yes, we can!” Acad Med. 2010;85:1105–1107.