Dr. Schroth is associate dean for administration, George Washington University School of Medicine and Health Sciences, Washington, DC.
Dr. Barrier is associate dean for student affairs, Mayo Medical School, Rochester, Minnesota.
Dr. Garrity is associate dean for student affairs, University of Colorado School of Medicine, Denver, Colorado.
Dr. Kavan is associate dean for student affairs, Creighton University School of Medicine, Omaha, Nebraska.
Correspondence should be addressed to Dr. Schroth, George Washington University School of Medicine and Health Sciences, Ross Hall, Suite 713-W, Washington, DC 20037; e-mail: firstname.lastname@example.org.
The medical student performance evaluation (MSPE) is a summative assessment prepared by the school during the final year of a student's medical education and provided as part of the application to residency programs. Historically, one role of student affairs officers, to provide career counseling, became linked to the preparation of the MSPE. The linkage between a primary counselor and the preparation of the MSPE is still the most common, with that counselor being a student affairs officer. Yet, concerns have been raised about this role, especially that a conflict of interest may arise if the officer refers a student for academic or personal counseling and then prepares the MSPE. It has been argued that a student's perception of the impact of this dual role on the MSPE could discourage the student from seeking assistance for academic or personal difficulties.
Although no studies have examined the relationship of help-seeking to student concerns about the content of the MSPE, at least for mental health problems, there is evidence that concerns about confidentiality and the perceived impact of disclosure on the academic record present barriers to the receipt of appropriate counseling and treatment.1–3 Nevertheless, we contend that there are substantial advantages to having student affairs officers provide academic support, career counseling, and referral services for students and that these officers are best suited to prepare the MSPE, since suitable safeguards are in place at schools to minimize the potential impact of these functions on students' help-seeking.
In most schools, student affairs officers provide longitudinal career and specialty choice counseling. Students highly value officers' broad knowledge of residency selection and matching issues. Because of this longitudinal role, the student affairs officer is generally the institutional official with the closest relationship to the student and the one who knows the most about the student's full range of academic achievement, personal attributes, and extracurricular activities. In addition, the student affairs officer usually has the most informed perspective on the qualifications of current students and former graduates. This comprehensive knowledge and experience allow the student affairs officer to enhance the value of the MSPE as a holistic description of the student's achievements while assuring program directors that comparative assessments rest on a firm foundation.
Students' concerns about confidentiality are well recognized by student affairs offices and underlie several important accreditation standards. Consequently, schools have developed confidential resources and clear delineation of administrative responsibility for such issues to reduce barriers for students who need counseling or treatment. Schools have established multiple pathways through which students can obtain confidential assistance for personal or academic problems, including student affairs staff, academic counselors, chaplains, psychiatrists, and student health services. Such services are frequently established outside of the school to enhance access and minimize concerns about confidentiality. If these resources are appropriately organized and well communicated to students, barriers should be minimized. Also, attention to potential conflicts of interest is part of the role of all student affairs officers as they balance the needs of students and the institution; such conflicts may exist no matter which school official prepares the MSPE. Careful education of students about what is and is not part of the MSPE should mitigate students' concerns.
Other barriers to help-seeking presented by stigma, bias, lack of time, and expense will require ongoing efforts. However, we contend that appropriate administrative structures and effective education will overcome any barriers presented by the MSPE and the institutional official responsible for its preparation, whether this individual is in the student affairs office or another administrative office. This will preserve the important benefits accruing when the student affairs officer is the primary career advisor and actively involved in the preparation of the MSPE.
1 Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Acad Med. 2002;77:918–921.
2 Roberts LW, Warner TD, Lyketsos C, et al. Perceptions of academic vulnerability associated with personal illness: A study of 1,027 students at nine medical schools. Compr Psychiatry. 2001;42:1–15.
3 Kavan MG, Malin PJ, Wilson DR. The role of academic psychiatry faculty in the treatment and subsequent evaluation and promotion of medical students: An ethical conundrum. Acad Psychiatry. 2008;32:3–7.