Letters to the Editor
To the Editor: The lack of standardization and clarity in clerkship evaluation detailed by Alexander et al1 in turn leads to a lack of clarity and consistency in the “dean’s letter.” In my experience, in the past 10 years the dean’s letter has had limited use in the selection of residents. Residency directors consistently arrange applicant interviews prior to their receiving dean’s letters, and for many directors, scores on the United States Medical Licensing Examination have become the critical variable in arranging applicant interviews.
Since clerkship evaluation reports are the critical elements in the dean’s letter, implementing the reforms of clerkship evaluations proposed by Alexander et al is critical to make this letter useful. If these reforms are accomplished, the dean’s letter could serve its intended purpose. It could provide residency directors useful, consistent, and reliable information for use in selecting residents.
The need for the reforms of the dean’s letter and its underlying clerkship evaluations has an increased urgency. In the absence of an effective and meaningful dean’s letter, as the number of medical graduates grows, it will become increasingly difficult for residency directors to effectively evaluate all applicants. Residency directors will act as they have in the past, relying increasingly on test scores or on the reputation of an applicant’s medical school in making decisions. Actual student performance may become a limited element in the assessment equation in arranging interviews for applicants to residencies, and possibly in the final resident selection process. This could lead to a form of subtle and unintended discrimination against graduates of new or less prominent medical schools.
Leaders of academic medicine need to hold a national conference to charge all stakeholders with developing a strategy to reform the system and to agree on a timetable to implement it.
Sidney Weissman, MD
Past president, American Association of Directors of Psychiatric Residency Training, and professor of clinical psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; firstname.lastname@example.org.
1. Alexander EK, Osman NY, Walling JL, Mitchell VG. Variation and imprecision of clerkship grading in U.S. medical schools. Acad Med. 2012;87:1070–1076