To the Editor:
The Point–Counterpoint essays1,2 on who should oversee the preparation of the medical student performance evaluation (MSPE, also known as the “dean’s letter”) raise important issues and reflect the spirited “Hot Topic” session that we attended at the 2010 AAMC annual meeting. Dr. Schroth and colleagues1 argue that student affairs officers, with their expertise in career counseling, performance standards, and personal knowledge of students, are in the best position to create an MSPE that is individualized and accurate. In his counterpoint, Dr. Hunt2 raises valid concerns about the objectivity of the MSPE when written by officers who are charged to be, first and foremost, student advocates. His suggestion to minimize bias is to have someone completely outside of the dean’s office oversee the MSPE. While Schroth and colleagues refer to procedures to ensure confidentiality when students seek help for sensitive matters, neither author discusses the actual process for constructing the MSPE. The AAMC’s 2002 Guide to the Preparation of the Medical Student Performance Evaluation3 clearly outlines how it should be developed, and if the guide is followed, subjectivity and bias are both minimized in the final product.
The two parts of the MSPE that have the highest potential for bias are “unique characteristics” and the “summary section.” Schools should make every effort to develop the content for these sections using processes that are clear, transparent, and based on explicit criteria. For example, at the Mount Sinai School of Medicine, we use an algorithm that takes into account a student’s Step 1 score on the United States Medical Licensing Examination, third-year clerkship grades, research, leadership, and community service to create a score that we use to divide the class into quartiles anonymously. The quartile to which a student has been assigned then determines the key descriptor we give the student (outstanding, excellent, very good, and good) in the summary section of the MSPE. Committees involving faculty and leadership outside of student affairs are also good ways to make sure processes are followed and individual biases minimized. When there is a clear and fairly applied process, it matters less what office ultimately oversees the MSPE. The issue is not who, but how.
Peter Gliatto, MD
Associate dean of undergraduate medical education and student affairs, Mount Sinai School of Medicine, New York, New York; firstname.lastname@example.org.
Reena Karani, MD
Associate dean of undergraduate medical education and curricular affairs, Mount Sinai School of Medicine, New York, New York.
Administrative director of student affairs, Mount Sinai School of Medicine, New York, New York.
1. Schroth WS, Barrier PA, Garrity M, Kavan MG. Student affairs officers should oversee preparation of the medical student performance evaluation. Acad Med. 2011;86:1336
2. Hunt D. Student affairs officers should not oversee preparation of the medical student performance evaluation. Acad Med. 2011;86:1337
3. Association of American Medical Colleges.. A Guide to the Preparation of the Medical Student Performance Evaluation. http://www.usmlemaster.com/board/gobyPDS/upLoadFiles/mspeguide-1.pdf
. Accessed January 29, 2012