I love these two letters! They are another important point and counterpoint for this important discussion. Let me be the first to concede and agree with Gliatto et al that my suggestion to have someone outside of the dean’s office prepare the Medical Student Performance Evaluation (MSPE) is not realistic; however, it did get their attention. They also make the observation that it is not who writes the letter but how the letter is written, emphasizing that objectivity follows if schools use the guidelines published in 1989.1 Weissman makes a strong argument, even if overstated, that if these letters don’t improve in objectivity, they will continue to be ignored.
Regarding how the letters are written, the MSPE has shown slow but steady improvement in the number of schools that adhere to these important guidelines. 2–4 The percentage of MSPE letters assessed as adequate, using the guidelines as the benchmark, has increased from 55% (1993), to 65% (1998), and to 75% in the most recent analysis (2005). The authors of the latest article noted a particular weakness across many schools in that only 17% provided “stand alone” comparative information in the summary paragraph; the authors commented, “Herein lies the Achilles heel of the MSPE; the dean of students must advocate, and the program directors must discriminate.”
So, allow me to make a more realistic recommendation about who writes the letters and an outlandish recommendation about how the letters are written. For the who, let’s follow the example of our Liaison Committee on Medical Education-accredited medical schools in Canada, where every one of the 17 schools relies on the education office’s side of the dean’s office to create the MSPE. That is, after all, the evaluation side of the dean’s office, as opposed to the advocates on the student affairs side.
The outlandish recommendation about the how is to ask all residency directors to give notice that in two years, they will no longer offer interviews to students who come from medical schools that refuse to follow the national guidelines. This would be totally unfair to students and therefore beyond outlandish and into unacceptable. However, regardless of who writes the letters, we cannot tolerate that a sizable percentage of schools bring the other schools’ good efforts down.
Dan Hunt, MD, MBA
Co-secretary, Liaison Committee on Medical Education, and senior director, Accreditation Services, Association of American Medical Colleges, Washington, D.C.; email@example.com.
1. Committee on Dean’s Letters, Association of American Medical Colleges. . A Guide to the Preparation of the Medical School Dean’s Letter. 1989 Washington, DC AAMC
2. Hunt DD, MacLaren CF, Scott CS, Chu J, Leiden LI. Characteristics of dean’s letters in 1981 and 1992. Acad Med. 1993;68:905–911
3. Hunt DD, MacLaren C, Scott C, Marshall S, Braddock C, Sarfaty S. Characteristics of dean’s letters in 1981, 1992, and 1998. Acad Med. 2001;76:727–733
4. Shea JA, O’Grady E, Morrison G, Wagner R, Morris JB. Medical Student Performance Evaluation in 2005: An improvement over the former dean’s letter? Acad Med. 2008;83:284–291