title: The State of Medical Student Performance Evaluations: Improved Transparency or Continued Obfuscation?
abstract: The medical student performance evaluation (MSPE), a letter summarizing academic performance, is included in each medical student's residency application. The extent to which medical schools follow Association of American Medical Colleges (AAMC) recommendations for comparative and transparent data is not known. This study's purpose was to describe the content, interpretability, and transparency of MSPEs.
  
  
  
  This cross-sectional study examined one randomly selected MSPE from every Liaison Committee on Medical Education-accredited U.S. medical school from which at least one student applied to the Stanford University internal medical residency program during the 2013-2014 application cycle. The authors described the number, distribution, and range of key words and clerkship grades used in the MSPEs and the proportions of schools with missing or incomplete data.
  
  
  
  The sample included MSPEs from 117 (89%) of 131 medical schools. Sixty schools (51%) provided complete information about clerkship grade and key word distributions. Ninety-six (82%) provided comparative data for clerkship grades, and 71 (61%) provided complete key word data. Key words describing overall performance were extremely heterogeneous, with a total of 72 used and great variation in the assignment of the top designation (median: 24% of students; range: 1%-60%). There was also great variation in the proportion of students awarded the top internal medicine clerkship grade (median: 29%; range: 2%-90%).
  
  
  
  The MSPE is a critical component of residency applications, yet data contained within MSPEs are incomplete and variable. Approximately half of U.S. medical schools do not follow AAMC guidelines for MSPEs.
authors.affiliation: J. Hom is clinical instructor, Department of Medicine, Stanford University School of Medicine, Stanford, California. I. Richman is a health services research fellow, Center for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California. P. Hall is a fellow in cardiovascular medicine, University of California, San Francisco, San Francisco, California. N. Ahuja is clinical associate professor, Department of Medicine, Stanford University School of Medicine, Stanford, California. S. Harman is clinical assistant professor, Department of Medicine, Stanford University School of Medicine, Stanford, California. R. Harrington is Arthur Bloomfield Professor of Medicine and chair, Department of Medicine, Stanford University School of Medicine, Stanford, California. R. Witteles is associate professor, Department of Medicine, and program director, Internal Medicine Residency Training Program, Stanford University School of Medicine, Stanford, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Hom
authors.forename: Ilana
authors.initials: I
authors.lastname: Richman
authors.forename: Philip
authors.initials: P
authors.lastname: Hall
authors.forename: Neera
authors.initials: N
authors.lastname: Ahuja
authors.forename: Stephanie
authors.initials: S
authors.lastname: Harman
authors.forename: Robert
authors.initials: R
authors.lastname: Harrington
authors.forename: Ronald
authors.initials: R
authors.lastname: Witteles
mesh_terms: D002982:Clinical Clerkship / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D030881:Disclosure / Q000592:standards* / Q000706:statistics & numerical data; D004504:Education, Medical, Undergraduate / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D012570:School Admission Criteria / Q000706:statistics & numerical data*; D012577:Schools, Medical / Q000592:standards* / Q000706:statistics & numerical data; D013337:Students, Medical / Q000706:statistics & numerical data*; D014481:United States