(0322) Pass/Fail: The Failures of the Medical Student Performance Evaluation

Introduction: The dissolution of step 1 scores has challenged residency programs to review residency applications more holistically, particularly in competitive fields such as otolaryngology. Focus has turned to the MSPE through which evaluators gain a sense of a student’s grades, noteworthy experiences, class rank, and comments from preceptors. The purpose of this study is to classify how medical schools construct MSPE letters, specifically in evaluating otolaryngology residency applicants.

Methods: This was a retrospective review of the 2022-2023 otolaryngology residency applications from US accredited medical schools sent to a single academic institution. Data collected from anonymized letters include clinical grading tiers, the specific breakdown of possible grades, the percentage of students receiving honors as a range for various required clerkships, the percentage contribution of shelf exams and clinical evaluations to overall clerkship grades, AOA eligibility, and class ranking system.

Results: In total, 263 applications from 127 medical schools were reviewed. For clinical clerkships, 16%, 17%, 39%, 20%, and 4% of schools have 2, 3, 4, 5, and 6 tiers of grades, respectively. Some 24% of schools gave no grade distribution for clinical clerkships. Of the schools that provide a grade distribution, the percent of students who received the highest grade for specific clerkships ranged from 5-100%. The percent contribution of clinical assessments to clerkship grades was given by 58% of schools. The range of percent contribution of clinical assessments was 0-100% of a student’s clerkship grade. Shelf score contribution to clerkships was noted in 52% of students MSPE letters, contributing to 0-60% of a students overall clerkship grade. Of the schools, 41% did not offer a class rank. Additionally, 24% of schools do not offer AOA elections.

Conclusions: The MSPE is inconsistent between medical schools making holistic review difficult. The variation in clerkship grade distribution and contribution makes it hard to determine a student’s actual clinical performance. A more standardized MSPE letter format would aid residency programs in evaluating applicants fairly.