The MSPE: The last part of your residency program application, explained

After perfecting personal statements, completing clerkships, requesting letters of recommendation, submitting transcripts and COMLEX-USA/USMLE scores, the final piece of the residency application puzzle is the MSPE, or Medical Student Performance Evaluation.

The MSPE, also referred to as the dean’s letter, provides a summary of a medical student’s achievements and academic accomplishments. Its purpose is to give residency program directors an objective summary of a student’s time in med school.

The MSPE has recently been revamped to make it easier for program directors to evaluate students. However, it’s up to individual schools to incorporate the new guidelines, and different program directors use the MPSE in different ways. Below, learn more about how this document impacts your residency application.

The new MSPE

In 2016, the Association of American Medical Colleges (AAMC) introduced new recommendations for MSPE letter writers for the first time since 2002. About 90% of student affairs deans surveyed took steps to introduce the new guidelines for the 2018 match.

The new guidelines attempted to make the MPSE more uniform across institutions. Previously, there were inconsistencies among MSPEs when it came to language used, letter format and clarity. Also, the new guidelines sought to emphasize student attributes that didn’t quite fit anywhere else in the residency application.

COVID-19 recommendations

In June 2020, the AAMC released special recommendations that advised schools on how to address COVID-19’s disruptions to medical education in students’ MSPEs. The recommendations are available here.

Clearing up confusion

Before AAMC’s new recommendations came out in 2016, 24% of schools used an adjective, also known as a code word, such as “good” or “great” to rank students on the MSPE. However, many schools did not provide a school-wide comparison to give context to these code words or explain what it truly meant to be called a “good” student on the MSPE. By 2017, however, only 9% of schools used code-word adjectives without explaining them.

“We all know that not everyone can be excellent. The recommendation is that if you use adjectives like that, you have to give some reason why and context to justify it,” says John Graneto, DO, AACOM-appointed AAMC MSPE Task Force member.

In a 2017 study about the differences in words used to describe racial and gender groups in MSPEs, researchers found white applicants were more likely to be described using standout keywords such as “exceptional,” “best,” and “outstanding,” while black applicants were more likely to be described as “competent.” The study examined applicants from 134 MD schools who had applied to Yale School of Medicine residency programs.

Standing out on the MSPE

Some schools allow students to write their own noteworthy characteristics for the MSPE, which are usually three bullet points that are unique to the student. At other schools, deans will write them for students based on their knowledge of the student.

If you are able to write your own characteristics, start by making a concise list of your strongest traits, then sit down and talk with your advisor about which ones to include, says Józia McGowan, DO, who assists in writing MSPEs at Kansas City University of Medicine and Biosciences College of Osteopathic Medicine. Foreign languages, volunteer work completed during med school (medical or non-medical), global mission trips, publications and presentations at conferences are all impressive things to highlight.

The bullet points are also a place to share anecdotal information that might not appear on a CV, such as a unique hardship overcome during medical school.

“Students should put themselves in the program director’s position and think, ‘Why would I want to add this student to my cohort of residents,’” Dr. Graneto says.

The weight of the MSPE on your residency application

Eighty-four percent of program directors across specialties cited the MSPE as an important factor for selecting applicants to interview, according to a 2016 National Resident Matching Program survey.

The MSPE is the last part of the residency program application that is released nationally for program directors to review by ERAS on Oct. 1.

While this may seem late in the application process, as applications for residency are available for program directors to view two weeks prior, just 16% of the average residency program’s interview offers are made to students before the MSPE is released.

Program directors of competitive specialties like otolaryngology, orthopedic surgery and dermatology will rarely invite students to interview prior to Oct. 1.

“The MSPE is the final piece of the residency application, summarizing the student’s work while in medical school,” says Brenda Chezek, director of residency placement and continuing medical education at KCU-COM. “Residency applications are not complete without it.”

Program directors will use the MSPE for different reasons, and may look for specific characteristics on it, says Dr. Graneto. For example, psychiatry program directors and surgery program directors may desire different qualities in their residents.

“Some program directors use the MSPE as a screening tool to decide whom they want to interview, but not every program director uses it the same way,” Dr. Graneto says.

Many program directors like that the MSPE provides a good snapshot of what a student looks like “on paper” and compiles a lot of information in one place, says Dr. McGowan.

Further reading:

Getting into residency: Why research experience can give you an edge

Road to residency: Starting the journey to Match day as a second- or third-year

10 tips for acing your residency interviews