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A Retrospective Analysis of Medical Student Performance Evaluations, 2014-2020: Recommend with Reservations
Rebecca L Tisdale1,2, Amy R Filsoof3, Surbhi Singhal3
1Health Services Research and Development (HSR&D), Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), 795 Willow Road, Building 324, Menlo Park, CA, 94025, USA. rtisdale@stanford.edu.
Background:
The Medical Student Performance Evaluations (MSPE) is a cornerstone of residency applications. Little is known regarding adherence to Association of American Medical Colleges (AAMC) MSPE recommendations and longitudinal changes in MSPE content.
Objectives:
Evaluate current MSPE quality and longitudinal changes in MSPE and grading practices.
Design:
Retrospective analysis.
Participants:
Students from all Liaison Committee on Medical Education (LCME)-accredited medical schools from which the Stanford University Internal Medicine residency program received applications between 2014-2015 and 2019-2020.
Main Measures:
Inclusion of key words to describe applicant performance and metrics thereof, including distribution among students and key word assignment explanation; inclusion of clerkship grades, grade distributions, and grade composition; and evidence of grade inflation over time.
Key Results:
MSPE comprehensiveness varied substantially among the 149 schools analyzed. In total, 25% of schools provided complete information consistent with AAMC recommendations regarding key word/categorization of medical students and clerkship grades in 2019-2020. Seventy-seven distinct key word terms appeared across the 139 schools examined in 2019-2020. Grading practices markedly varied, with 2-83% of students receiving the top internal medicine clerkship grade depending on the year and school. Individual schools frequently changed key word and grading practices, with 33% and 18% of schools starting and/or stopping use of key words and grades, respectively. Significant grade inflation occurred over the 6-year study period, with an average 14% relative increase in the proportion of students receiving top clerkship grades.
Conclusions:
A minority of schools complies with AAMC MSPE guidelines, and MSPEs are inconsistent across time and schools. These practices may impair evaluation of students within and between schools.
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