Primary Care Residency Perspectives on Medical Student Performance Evaluations

With the transition of the United States Medical Licensing Examination (USMLE) Step 1 exam to pass-fail, residency directors are exploring alternative objective approaches when selecting candidates for interviews. The Medical Student Performance Evaluations (MSPE) portion of the application may be an area where objectivity could be provided. This study explored program directors' (PDs) perspectives on the utility of the MSPE as a discriminating factor for residency candidate selection.

We invited PDs of primary care residencies listed in the American Medical Association FRIEDA database to participate in a mixed-methods study assessing opinions on the MSPE, and the importance of student skills and application components when considering a candidate for interview. We obtained summary statistics for Likert-scale responses. We used inductive thematic analysis to generate themes from open-ended comments.

Two hundred forty-nine PDs completed the survey (response rate=15.9%). Patient communication (83.6%) and teamwork (81.9%) were rated as very/extremely important skills, and being a graduate of a US medical school in the past 3 years (73.1%), no failures on board exams (58.2%), and MSPEs (54.8%) were rated as very/extremely important application components. Six hundred seventy-eight open-ended comments yielded themes related to desire for more transparency and standardization, importance of student attributes and activities, and other important components of applications.

PDs place a high value on the MSPE but find it limited by concerns over validity, objectivity, and lack of standardization. The quality of MSPEs may be improved by using a common language of skill attainment such as the Association of American Medical Colleges' Entrustable Professional Activities and using the document to discuss students' other attributes and contributions.