Rationale and Objectives
Program directors would like to interview the very best students applying to their programs. The summary paragraph of the dean’s letter should provide useful information regarding a student’s performance in medical school. One frequently found descriptor is excellent. However, its very frequency suggests the word may be loosely used. The purpose of this investigation is to determine the meaning of excellence.
Materials and Methods
The descriptor excellent was searched for in the summary paragraph. An effort was made to determine how many medical schools used excellent , how precisely the medical school defined this word, whether numbers were used to define the upper and lower boundaries of excellent , and what other buzzwords were used in the summary paragraphs for students not defined as excellent.
Results
Excellent was the most common descriptor, used by 75% of the medical schools. Defined numeric boundaries were used by 47% of schools. Tabulated results showed that within a school the range of excellence varied from as tight as 20 percentile points to so broad that 65% of the students were classified as excellent. The boundaries of excellent , among different schools, varied from as low as the third to as high as the ninety-second percentile. In half the schools, students described as excellent might be in the bottom half of their class. A total of 28% of the schools used excellent , but without any numeric definition. No school used excellent to describe its best students.
Conclusions
Medical student deans often exaggerate the quality of their graduates by using the word excellent at variance with the dictionary definition of exceptionally good. Inaccurate descriptions by deans of their graduating medical students diminish the value of MSPE.
Program directors would like to interview the very best of the graduating medical students applying to their programs. Diagnostic radiology is a competitive residency with far more candidates than can be invited for interviews. Accompanying each application is the dean’s letter, an obvious tool to help in the selection process.
The Association of American Medical Colleges (AAMC) in their 2002 publication ( ) offered explicit guidelines for the composition of the dean’s letter, including renaming this document the Medical Student Performance Evaluation (MSPE) so as to emphasize its purpose, to provide information regarding how a student performed at the medical school compared with his and her peers. It is the AAMC standard that each MSPE contain a summary section that will include this comparative information and any school specific categories that differentiate among levels of student performance. They also recommend an Appendix D, a graphic representation of the student’s relative performance compared to their classmates.
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Materials and methods
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Results
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Table 1
Medical Schools Using Excellent in their Summary Paragraph
Medical schools surveyed 75 (100%) Medical schools using excellent as a descriptor in their summary paragraph 56/75 (75%) Medical schools using excellent as a descriptor in their summary paragraph with a defined hierarchy of categories (eg, good, very good, excellent, superior , and outstanding ) 40/75 (53%) There are three subcategories for the 40 medical schools using excellent as part of a defined hierarchy:
32/75 (43%)
3/75 (4%)
5/75 (7%) Medical schools using excellent as a descriptor in their summary paragraph, but without a defined hierarchy. 16/75 (21%) Medical schools not using the descriptor excellent. 19/75 (25%)
Table 2
The Range of Excellence
The three schools at the bottom of this chart have defined the upper but not the lower boundary for their descriptor excellent .
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Table 3
Idiosyncratic Medical School Variations of the Hierarchy of Good, Very Good, Excellent, Superior , and Outstanding
Three schools used superior as their top category with outstanding second best. One school used superior as their top category and eliminated outstanding. One school eliminated superior and used instead superb as their top category, with outstanding relegated to second best. One school eliminated excellent , and used instead exceptional as their top category with outstanding second best. One school used excellent as better than superior , but subordinate to outstanding. In this case, the range of excellent was 61%–83%, but the range of superior was only from 36%–60%. One school described 65% of their students as excellent , but with the lowest 20% of the class categorized as very good and the top 25% as either superior or outstanding . This adds up to 110%.
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Discussion
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In evaluating our students for residency, the scale below is utilized. The percentage of this year’s senior class falling into the top two categories is noted. Exceptional performer/outstanding 26% Outstanding 32% Excellent Very good Good Meets requirements
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References
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