The MSPE and Residency Process

1
The MSPE and Residency Process

• January 17, 2008
• Class of 2009
• Meredith, Buck, and Dr. Parker

2
Who Writes the MSPE?
Dean Parker Supplemental
information provided by SAO, Colleges Chairs, and
YOU!
3
What goes into the MSPE?

• 1-2 Paragraphs about your performance in Years 1
  and 2.
• Does NOT include exam scores
• All of Year 3 evaluation comments (verbatim)
• Summary of academic progress (including gaps or
  leaves of absence)
• Summary paragraph
• Unique characteristics

4
What does an MSPE Look Like?

• All Medical Schools follow the AAMC guidelines to
  format and submit their MSPE.
• All have the same headings and content.
• For review of the guidelines
• http//www.aamc.org/members/gsa/mspeguide.pdf

5
Identifying Information

• MEDICAL STUDENT PERFORMANCE EVALUATION
• FOR
• JOE BRUIN
• NOVEMBER 1, 2008
• IDENTIFYING INFORMATION
• Joe Bruin is a fourth-year student at the Joe
  Geffen School of Medicine at UCLA in Los
  Angeles, California.

6
Unique Characteristics

• UNIQUE CHARACTERISTICS
• Joe Bruin was born in New York to immigrant
  parents. His mother is a nurse, and his father
  is a dentist. At age three, the family moved to
  downtown Los Angeles while his father completed
  dentistry licensure, then to Orange County and
  finally to Palos Verdes. In elementary and high
  school, Joe developed an interest in science and
  excelled in his studies. He also competed in
  Tae-Kwan Do and held an international junior
  ranking.
• Seeking to broaden horizons, Joe did his
  undergraduate work at Rutgers University, where
  he received a Bachelor of Arts degree in Genetics
  and Human Biology. He made the Deans List for
  two years. In the summer following his freshman
  year, he became an Emergency Medical Technician
  in a ten-week program at UCLA, and this led to a
  two-year stint as a live-in volunteer firefighter
  and EMT at the Cayuga Heights Fire Department in
  Ithaca. He assumed leadership roles as company
  secretary and then president.
• After graduation, Joe decided to take a
  research year with Dr. Buchanan in the Department
  of Orthopedic Surgery at UCLA. He was involved
  in a number of basic projects concerning bone
  repair. This work has continued and expanded to
  include a project on imaging of experimental
  metastatic lesions. As a result of his research,
  Joe is co-author of seven manuscripts in print or
  in press. During the dedicated research year,
  Joe supported himself by teaching at the Kaplan
  Learning Center and an independent learning
  center in Torrance and by private tutoring.
• Joe has done very well at the School of
  Medicine. He maintains a wide scope of interests
  outside of medicine, including athletics, travel,
  cooking, auto restoration, and music. His
  interest in orthopedics has been strengthened by
  his clinical experiences and his ongoing
  research. He enjoys the technical challenges
  that orthopedics provides, the camaraderie among
  physicians in the discipline, and the nature of
  the clinical problems.

7
Academic History

• ACADEMIC HISTORY
• Date of expected graduation from Medical School
  June 2, 2009
• Date of initial matriculation in Medical School
  August 4, 2005
• Please explain any extensions, leave(s) of
  absence, gap(s) or breaks in the students
  educational program N/A
• Transfer student N/A. UCLA does not accept
  transfer students.
• For dual/joint/combined degree students N/A
• Date of Initial Matriculation in Other Degree
  Program
• Date of Expected Graduation from Other Degree
  Program
• Type (degree and major) of Other Degree Program
• Was this student required to repeat any
  coursework during his/her medical education?(if
  yes, please explain) No
• Was this student the recipient of any adverse
  actions by the medical school or its parent
  institution? (if yes, please explain) No

8
Academic Progress

• ACADEMIC PROGRESS
• The Joe Geffen School of Medicine at UCLA adopted
  a pure pass/fail grading system without the
  ability to obtain honors with the 1993 entering
  class. However, a Letter of Distinction can be
  awarded. A Letter of Distinction is based on the
  extraordinary quality of a students performance,
  irrespectivof the performance of other students
  in the course. These letters are not awarded on
  any type of quota system.
• An assessment of Joes academic abilities both in
  the basic sciences as well as in the clinical
  sciences can be readily ascertained from the
  narratives below. These are taken directly from
  the evaluations submitted by the course chairs
  and the faculty of the basic sciences, small
  group discussion sections, and clinical
  clerkships
• Years One and Two
• Joe successfully completed the curriculum of the
  first two years. Comments from his evaluations
  include Joe uses his good knowledge of basic
  science and his own hands-on experience and
  applies them very well. He had excellent problem
  solving and critical thinking skills. Often made
  astute comments. He had the most outstanding
  patient interviewing skills in the group. Joe
  will make an incredibly observant, thoughtful and
  effective physician.

9
Academic Progress

• Required Clinical Clerkships and Elective
  Rotations
• Narratives are edited for length, grammar and
  redundancy only.
• Doctoring 3 (Required) For the duration of the
  3rd year
• Center for Health Sciences
• Joe Bruin is an active, enthusiastic and valuable
  member of our doctoring group. Joe combines his
  naturally personable, open demeanor with a fine
  capacity to articulate and present well reasoned
  opinions and knowledge on pertinent issues. He
  demonstrated a highly skillful patient interview
  and appeared to easily understand the need to
  subordinate his own rapid, decisive pace and
  opinions to the needs and pace of the patient.
  Joe has been a thoughtful participant on all
  issues and his written and verbal participation
  have been outstanding in every session.
• Longitudinal Preceptorship (Required) For the
  duration of the 3rd year
• Center for Health Sciences
• Cardiology Joe is a star! He is one of the most
  delightful, insightful, engaging students I have
  interacted with. During his preceptorship he
  displayed abilities and talents comparable to a
  fourth year medical student. He is clearly at
  the head of the class. During the
  preceptorship he used the time to practice and
  hone his physical diagnosis skills, interviewing
  skills and fund of knowledge. Joe also has a
  very large interest in scientific investigation.
  He was always on the lookout for interesting
  scientific questions and he saw each case as a
  new opportunity to ask insightful and probing
  questions. Joe will undoubtedly succeed in any
  field he chooses. I thoroughly enjoyed my
  interactions with him and give him my very
  highest and most enthusiastic evaluation.

10
Academic Progress

• Ambulatory Internal Medicine (Required) 7/25/2006
  (4 weeks)
• Kaiser Foundation Hospital
• Joe rotated through Kaiser Foundation Hospital
  for his ambulatory medicine rotation 8/8-9/4/05.
  History taking was superior, very thorough and
  included most all important details. PEs were
  high-satisfactory and were complete and
  appropriately targeted and demonstrated good
  technique. Oral case presentations were superior,
  demonstrating good organization and clarity and
  were of appropriate length. Write-ups were
  superior demonstrating good DDX and problem lists
  and a thorough TX plan. Fund of knowledge was
  superior and above the level for a third year
  student. His clinical judgment was
  high-satisfactory he was able to frequently
  integrate clinical information, medical facts and
  TX options applying an evidence-based approach.
  Joe's humanism was Superior. He demonstrated
  great empathy for his patients and was clearly
  interested in his patient's emotional as well as
  physical problems. He was enthusiastic and
  hardworking. His Attending wrote "Joe
  demonstrated an outstanding medical knowledge
  base during this rotation". Overall Joe performed
  at a superior level during his ambulatory
  medicine rotation at Kaiser Foundation Hospital.

11
Academic Progress

• Inpatient Internal Medicine (Required) 9/1/2006
  (8 weeks)
• West Los Angeles VA
• Joe did and outstanding job on the first month of
  his medical clerkship at the West LA VA. He is a
  pleasure to work with and displayed a strong
  interest in learning and a deep commitment to
  patient care. He has outstanding interpersonal
  skills. His ability to care for and communicate
  with his patients is perhaps best illustrated by
  the several occasions when he was able to
  translate complex medical information into
  language that his patients could understand,
  resulting in improved patient adherence and a
  strong bond between him and his patients.
  Several observers observed his constant effort to
  improve his medical knowledge and his
  presentations. His depth of interest in learning
  medicine is beyond the typical medical student
  leading one house officer to judge him at the
  level of a sub-intern or intern. In summary, Joe
  is a "wonderful personality" who "always did more
  than what was needed to make sure his patients
  received the best medical care.Joe will make an
  outstanding house officer and physician.
• Joe rotated at Harbor-UCLA Medical Center. This
  student's evaluation is a composite of scores and
  evaluations from attending physicians and
  residents. History taking was excellent, with
  consistent precision and focus on relevant
  problems. Nearly all pertinent positive and
  negative findings were elucidated skillfully and
  with appropriate attention to details. The
  student performed satisfactory physical
  examinations that were, on occasion, very good.
  The student demonstrated current knowledge,
  including information from journal articles, that
  was at a high level for 3rd year students. The
  student regularly demonstrated excellent
  judgment, including the ability to integrate data
  and facts, balance risks and benefits, and make
  justifiable decisions. "Good fund of knowledge.
  Good team player, willing to help out and always
  interested in learning. Strong foundations of
  skills that will serve him well in the future."
  The overall performance of this student on the
  Harbor-UCLA portion of the Inpatient Medicine
  clerkship was excellent.

12
Academic Progress

• Neurology (Required) 12/1/2006 (3 weeks)
• Harbor-UCLA Medical Center
• Joe was outstanding on this rotation. He
  mastered the neurologic exam rather quickly, and
  was very good at drawing out important details
  from patient's exams to guide differential
  diagnosis. He was inquisitive and extremely
  conscientious, and his organized presentations
  were top-notch. He was very easy to work with,
  and was very reliable. He essentially functioned
  at the level of an intern for our team, and this
  bodes very well for his future residency of
  choice.
• Obstetrics and Gynecology (Required)
  2/12/2007 (6 weeks)
• Harbor-UCLA Medical Center
• Joe did an outstanding job during his 3rd year
  clerkship on Ob/Gyn at Harbor-UCLA. He learned
  rapidly, read widely, became very involved in
  patient care and sought out clinical and learning
  experiences. The faculty noted that "Joe was an
  enthusiastic, capable, hard working, pleasant
  student. Joe is a very interesting young man who
  brings a wide breadth of experiences to his
  medical career. He should make a very good
  physician/surgeon. A second faculty noted "He
  has great potential and I believe he will be an
  asset to whatever specialty he chooses. A third
  on said "This is a stellar student. Very
  responsible, great fund of knowledge. The
  residents were also impressed, the comment "Great
  Job" sums up their assessment.
• Joe received a Letter of Distinction in
  Obstetrics/Gynecology

13
Academic Progress

• Pediatrics (Required) 4/1/2007 (6 weeks)
• Center for Health Sciences
• Excellent medical student. I am sure he'll be an
  outstanding resident in whatever field he
  selects. Nice to work with. Calm and composed.
  Integrated clinical information extremely well.
  Always professional and appropriate with
  coworkers and patients. Efficient and took
  charge of his own independent learning as well.
  Joe did a very good job on his Nursery rotation,
  and it was nice to work with him. Although he is
  not interested in a Pediatrics career, Joe was
  always willing to learn new things and experience
  new patients. He related well with the patients'
  families, he was always on time, and did a very
  good job with his history taking and physical
  exams. I wish him well in his future as a
  Cardiologist or surgeon. Very professional among
  patients. Interacted very well with children.
  In the nursery Joe demonstrated himself to be an
  eager pleasant student who worked well with the
  nursery staff.
• Psychiatry (Required) 5/28/2007 (6 weeks)
• Harbor-UCLA Medical Center
• Joe was one of the best medical students that
  particular psychiatric service has seen. He is
  self-motivated, knowledgeable, hard-working,
  professional, caring conscientious and
  well-organized. He will be a truly outstanding
  resident.
• Orthopaedic Surgery (Elective) 8/24/2007 (4
  weeks)
• Center for Health Sciences
• Truly an outstanding job by this exemplary
  student. Joe embodies what I look for in an
  exceptional future houseofficer extremely
  bright, asks provocative questions, hard working,
  and has an easy going calm demeanor.

14
Summary

• SUMMARY
• Joe Bruin has performed admirably throughout his
  education. He is bright, friendly, dedicated,
  and well-rounded. His clerkship evaluations have
  been particularly strong and seem to predict that
  he will be a very effective clinician, as well as
  a good teacher. He has tested his interest in
  orthopedics with an extended exposure to research
  and close relationships with a number of faculty
  members. He has a sophisticated understanding of
  the field and the intellect and personality to
  succeed through training and beyond.
• Sincerely,
• Neil H. Parker, M.D.
• Senior Associate Dean for Student Affairs

15
Appendix

• Appendix A Graphic Representations of
  Comparative Performance in Preclinical/Basic
  Science Coursework
• The grading system for all four years is
  Pass/Fail without the possibility to obtain
  Honors. Thus a class ranking or placement into
  quartiles cannot be calculated.
• Appendix B Graphic Representations of
  Comparative Performance in Core Clinical
  Clerkships
• The grading system for all four years is
  Pass/Fail without the possibility to obtain
  Honors. Thus a class ranking or placement into
  quartiles cannot be calculated.
• Appendix C Graphic Representations of
  Comparative Performance in Professional
  Attributes
• The grading system for all four years is
  Pass/Fail without the possibility to obtain
  Honors. Thus a class ranking or placement into
  quartiles cannot be calculated.
• Appendix D Graphic Representations of Overall
  Comparative Performance in Medical School
• The grading system for all four years is
  Pass/Fail without the possibility to obtain
  Honors. Thus a class ranking or placement into
  quartiles cannot be calculated.
• Appendix E Medical School Information Page
  Class of 2006
• Joe Geffen School of Medicine at UCLA Los
  Angeles, California
• Special programmatic emphasis, strengths,
  mission/goal(s) of UCLA
• The mission of the Joe Geffen School of Medicine
  at UCLA is to prepare graduates for distinguished
  careers in medicine. Students are selected from
  an applicant pool of over 6,000 and are chosen
  for demonstrated excellence in academics,
  community service, research, and teaching. Over
  their four years at UCLA, students participate in
  a wide range of activities that continue to
  emphasize our selection criteria. Over 80 of
  the students will have had meaningful experiences
  in community service, teaching, or research. In
  the middle of the third year, students choose to
  belong to a College which has special emphasis on
  advising and mentoring.
• Special characteristics of the UCLA educational
  program
• The curriculum for the class of 2006 was a
  discipline-based coursework for the first two
  years with emphasis on small groups and
  problem-based learning. The third year is taken
  in two blocks of 24 weeks each of surgery,
  obstetrics gynecology, and pediatrics or
  inpatient and ambulatory medicine, family
  medicine, and psychiatry neurology. Half of
  all the clinical coursework is in the ambulatory
  arena where students learn to do focused
  histories and physicals and are exposed to
  system-based practices and real life issues in a
  highly managed care environment.
• Over the first three years, students participate
  in Doctoring, which focuses on learning and
  improving their skills in communication, history
  taking and integrating psychosocial issues into
  patient care. The program uses standardized
  patients, direct observation of students
  interviews, and trigger tapes of common problems
  and situations to stimulate small group
  discussion.
• Students join a College in the middle of their
  third year organized around specialties sharing
  common perspectives Applied Anatomy, Acute Care,
  Primary Care, M.B.A./M.P.H., Medical Scientist,
  and Urban Underserved. The colleges start with a
  week long Foundation course to prepare students
  for the fourth year, have a set of defined
  selectives, include evening seminars and
  preparation sessions for residency, and focus on
  advising and mentoring for career selection and
  preparation.
• There are both the MSTP program, which accepts
  students for their M.D. and Ph.D. from the
  initial application, and the Access program,
  which accepts students during their second year
  for their Ph.D. Most students spend 3-5 years
  between their second and third years.
  Additionally, students are increasingly electing
  to obtain their M.B.A. or M.P.H. Students are
  selected in their third year and do joint courses
  over the subsequent two years, obtaining both
  degrees at graduation in a total of five years.
• Average length of enrollment (initial
  matriculation to graduation) at UCLA
• Seventy percent of the Class of 2006 will have
  spent three years and ten months in our four year
  program. Thirty percent elected to take
  additional training for research, community
  service, or an advanced degree. Only the summer
  between the first and second years is non
  structured time.

16
Appendix (cont.)

• Description of the evaluation system used at
  UCLA
• The grading system for all four years is
  Pass/Fail without the possibility to obtain
  Honors. Thus a class ranking or placement into
  quartiles cannot be calculated.
• A student may be awarded a Letter of Distinction
  (LOD) based on extraordinary quality of his/her
  performance in all segments of the course and
  irrespective of the performance of the other
  students. LODs can only be awarded for first
  and second year courses which have small group
  and problem-based components. All required
  clerkships of the third year (except Radiology
  and Preceptorship) may award LODs. They are,
  however, not awarded for any fourth year
  coursework (elective clerkships).
• Requirements for completion of USMLE Steps 1, 2
• USMLE Step 1 passage required for promotion
  into senior year and for graduation
• USMLE Step 2 Both CK and CS must be taken to
  graduate and CK passed
• Requirement for completion of OSCE
• An OSCE is required for completion of the Second
  Year Physical Diagnosis course.
• The Clinical Performance Examination by the
  California Consortium for assessing clinical
  competence is required of all students at the end
  of their third year.
• Utilization of course, clerkship or elective
  directors narrative comments
• Narratives are edited for length, grammar, and
  redundancy.
• Utilization of AAMCs Guidelines for Academic
  Transcripts
• Partially in compliance with guideline
  recommendations.
• Student review MSPE prior to transmission for
  accuracy
• Yes

17
The Evaluation Section of MSPE

• Evaluations go in verbatim-remember this is an
  evaluation not a recommendation
• The only way to have the comments revised on your
  MSPE is to have the Clerkship Director submit new
  comments on ESS. Revised comments must be
  submitted to the SAO on ESS by September 1, 2008.
• Buck and Meredith will not be able to make
  revisions or alter your evaluations in any way
  during the MSPE review process
• Questions or concerns about evaluations should be
  discussed with Dr. Parker, Buck, or Meredith
  before approaching Clerkship Director.

18
Sample Evaluation Reformat

• Before Edit
• Comments from faculty
• "Excellent job getting clinical information
  efficiently and presenting cases in clear logical
  format. Good rapport with patients."
• "Joanne Bruin is bright and enthusiastic, and did
  an excellent job on this rotation. She developed
  instant rapport with patients, putting them at
  ease. Her histories were detailed and
  systematic. She evaluated patients carefully,
  and formulated excellent differential diagnoses
  and management plans. Her case presentations
  were complete and focused. It was a pleasure to
  work with her!"
• On her case presentation project she received a
  score of 20/20 and on her written final
  examination she received 70.
• After Edit
• "Excellent job getting clinical information
  efficiently and presenting cases in a clear
  logical format. Good rapport with patients."
  "Joanne is bright and enthusiastic, and did an
  excellent job on this rotation. She developed
  instant rapport with patients, putting them at
  ease. Her histories were detailed and
  systematic. She evaluated patients carefully,
  and formulated excellent differential diagnoses
  and management plans. Her case presentations
  were complete and focused. It was a pleasure to
  work with her!"

19
What Is Removed from the Evaluation?

• PDA logs
• Attendance (Unless it is an issue noted within
  the narrative of the evaluation.)
• Nomination for a LOD (If you received one, it
  will be noted in bold at the end of the
  evaluation.)
• Exam scores or percentiles
• References to graded presentations
• Physician/evaluator names
• Websites and journal citations
• Dates of Clerkships (the MSPE is written in
  chronological order)

20
What edits does the SAO make?

• Correction of name You will be referred to by
  your given first name throughout the MSPE
• Gender Pronouns will be changed to reflect your
  gender
• Spelling and punctuation All spelling will be
  corrected, but the nature of composite
  evaluations is that punctuation may not be 100
  accurate. Sentence fragments may be left in.
• Redundant comments may be removed

21
What do I edit on the MSPE?

• Unique Characteristics Section
• Errors, omissions, and chronology
• Reference to specialty choice (this is up to you
  whether or not you want your specialty included
  in the MSPE)
• Personal information you do not want included in
  your application
• Summary Section
• Errors, omissions, and chronology
• Reference to specialty choice (this is up to you
  whether or not you want your specialty included
  in the MSPE)
• Ensure LODs and AOA are included if applicable

22
How does the MSPE process work?

• Spring 2008
• Complete online MSPE Personal Information
  Form-turn in to SAO by April 1st
• June 5, 2008
• Mandatory Application Process Meeting
• Handbooks distributed (Application and Interview)
• June-September
• Meet with Dean Parker (appointments will be
  scheduled by SAO)
• July 1
• Issued ERAS token by SAO to BOL account-make sure
  there are no junk mail filters set
• All students (early match too) register on ERAS
• July-September
• Schedule CV/PS meeting with Buck or Meredith
• August 1-October 1
• MSPE Editing Begins

23
MSPE Editing Timeline

• Each student allotted 1 opportunity to make
  edits-Unique Characteristics and Summary only
• Edits will be made by SAO and you will be
  contacted to sign-off on your MSPE when completed
  
• MSPE must be reviewed in SAO (allow 30 minutes to
  review)
• You will not be allowed to make copies of your
  MPSE nor remove it from the SAO
• Content of each MSPE is confidential and should
  not be shared with other classmates
• Until you have signed-off on your MSPE it will
  not be released
• NOTE Revised comments must be received by SAO
  before you begin the editing process-you will not
  be allowed to contest comments during the MSPE
  review.

24
Letters of Recommendation

• Download ERAS Recommendation form from Forms
  Index on website
• You do not need to include your AAMC ID on the
  form
• You do need to waive your right to see the letter
  by signing this form
• Requests for LORs should begin this spring. All
  requests should be made by September 1 to allow
  letter writers time to complete them
• LORs are submitted to the SAO and uploaded onto
  ERAS as received as PDFs

25
Suggested types of Letters

• Early Match (Ophthalmology and Urology)
• LOR from either Medicine or Surgery (Yr 3)
• Can be used for Preliminary Programs in ERAS
  Match
• 1-2 LORs in specialty of choice (Yr 4)
• At least one LOR should be from UCLA, the others
  can be from Away Electives
• LOR from research mentor (if applicable)

26
Suggested types of Letters

• Regular/ERAS Match
• LOR from either Medicine or Surgery (Yr 3)
• Can be used for Preliminary Programs if
  applicable
• At least one LOR in specialty
• One should be from UCLA
• Should be from Faculty Only (no residents)
• 1-2 LORs in Sub-Is or Electives taken in the
  summer
• Good to have a variety of specialties
• NOTE for Orthopaedics Applicants 2-3 LORs should
  be in specialty and should include Away Electives

27
Chairs Letters

• For applicants applying in
• Internal Medicine
• Pediatrics
• Orthopaedics
• OB/Gyn
• Preliminary Medical programs
• You may be required to submit a Chairs Letter.
  Requests for Chairs Letters happen in June.

28
Residency Application Includes

• The MSPE (sent out nationally on November 1)
• Personal Statement(s)
• CV
• Letters of recommendation
• Medical School Transcript
• Photograph
• USMLE Score Report (automatically released by
  ERAS)

29
Advising in the Third and Fourth Year

• College Introduction Meetings (Mandatory)
• First Week in January
• Scheduling 4th Year Clerkships Meeting
  (Mandatory)
• January 30, 2007
• Residency/Match Timeline Meeting (Mandatory)
• June 5, 2008
• Open Advising Office Hours for Personal
  Statements, CVs, and application preparation
  July 1-September 1

30
How Should I Structure my Time?

• Year 3
• Continue to excel on Clerkshipsearning an LOD is
  one of the strongest things you can do to
  increase your competitiveness
• Attend Doctoring Lunches with Dean Parker and
  Meredith throughout 3rd Year
• Think about obtaining LORs from required
  clerkships. You may officially begin to ask for
  these letters January of Year 3.
• Continue to attend career specialty luncheons and
  lectures
• Focus on career exploration and choice
• Scheduling for Year 4 and the College selection
  process begins in January
• Meet with Meredith or Buck after Match Day (early
  April) to assess status of your application,
  confirm Year 4 schedule-etc
• June of Year 3 Residency process officially
  begins

31
What do I until June of Year 3?

• Continue to explore career choices
• Establish faculty mentor through College
• Hang-out with the people in the specialties you
  are consideringsee if you fit in.
• Plan away electives and sub-internships
• Your future career should fit like a glove!
• -Dean Parker