The Medical Student Performance Evaluations: A Partial Retrospective

By Thomas E. McNalley, MD, MA, and Ross Hays, MD, Department of Rehabilitation Medicine, University of Washington, Seattle,WA

The Medical Student Performance Evaluation (MSPE), formerly known as the “Dean’s Letter,” has continued to evolve over recent years.  Some institutions use a committee of writers, others rely on one or two individuals to compile and comment on the student’s performance. Academic Medicine has explored the questions of who are the correct persons to write the letter, what professionalism issues may arise in the letter that are predictive of future challenges in residency.

This submission itself arises from the work one of us, Dr. McNalley, did as part of the University of Washington’s MSPE writing team.  After producing about 40 of these he found, perhaps a bit later in the evening, there might be other ways of approaching the summary paragraph.  His colleague, Dr. Hays, joined in and together they provided this look at MSPEs of years’ past.

We welcome similar unveilings from our colleagues around the country.


Mr. Faulkner’s performance in the clinical curriculum was excellent.  Whenever he sat with the last outraged and uncomprehending atavistic shadows of that generation whose aspirations shared equal parts of savagery and tenderness and yes even despair, smelling in the bedside orchids the same rank oversweet aroma of death and decay, he saw that he was like them, at once vanquished and triumphant, and would never escape them; that in the application of thought, study and perseverant toil he would not only ease their journey but more:  he would banish these fell demons of torpid despondency, of incredulous mortality and replace them with his own hieratic avatars of some forgotten antebellum kingdom.  He also performed community service.

Ms. Stein performed well. She determined that a required clerkship is handily made of what is necessary to replace any substance. Suppose an example is necessary, the plainer it is made the more reason there is for some outward recognition that there is a result. An elective is made sometimes and then to see to see to it neatly and to have the holes stopped up makes it necessary to use paper. In her sub-internship in radiology she determined that a custom which is necessary when an x-ray is used and taken is that a large part of the time there are three which have different connections. The one is on the light box. The two are in an envelope. The three are available only through EPIC.  The one, one is the same length as is shown by the cover being longer. The other is different there is more cover that shows it. The other is different and that makes the corners have the same shade the eight are in singular arrangement to make four necessary.

Someone must have been telling lies about Mr. Kafka, because he still has not finished his medical curriculum.  There is a gate, and outside the gate stands the most horrible preceptor you can imagine, and beyond him is another gate, with an even more horrible preceptor.  And to graduate, Mr. Kafka must walk through the gate.  But he does not yet have enough courage to even face the first preceptor.   He has been standing outside of the clinic door for so long that he cannot remember when he wasn’t, always a hand about to turn the knob, but never able to.  While waiting, Mr. Kafka dreams of things he enjoys:  cooking, snowshoeing and line dancing.

Mr Ginsberg completed the curriculum with a unique perspective. He saw the best minds of his generation destroyed by madness, starving hysterical naked, dragging themselves through the negro streets at dawn looking for an angry fix, angelheaded hipsters burning for the ancient heavenly connection to the starry dynamo in the machinery of night, who poverty and tatters and hollow-eyed and high sat up smoking in the supernatural darkness of cold-water flats floating across the tops of cities contemplating jazz, who bared their brains to Heaven under the Metro bus and the new Light Rail and saw Mohammedan angels staggering on tenement roofs illuminated, who passed through universities with radiant eyes hallucinating Arkansas and Blake-light tragedy among the scholars of war, who were expelled from the other west coast medical schools for crazy & publishing obscene odes on the windows of the skull, who cowered in unshaven rooms in underwear, burning their money in wastebaskets and listening to the Terror through the wall.

Mr. Hemingway’s performance in the pre-clinical curriculum was very good.  Yes, it was very good and true and strong, and when his day was done he left the library to walk up the avenue as he always did.  If the weather was fine, he walked by the water that moved over the round stones, and he looked for the flash of trout just below the surface when the sun caught them.  He walked then to Harry’s, where he was known and where he could drink the dry, astringent red wine while he read and wrote.  He picked up the knife by his plate and drew the dull blade harmlessly across the antecubital fossa, picturing how the straight, sharp, fair and true scalpel would begin the cutdown for an arteriovenous fistula.  And then she walked in, again, and the books and the scalpel and the fistula were forgotten like the last light in the water before the trout swam to cooler depths to wait out their night until the morning hatch.

This is just to say

Mr. Williams completed the curriculum

In five years with honors,

And will now continue his training

In gastroenterology.

Hire him:

He is so smart,

So kind

And so capable.

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