Medical School Performance Evaluations (MSPEs) Lack Objectivity: A Challenge in the Surgery Residency Selection Process

IMPORTANCE In the past several years, the methods used to evaluate medical students have undergone significant shifts. The United States Medical Licensing Examination Step 1 grading has become pass/fail, as has clinical grading at many institutions. Residency program directors have lamented the loss of objective data in applications. OBJECTIVE To assess and compare current practices of medical school performance evaluations among MD, DO, and Top 40 schools. DESIGN A retrospective review was performed of the Medical Student Performance Evaluations. Grading systems, formulas, and distribution for surgery clerkships were measured. Statistics were performed using Chi-square tests. SETTING This study was performed at a single general surgery residency program. PARTICIPANTS Medical schools associated with applications during the 2024 to 2025 application cycle to the residency program. Medical schools located within the United States, both MD and DO, were included. Medical school rankings were determined using the Blue Ridge Institute’s 2024 Schools in Medicine report. RESULTS Applications were received from 138 MD schools and 26 DO schools. Seventy-six schools (46.3%) ranked the students, 143 (87.2%) graded clerkships, and 77 (47%) displayed the formula used for grading. Top 40 schools were less likely to use class rank (26.3% vs 52.4%, p < 0.01) or give clerkship grades (71.1% vs 92.1%, p < 0.001). For Top 40 schools, the shelf exam was less likely to constitute more than 40% of the clerkship grade (0% vs 27.1%, p < 0.05). These schools were more generous with grading, with no Top 40 schools bestowing less than 25% of their class honors (0% vs 27.4%, p < 0.01). CONCLUSIONS There is little available to distinguish academic performance in Medical Student Performance Evaluations and Top 40 medical schools are less discerning in the evaluation of medical students.