The Deans Letter Dilemma: A Rogue Evaluation
Within the application, few sources give as much information to the residency application committees as the Deans Letter. Yet, the Deans Letter also exposes a large crack in our system for deciding upon applicants. And today, I am going to talk about one of them- the rogue evaluation.
Here is an example of the sort of rotations comments that you may come across in a Deans Letter with a rogue evaluation:
Surgery- A, Excellent. Received glowing evaluations from all residents and attendings.
Psychiatry- A, Fantastic student, Able to empathize well with patients, acts as an intern (above his level of training!)
Family Medicine- A, Actively participated and gave great concise and helpful histories
Radiology- A. Incredible eye, Great talk on Histiocytosis X/eosinophilic granuloma.
Medicine- A-, Worked hard, good scores on shelf exam.
Ob/Gyn- B, Unable to do an appropriate pelvic exam, forgot to take a proper history on several patients, would not scrub in on many of the cases because he didn’t think it was necessary.
Whoa. Look at that last rotation. Notice how it does not fit in with all the others. So, what are the possibilities behind the poor Ob/Gyn Deans Letter evaluation? What do admission committees do with this information? And, how does a Deans letter such as this one affect the applicant?
Why Did This Student Get Such A Horrible OB/GYN Evaluation?
Well, first it could have been the medical student’s first rotation. Sometimes, in this situation, you have a medical student who initially had no clue how clinical rotations worked and just messed up. Or, maybe, one resident or attending had a vendetta against this medical student and wanted to stick it to him. And finally, perhaps, this medical student indeed did not function well in a rotation that did not interest him.
Regardless of the cause, this resident has been screwed (for lack of a better term!). When you have scores of applications without a significant blemish, and then you run into this one rogue Deans Letter, what do you do? Well you run it by your team, the admissions committee!
The Next Step: The Admissions Committee
So, how does the Admissions Committee deal with a Deans letter like this? And, let’s assume that all the other factors such as board scores, recommendations, personal statement, and extracurricular activities were just fine.
Well, you can probably imagine the discussions at an admissions committee meeting. First of all, half the committee says we should give this candidate a shot at an interview because everything else on the applications sounded OK. And, the other half wants to dump this application since it has a blemish. Moreover, this year has such stiff competition. In the real world, these are the discussions that take place.
As a program director, if the candidate makes it to the interview process, then the interview needs to proceed with this issue in mind. Typically, we need to press the medical student on this question. If he responds to issue with a reasonable answer, we will then place the application in a separate pile where we need to confirm the candidate with another well-placed phone call to some of the faculty. On the other hand, if he evades the question or gives an insufficient answer, we put the application in the DNR (Do Not Rank) pile. The whole process can hinge on this one comment.
The Moral Of The Deans Letter
All this brings us back to the double point of this blog. First of all, as you can see, some schools do not filter the Deans Letter at all. And, its comments can change the whole disposition of the applicant because often it is the only negative piece of information on the entire application. Is it fair? Sometimes, if the alleged student misconduct is true. But, many times a poorly edited/written Deans Letter is merely a function of the negligence of the institution delivering it. Vengeful comments do not belong in a Deans Letter. Truthful and objective comments do. But, most institutions will allow any old comment to go into the Deans Letter. I see that as a significant issue with the system.
And lastly, all medical students must look at their Deans letter if they can. For one, they should try to edit it if the can. Or, at the very least, they need to know to address it if they make it to the interview stage. Better off knowing the issues on the Deans Letter, before starting at your first interviews (if you are fortunate enough to get one).
Deans Letter Woes
My relationship with the Deans Letter is a love/hate one. Why? Primarily because it does help to ferret out differences among the candidates so that you can rank residents appropriately. At the same time, I am aware that it is an imperfect evaluation tool that can cause the demise of many applications of good candidates. Bottom line. We need to find a better way to evaluate our medical students. Perhaps, medical schools should take a second look to re-evaluate how they create the Deans Letter. It may lead to better selection criteria and improved treatment of their students!