Tuesday, September 20, 2005
  The Dean's Letter
The Dean's Letter is something medical students bemoan. Many think they are form letters - some I've seen or heard about have seemed to be that exactly - others think they are useless because what dean is going to say something bad about a student their institution has trained? That would make for bad press all around - "this is a poor student" or something similar begs the question from residency committees "Well why did you accept them to your program or not terminate them when you discovered they are a poor student?" This only causes a loss of faith in that school's students overall. Of course, if the dean extolls the student to high heavens, they are hired into a residency program and then suck - that's even worse... like I said - bad press.

This year, the Dean's Letter has been renamed the "Medical Student Performance Examination," or MSPE for short. I don't know why, it still serves the same purpose - to tell the residency director what the dean thinks of that student and allow the residency committee to have a "sneak peek" into that student's performance evaluations. Some postulate there is a "code" used by deans to secretly tell a residency director/committee what kind of candidate the student will be. Personally (and from the research I've seen showing how insignificant a factor Dean's letters are in the residency selection process), I think the code does not exist, or if it does, it is not widely attended to. Most articles I've seen place the Dean's letter lower than the top 5 priorities for residency selection. One of the highest is the interview or an "audition rotation" at the site or a letter from a person on an "audition" somewhere else. That means when you go on a rotation somewhere, you'd better lay it all out on the table. Same goes for the interview.

That said, below is the "evaluation copy" of my MSPE sent to me yesterday. I'll make comments in italics where appropriate:


September 20, 2005

Medical Student Performance Evaluation



Prior to matriculation at UNTHSC, Mr. DeLaughter graduated from Angelo State University with an AAS degree in Nursing. While enrolled he was named to the University Dean’s List. Upon graduation Mr. DeLaughter worked as an RN for the next several years prior to his admission to medical school and also during his first two years. He is currently a fourth year student at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine.


After entering medical school, Mr. DeLaughter enriched his educational experience through participation in a wide variety of activities. He worked as a medical team member during the annual Cowtown Marathon and also a spent spring break working in Mexico providing healthcare to the indigent population of that region.

Nevermind all the other things I did in medical school - such as running EM related clinics every other month or attending numerous state and national meetings, volunteering with a sports medicine doc for a professional women's football team, etc.

While at the health science center Mr. DeLaughter maintained high academic standards. He has been named to the Dean’s List each semester. He has also been actively involved in leadership, serving as first year representative and later President of the Emergency Medicine Club. He was the Medical Student Section Student Coordinator for the Emergency Medicine Resident’s Association and is currently serving as Regional Coordinator for Region W3 of the EMRA’s Medical Student Governing Council. He is also a member of the following student organizations: American Osteopathic Association; American Medical Association; American College of Osteopathic Family Physicians; American Medical Student Association; Emergency Medicine Club; Emergency Medicine Resident’s Association; American College of Osteopathic Emergency Physicians – Student Chapter; American College of Emergency Physicians; Texas College of Emergency Physicians, American Academy of Emergency Medicine – Student Member.


Expected date of graduation from Medical School:
May 20, 2006
Date of matriculation into Medical School:
August 5, 2002
Please explain any extensions, leave(s) of absence, gap(s), or break(s) in the student’s education program.


Preclinical/basic science curriculum:
The first year of the preclinical curriculum includes 80 percent basic science and 20 percent clinical science instruction and is devoted to learning the preclinical sciences in the context of patients’ clinical problems. Students move through a sequence of seven organ system courses designed around normal human structure, finishing the first year curriculum with the study of the mechanisms of disease. The second year includes 80 percent clinical and 20 percent basic science instruction and is devoted to learning the clinical sciences and osteopathic manipulative medicine and their relationship to basic science. This time the focus is on abnormal structure and functions in each of nine organ systems. At the completion of the basic science portion of the curriculum, Mr. DeLaughter’s cumulative weighted average was 94.34, which placed him 6 in a class of 123. His current cumulative weighted average is 94.27, placing him 3 in a class of 114.

The following are a sampling of grades from completed clinical clerkships. Core clerkships are reported in the order in which they were completed. All clerkships are completed with health science center faculty unless otherwise specified. When available, verbatim comments made by clinical faculty during the clinical experience are included.

MEDICINE: 97 John Peter Smith Hospital
This clerkship is eight weeks in duration. Comments were provided by two preceptors.
Excellent student
Good student

I think I can guess who made the second comment - a doctor with whom I had a severe personality conflict. He seemed to think that medical student = attending slave and also tried to make me break the law by giving orders to nurses over the phone. His rationale: "Well, you are a nurse, aren't you? You can relay an order from a physician to another nurse!" My response: "Sure, I'm a nurse, but I am not functioning as such in this setting, so it would be illegal for me (a medical student) to issue a medical order and have it followed without a physician signing off on it." He didn't like that at all and began yelling at me, saying he was going to have me failed.. yeah. See where that got him :)

This clerkship is twelve weeks in duration.
Admissions committee scored 10/10 in accepting Jonethan to ROM. His previous life experiences as a nurse has aided in his clinical development and performance. Jonethan will make an Excellent clinician and will be an asset to the community he serves and to our profession.

I have no idea what "ROM" is. Family Medicine was a great rotation. I really enjoyed my time there and would highly recommend everyone I can to take a rotation with Dr. U.

SURGERY: 95 John Peter Smith Hospital
This clerkship is eight weeks in duration. Comments were provided by three preceptors.
A very good student and excellent bedside manner. He’ll be a good doctor.
Excellent knowledge site. Could use improvement in inter-personal skills. Patients have commented – “very distant”.
Hardworking in clinic and on call, very good at completing assigned tasks in a timely fashion. Good Attitude. Good clinical knowledge.

I found it funny how one comment was "excellent bedside manner" and the next says I have poor interpersonal skills. This is the anomaly I think every Dean's letter has - overall glowing comments and that one that just makes you say "huh?" Funny thing is, I never heard any complaints from patients, nor was I EVER reprimanded by a physician while on this rotation.

This clerkship is six weeks in duration. Comments were provided by three preceptors.
Excellent, knowledgeable student.
Sound clinical skills and effective communication.
Excellent Pe’s; Very good Hx’s; competent progress notes; excellent management plans; professional interactions with patients.

Pediatrics was fun. Kids are great, so long as you can give them back ot their parents when you're finished playing with them! I really enjoyed my time at the Peds clinic, though. The teachers are first-rate, even though the clinic is constantly swamped and usually 1-2 hours behind schedule.

OB/GYN: 92 Texas Tech University HSC-Odessa
This clerkship is six weeks in duration. Comments were provided by three preceptors.
Very helpful, eager to learn.
Eager to learn, well prepared, self-motivated. Great to work with.
Good knowledge. Pleasant, enthusiastic – Loves ER!

OB/Gyn was an interesting rotation, to say the least. This rotation was out in waaaaaaayyy West Texas. If you've seen the movie "Friday Night Lights" this is that town. Everyone is psycho about football. That and sex. There were so many pregnant teenagers out there, it was uncanny. I guess when your town doesn't even have a movie theatre you have to do something to keep yourself occupied. The residents out there were very interesting - most of them were foreign grads, as were most of the residents in all their programs. Nothing wrong with that - apparently this program is one of the most FMG friendly places in the state. It made for some interesting patient-physician dynamics, though.

PSYCHIATRY: 94 John Peter Smith Hospital
The clerkship is four weeks in duration.
Basic knowledge of psychiatry was excellent. He did readings/computer research on issues appropriate to the patient. He was very respectful of staff and patients which was reciprocated. He did an excellent job in obtaining detailed histories from families.

This four week clinical clerkship is performed in the office of a private practice physician.
This young man has rotated with me for the last 3 years and I have had students since 1978 – he is the best I’ve ever had. He may return anytime

Dr. Sparks ROCKS!!! I had a blast with him. He is really freaking hilarious and we had a great time and we still got a lot done. Spending time with him during the first 3 years of medical school helped me realize and understand that not all physicians have to be stuffy and boring. Thank you Dr. Sparks!!

The clerkship is four weeks in duration.
S/D DeLaughter far exceeded expectations on this rotation. His knowledge, skills and attitude surpassed that of his classmates and he was a delight to work with.

My preceptor for OMM was great. Dr. G was super-cool. He was incredibly laid back and wonderful with his patients. No matter if the manipulations we provided changed a darn thing, every patient left feeling like a million bucks because of the way he interacts with them. Mucho kudos to you, Dr. G!

It is a pleasure to write a Deans letter for a top student. This is the case for student doctor Jonethan Delaughter. Jonethan has been a top performer here at the University of North Texas Health Science Center - Texas College of Osteopathic Medicine since day one. He has mastered his studies; giving him an overall GPA of 94.27 and a score of 735 on his COMLEX I National Board examination. This score placed Jonethan in the top 1% nationally of all examinees!!! Jonethan is a pleasure in the classroom, wards and in the clinics. He has been named to the TCOM Deans List because of his excellent performance.

Clinical evaluations all report Jonethan to be an excellent student with excellent diagnostic acumen and sound treatment plans. Jonethan performs way above expectations for a medical student and frequently outperforms residents at a higher level. Jonathan’s shelf exam scores on his NBME subject examinations were 100 in Family Practice, Internal Medicine, Pediatrics, and Surgery!! In Obstetrics he received a 96 and in Psychiatry it was a 94!! This is all quite an accomplishment.

I'm not so sure about "outperforms residents at a higher level..." I'm still just a student and am shielded from a lot of the crap residents have to deal with - and from my last couple of rotations, I've come to realize I have a lot to learn before I am a solid physician. I still tend to oversimplify things - when I think I've found the diagnosis (or something similar) I like to put on the blinders and go at it full force. Fortunately, the attendings I've worked with have always caught my mistakes and showed me where I went wrong. I need to stop doing that before I'll consider myself as good as a resident. I need to take a step-wise approach and make sure I have a good differential that I can work through before I plunge in. I've worked on that a lot this month in EM, and I'm getting better. Now, a lot of the time when I miss something, it's because I didn't see the connection at all (or forgot something very basic and completely screwed the pooch, so to speak). I'm still working on it, but it's a work in progress.

Jonethan exhibits natural leadership ability along with his excellent knowledgebase. He has been both a leader and member of a variety of student organizations and provided many hours of community service.

In summary, student doctor Jonethan Delaughter is an excellent student with exceptional potential. He has all the qualities for great success as a resident and beyond.

Ok, so here we go with the code: is "excellent potential" code for "ok, but needs work?" If so, I'd agree with that. I'm nowhere near as wonderful as this letter tends to make me sound. I'm slow, I am iffy on which studies to order a lot of the time, and sometimes I forget things. The last is what pisses me off the most: I'll know I know something, but I just can't connect A and B to make a coherent thought.. like a short circuit in my brain. Really gets my goat!!


Bruce Dubin, D.O., J.D., FCLM
Associate Dean for Academic Affairs

After writing all this, I just hope a residency director/committee doesn't read it and get second thoughts. I really do work hard, and my head is in the right place. I'm just not done learning - no student is. If any tells you so, they're lying through their teeth. In fact, no physician should EVER stop learning. Medicine is an ever-changing field. If you stand still, you will be left far, far behind. I was told something the other day, and I'd heard it before:

A speaker at a medical school graduation said this to the graduating class, "If you're worried at all you've forgotten over the past four years, don't fret - studies show that half of what you've learned in medical school is wrong, and the other half will be outdated or proven wrong in the next 5 years. The problem is, we don't know which half is wrong now!"

See the point?
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