Clerkships (in chronological order)

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School of Medicine

Date

Identifying information

<Student’s legal name and year in school name and location of medical school>

Noteworthy characteristics

<Provide a maximum of three characteristics highlighting the most salient noteworthy characteristics of the student. This section should be presented as a bulleted list. Each characteristic should be described in 2 sentences or less. Information about any significant challenges or hardships encountered by the student during medical school may be included.>

· <text>

· <text>

· <text>

Academic History

Date of Initial Matriculation in Medical School

Date of Expected Graduation from Medical School

Please explain any extensions, leave(s), gap(s), or break(s) in the student’s educational program below:

Information about the student’s prior, current, or expected enrollment in, and the month and year of the student’s expected graduation from dual, joint or combined degree programs.

Was the student required to repeat or otherwise remediate any course work during their medical education? If yes, please explain.

Was the student the recipient of any adverse action(s) by the medical school or its parent institution?

Academic progress

Professional Performance

<Describe how the medical school defines professionalism and what it assesses in students. Whenever possible, areas of strength and weakness should be addressed.>

Preclinical Coursework

<If preclinical courses are graded as Pass/Fail, the MSPE should convey that the student has met all requirements. Whenever possible, areas of strength and weakness should be addressed.>

<The components of each clerkship grade and the weight of each component (for example, % clinical assessment, % shelf exam, % case write-up, % OSCE, etc.) should be included to better inform program directors on performance. Whenever possible, areas of strength and weakness should be addressed. Clerkship evaluations are a crucial piece of information for program directors and are considered by many to be the most important section of the MSPE in determining applicants for interview selection and rank order list.>

NOTE: The graphs included in this template are meant onlyas examples. Schools should use their own grading systems or schemes in their graphs depicting comparative student performance.

Specialty (Month – Month Year) Grade:

Overall grade based on:

Specialty (Month – Month Year) Grade:

Overall grade based on:

Specialty (Month – Month Year) Grade:

Overall grade based on:

Specialty (Month – Month Year) Grade:

Overall grade based on:

Specialty (Month – Month Year) Grade:

Overall grade based on:

Summary

<The Task Force recommends providing a summative assessment , based upon the school’s evaluation system, of the student’s comparative performance in medical school, relative to their peers. Schools should include information about any school-specific categories used in differentiating among levels of student performance. This may, though does not have to, include graphic representation of the student’s performance relative to their class overall>

Sincerely,

<Name>

<Title>

Medical school information

For additional information about the School of Medicine, please see: <website> or <appendix>

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