The Dean's Letter Dilemma: A Rogue Evaluation

Within the application, few sources give as much information to the residency application committees as the Dean's Letter. Yet, the Dean's 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 Dean's Letter with a rogue evaluation:

Evaluations

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 their 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 they didn't think it was necessary.

The Dilemma

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 Dean's Letter evaluation? What do admission committees do with this information? And, how does a Dean's 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 them. And finally, perhaps, this medical student indeed did not function well in a rotation that did not interest them.

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 Dean's 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 Dean's 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 okay. 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 they respond to the 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 they evade the question or give 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 Dean's 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 Dean's 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's misconduct is true. But, many times a poorly edited/written Dean's Letter is merely a function of the negligence of the institution delivering it. Vengeful comments do not belong in a Dean's Letter. Truthful and objective comments do. But, most institutions will allow any old comment to go into the Dean's Letter. I see that as a significant issue with the system.

And lastly, all medical students must look at their Dean's Letter if they can. For one, they should try to edit it if possible. 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 Dean's Letter, before starting at your first interviews (if you are fortunate enough to get one).

Dean's Letter Woes

My relationship with the Dean's 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 Dean's Letter. It may lead to better selection criteria and improved treatment of their students!

Barry Julius, MD, is a board-certified radiologist at St. Barnabas Medical Center. He developed the educational website radsresident that aims to connect radiologists. He is a 2018–19 Doximity Author.

More from Op-Med