When it’s Bad to be a “Good” Medical Student: The Secret Code of Dean’s Letters only Program Directors Know

When it’s Bad to be a “Good” Medical Student:

The Secret Code of Dean’s Letters only Program Directors Know

Each fall, as part of the residency application process, medical school deans write Medical Student Performance Evaluations also known as Dean’s Letters to be included with the ERAS application.  The letters, which are released on November 1, describe a student’s academic and extracurricular performance throughout his or her medical school career.  Students are allowed to review the letters for accuracy; for the vast majority this is a very pleasant experience because the letters are extremely complimentary.  However, hidden within the first and last sentence of each letter are code words that are known to program directors and are meant to stratify medical students from the top to the bottom of their class.  It is important to be aware of this secret ranking because only part of the ranking is based on fixed objective performance criteria like grades and USMLE scores; the other part is based on subjective perceptions, which can be easily be influenced.

Somewhere in the first sentence of every Dean’s Letter is a code word that sums up years of medical school performance.  “Outstanding” is the best and translates to mean that the student is roughly in the top 25^th percentile of the class.  “Excellent” means 50^th to 75^th percentile.  “Very Good” actually means “worse then average for our school,” and denotes a ranking in the bottom 50%.  Finally, “Good” or “Fine,” depending on the medical school, is meant to reflect that the student is actually in the bottom 25% of the class.

A similar set of codes can be found in the last sentence of the letter.  “Strongest recommendation” or “highest recommendation” are the same, and represent the highest praise.  “High recommendation” means that there is a whole quartile of the class that is better ranked.  And finally, the word “recommendation” without any adjective before it testifies to the lukewarm praise that is made.

The code word combination that appears in any letter has some degree of flexibility and can be influenced. At the beginning of your 4^th year, schedule an appointment with your dean to discuss the contents of your letter.  Dress professionally for this meeting and come prepared.  Bring a copy of your CV, your personal statement, as well as any other supporting documents.  In a 30-40 minute session be prepared to discuss your academics, extracurriculars, and residency application plans (See the section “Winning at Interviews” on www.bestresidency.com to see a more complete list of discussion topics).  This is not a meeting where you explore your potential career interests, but rather where you present the blueprint that you’ve designed for you medical career.  Deans are people too, and when they see a student who is prepared, motivated, and excited to pursue the next step in their career they are likely to bump up an “excellent” medical student to be an “outstanding” one, and recommend them with their highest praise.  When the letter gets written, be sure to go over it with a fine tooth comb as errors are common.  If you find something you don’t like, be sure to appeal it because until it is published through ERAS nothing is set in stone.

Before stressing out too much about meeting with the dean, keep in mind that it is in the dean’s best interest to have all the students match at programs they like, so think of this as helping them help you.  Finally, to put things in perspective, remember that the person that graduates last in their med school class is still called “Doctor.”