Annual Meeting 2008 Creating a Better Tomorrow GSA Transition Forum: Is the MSPE Dead? AAMC Annual Meeting San Antonio, Texas November 1, 2008.

Annual Meeting 2008 Creating a Better Tomorrow GSA Transition Forum: Is the MSPE Dead? AAMC Annual Meeting San Antonio, Texas November 1, 2008

Creating a Better Tomorrow 2008 Annual Meeting Chair Molly Osborne, M.D., Ph.D. Associate Dean for Student Affairs Oregon Health & Science University Chair-Elect, AAMC Group on Student Affairs

Creating a Better Tomorrow 2008 Annual Meeting Speakers Richard P. Wheeler, M.D. Executive Associate Dean for Academic Affairs, College of Medicine University of Arkansas for Medical Sciences Lanny Garth Close, M.D. Professor and Chair, Department of Otolaryngology Columbia University College of Physicians & Surgeons

Creating a Better Tomorrow 2008 Annual Meeting Speakers Neil H. Parker, M.D. Senior Associate Dean, Student Affairs & GME University of California Los Angeles Geffen SOM Angela Nuzzarello, M.D., MHPE Associate Dean, Student Programs & Professional Development Northwestern University Feinberg School of Medicine

Creating a Better Tomorrow 2008 Annual Meeting Speakers Maria C. Savoia, M.D. Vice Dean for Medical Education Professor of Medicine University of California San Diego School of Medicine

Creating a Better Tomorrow 2008 Annual Meeting Question # 1 Which of the choices below is your primary affiliation? 1.Student Affairs (GSA) 2.Undergraduate Medical Education (GEA) 3. Graduate Medical Education (Program Directors) 4. Student (OSR) 5. Resident (ORR) 6. Other

Creating a Better Tomorrow 2008 Annual Meeting Question # 2 If you are involved with GSA what part are you primarily involved with? 1.MAS 2.COSR 3.COSA 4.COSFA 5. OSR 6. All

Creating a Better Tomorrow 2008 Annual Meeting Question # 3 How long have you worked in this position? 1.< 1 year 2.1-5 years 3.5-10 years 4.>10 years

Creating a Better Tomorrow 2008 Annual Meeting Question # 4 Are you the sender, recipient or subject of the MSPE? 1.Sender 2. Recipient 3. Subject 4. None of the Above

Creating a Better Tomorrow 2008 Annual Meeting Richard P. Wheeler, M.D. Executive Associate Dean for Academic Affairs, College of Medicine University of Arkansas for Medical Sciences

Creating a Better Tomorrow 2008 Annual Meeting History of the Dean’s Letter AKA – M S P E AKA – MISSPEEEEEEEE AKA – “It’s not time yet to do those darn things again this year, is it?”

Creating a Better Tomorrow 2008 Annual Meeting National Library of Medicine 4 th or 5 th Century AD

Creating a Better Tomorrow 2008 Annual Meeting This was too damn hard. Have the Associate Dean do it from now on!!

Creating a Better Tomorrow 2008 Annual Meeting National Library of Medicine 4 th or 5 th Century AD

Creating a Better Tomorrow 2008 Annual Meeting Henry M. Sondheimer, M.D. November 1, 300

Creating a Better Tomorrow 2008 Annual Meeting No rules or standardization. Personal letters written to individual program directors. Many times a real letter of recommendation rather than reference.

Creating a Better Tomorrow 2008 Annual Meeting

Creating a Better Tomorrow 2008 Annual Meeting UAMS Dean’s Letters = 1 to 2 pages

Creating a Better Tomorrow 2008 Annual Meeting 1989

Creating a Better Tomorrow 2008 Annual Meeting November 1 release date approved through a complex process. Intended to slow down the process - and it worked. Few interviews before November.

Creating a Better Tomorrow 2008 Annual Meeting ERAS September 1 release established by ERAS Committee but not through complex approval process like the November 1 release date 1995

Creating a Better Tomorrow 2008 Annual Meeting Camel

Creating a Better Tomorrow 2008 Annual Meeting 2002

Creating a Better Tomorrow 2008 Annual Meeting TODAY

Creating a Better Tomorrow 2008 Annual Meeting OR

Creating a Better Tomorrow 2008 Annual Meeting Lanny Garth Close, M.D. Professor and Chair, Department of Otolaryngology Columbia University College of Physicians & Surgeons

Creating a Better Tomorrow 2008 Annual Meeting THE PROGRAM DIRECTOR’S POINT OF VIEW The Medical Student Performance Evaluation

Creating a Better Tomorrow 2008 Annual Meeting MSPE 2004 Survey of Oto/HNS PD’s Rank Order of ERAS Candidate Information USMLE step 1 score Performance as sub-I LOR from fellow Chairs/PD’s AOA status Candidate’s Personal statement Dean’s Letter (MSPE)

Creating a Better Tomorrow 2008 Annual Meeting MSPE The PD’s dream MSPE……… “ Josephine Smith’s class rank at the completion of the third year of medical school is **/***.”

Creating a Better Tomorrow 2008 Annual Meeting MSPE The PD’s nightmare MSPE……….. “Although the Dean’s Letter Advisory Committee of the AAMC recommends that the MSPE contain comparative performance statements, ………..’s evaluation system was not designed to provide information comparing one student to another. For that reason, we encourage review of this evaluation in it’s entirety.”

Creating a Better Tomorrow 2008 Annual Meeting MSPE Why is the non-revealing “stealth” MSPE a problem for the PD in a highly competitive specialty for which large numbers of highly qualified candidates are applying? 450 applicants 4 positions 40 interview slots One PD

Creating a Better Tomorrow 2008 Annual Meeting MSPE What does the PD want from the MSPE Earlier release Clearly stated, uniform performance scoring Clearly stated and illustrated performance comparisons for All subjects (rotations) for all 3 years An overall ranking of performance at the end of the third year (at least by quartiles) As few adjectives and adverbs as possible

Creating a Better Tomorrow 2008 Annual Meeting MSPE Where does the PD turn when the MSPE does not provide a meaningful comparison of performance for the candidate? Other schools USMLE scores AOA status (when available) LOR from colleagues College transcript

Creating a Better Tomorrow 2008 Annual Meeting MSPE Example of scored/illustrated performance by course Number of Students

Creating a Better Tomorrow 2008 Annual Meeting MSPE Example of scored/illustrated overall performance at completion of third year % Students

Creating a Better Tomorrow 2008 Annual Meeting MSPE A Review of 2007 MSPEs from 62 U.S. Medical Schools

Creating a Better Tomorrow 2008 Annual Meeting MSPE SCORING CRITERIA 3 CATAGORIES MS performance scored MS performance compared MS performance comparison illustrated

Creating a Better Tomorrow 2008 Annual Meeting MSPE MS Performance Scored 0- not done 1- poorly/incompletely done 2- average (acceptable) 3- well done 4- uniformly done (excellent)

Creating a Better Tomorrow 2008 Annual Meeting MSPE MS Performance Compared 0- not done 1- poorly/incompletely done 2- average (acceptable) 3- well done 4- uniformly done (excellent)

Creating a Better Tomorrow 2008 Annual Meeting MSPE MS Performance Comparison Illustrated 0- not done 1- poorly/incompletely done 2- average (acceptable) 3- well done 4- uniformly done (excellent)

Creating a Better Tomorrow 2008 Annual Meeting MSPE Overall Score for Institution 0- No attempt to follow AAMC guidelines 6- Acceptable presentation of MS performance 12- Outstanding (Gold Standard)

Creating a Better Tomorrow 2008 Annual Meeting MSPE SCORES # of Institutions

Creating a Better Tomorrow 2008 Annual Meeting MSPE Study Results 20/62 (32%) U.S. Medical Schools failed to present MS Performance in acceptable format 42/62 (68%) U.S. Medical Schools present MS Performance in acceptable format 6/62 (10%) U.S. Medical Schools present MS Performance in outstanding format

Creating a Better Tomorrow 2008 Annual Meeting Timing of MSPE Present date is November 1 st Applications reviewed from mid-September until mid-October First batch of interview invitations go out 1 st week of October Interview slots filled by 2 nd to 3 rd week of October MSPE used by PD to help rank candidates after interviews

Creating a Better Tomorrow 2008 Annual Meeting Timing of MSPE Proposed date is October 1 st Applications reviewed mid-September until mid- October Interview slots filled by 2 nd or 3 rd week of October MSPE used by PD to select resident applicants for interview

Creating a Better Tomorrow 2008 Annual Meeting Student Affairs Dean Prospective on the MSPE Neil H. Parker, M.D. Senior Associate Dean, Student Affairs & GME University of California Los Angeles Geffen SOM

Creating a Better Tomorrow 2008 Annual Meeting MSPE – One Dean’s Perspective Accurate assessment of student’s performance Perspective over three plus years Preclinical coursework minor component and not very useful Clinical coursework major component and should be very useful Summary provides perspective on student, potential and overall assessment Predictive of success as a houseofficer

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Unique Characteristics Provides insight into what makes this student different, special, unique…. Documents the Road Travelled Different from Student’s Activity and Background sections of ERAS as seen through the eyes of the Student Affairs Dean and Educator Non-cognitive variables important for choosing residents - Programs three to seven years in length

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Education Demographics Important for years of school Leaves of absence important but very variable in how schools represent leaves and reasons Academic difficulty and disciplinary issues Predictive of future problems in licensure, etc

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Years One and Two Too short to be meaningful All students about the same Little information from course chairs Can be left out without / not very different from transcript grades Trumped by USMLE Step 1 score

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Clinical Years Not same as clinical transcript Critical information on student’s performance in required clerkships Best predictor of abilities, attitudes and future potential and problems This is the meat of the MSPE Essentially same as evaluations of residents by faculty in programs Needs faculty and resident development

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Summary Short and puts residency applicant into perspective Not specialty oriented Not a recommendation Would be better if was recommendation and uniform as to prediction of success as a resident

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Graphs & Appendix In Pass Fail Schools, totally useless What does it predict Adds multiple pages that make MSPE seem long Appendix E – Does anyone read in selection or only when there is a problem in residency

Creating a Better Tomorrow 2008 Annual Meeting MSPE – One Dean’s Perspective Written by Student Affairs Dean 169 Students Follow AAMC MSPE recommendations Use Automated System for Processing Senior reviews for accuracy 1 ½ - 2 hours per student

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Production Time / Cost At UCLA, production of MSPE reduced by 50% through automation Students complete web-based survey on their activities, background and other unique characteristics – 2+ hours Individual meeting with students 20-30 minutes, SAD Production of Unique characteristics and Summary – SAD ( Student Affair Dean – and is sad) 1 – 1 1/2 hours Electronic formulation of clerkships information from evaluation system – HAL Cost $300-400 per student x 169 students = $ 45,000 +

Creating a Better Tomorrow 2008 Annual Meeting Timing Students complete questionnaire on Activities, Background and Characteristics - August Letters written between August and October Students review letter for accuracy between September and mid October Uniform release November 1 This allows for all the Third Year electives and first Sub I’s of fourth year to be received and place in the MSPE

Creating a Better Tomorrow 2008 Annual Meeting MSPE Geffen School of Medicine Pass/Fail all Years Number of Students

Creating a Better Tomorrow 2008 Annual Meeting MSPE - Problems PD’s and faculty increasingly busy with clincial & research productivity and ACGME requirements Extremely useful but not appreciated by PD’s Decisions on Interviews often decided before MSPE released Undervalued Clerkship evaluations require 6-8 weeks to collect Senior electives evaluations difficult to collect and late

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Perspective Cont. MSPE really only 2-3 Pages 5 -6 pages of graphs, Appendices, etc Written comments 2-3 pages Has the MSPE gone the way of the Physical Exam and the Medical Write-up? Should it be reduced to Consumer Report style? Is complete, valuable information overruled by need for bottom lines and byte size information?

Creating a Better Tomorrow 2008 Annual Meeting MSPE – Thoughts from the Weird side Consider component release – everything short of Senior electives by October 1st Hold ERAS process till two weeks after release of MSPE – lite No interviews scheduled till after MSPE lite Senior Elective evaluations supplement Dec 1 st Transcripts folded into MSPE’s

Creating a Better Tomorrow 2008 Annual Meeting MSPE - From the Far Side Don’t change, they will come around Go back to letter of recommendation Clerkship evaluation development Do away with MSPE Just send unabridged clerkship evaluations Develop electronic MSPE that PD’s can sort for the parts they want

Creating a Better Tomorrow 2008 Annual Meeting Are we dealing with Millennials Not the Students but PD’s – younger and have tenure of 3 years on average Want everything electronic Information must be in Byte size Want it their way and don’t except No as an answer Multitaskers who don’t have time to read 8 pages Just give me the bottom line

Creating a Better Tomorrow 2008 Annual Meeting Angela Nuzzarello, M.D., MHPE Associate Dean, Student Programs & Professional Development Northwestern University Feinberg School of Medicine* *As of January 1, 2009 – Oakland University William Beaumont School of Medicine

Creating a Better Tomorrow 2008 Annual Meeting What are we duplicating? Unique Characteristics Leadership, research, community service, already in personal statement, CV, and LoRs Academic History Grades already on transcript Summary If summary statements are included, information has already been presented in LoRs or unique characteristics

Creating a Better Tomorrow 2008 Annual Meeting What information is unique to the MSPE? Explanation of any extension of time Recipient of any adverse action Assessment of professional performance Clerkship narratives Comparative performance (ranking, or quartiles, etc) Grade percentages for each clerkship

Creating a Better Tomorrow 2008 Annual Meeting The Problem with Creating MSPEs Information from multiple sources required a significant amount of “cutting and pasting” Students previewed MSPE as PDF and suggested changes through email or in person Changes to document were required every time a new grade was finalized Setting up comparative charts and tables was time consuming Creating each student’s graphical record was also time consuming.

Creating a Better Tomorrow 2008 Annual Meeting Solutions Web-based system allows students easy access to MSPE document Can make suggestions for changes through web interface which decreases number of emails Any information that is stored in a database can be put in to the MSPE template New information (i.e. grades) continually updated

Creating a Better Tomorrow 2008 Annual Meeting Unique Features of Web-based MSPE Email notification to students when the draft is ready; when student comments have been addressed Forum-style system for collaboration on various sections of MSPE letter Real-time clerkship narrative and grade inclusion Dynamic chart and table generation MS Word document generation Allows tracking of progress of individual MSPEs

Creating a Better Tomorrow 2008 Annual Meeting Comments from students “I think it worked well. The ability to send e-comments was very helpful and response time was quick.” “I think it was great that we could view our MSPEs and any comments I had were immediately addressed.” “I feel that the bi-directional feedback and electronic format made this quite efficient.” “I liked that everything was web based.”

Creating a Better Tomorrow 2008 Annual Meeting Maria C. Savoia, M.D. Vice Dean for Medical Education Professor of Medicine University of California San Diego School of Medicine

Creating a Better Tomorrow 2008 Annual Meeting “ BOTH SIDES NOW” A VIEW ABOVE THE FRAY & A REVIEW OF THE RELEVANT LITERATURE

Creating a Better Tomorrow 2008 Annual Meeting Do MSPEs Accurately Reflect Medical School Performance? Are they based on accurate data? Are data accurately reflected in letters?

Creating a Better Tomorrow 2008 Annual Meeting Based On Accurate Data? Evaluation often done by the least experienced › Experience important in preceptor’s ability to assess cognitive levels  Taylor C., Lipsky MS Fam Med 1990 Jul- Aug;(2294)296-8

Creating a Better Tomorrow 2008 Annual Meeting Based On Accurate Data? For data to be reliable, either many observations or many observers For data to be valid, they have to measure what they say they measure › “Knowledge and skill” in a Psychiatry clerkship correlated with personality characteristics and not with NBME Subject exam or OSCE scores  Chibnall JT, BlaskiewiczRJ. Acad Psychiatry 2008 May-Jun;32(3); 199-205

Creating a Better Tomorrow 2008 Annual Meeting Based On Accurate Data? “Objective” data often maligned Although many recent studies have not demonstrated gender or ethnic biases… it is better to be good looking and thin & to work closely with the person who evaluates you › Supervisors grade higher than control graders  McKinstry BH, et. al. BMC Medical Education 2004, 4;28

Creating a Better Tomorrow 2008 Annual Meeting Based On Accurate Data? The great group of “Very Good” › In Pass/Fail curriculum, how do you distinguish among those who excel &those who scrape by? › P/F grading puts students at a disadvantage in applying to General Surgery programs  Dietrick JA, et. al., Am J Surg 1991 Jul;162(1);63-6 › In a survey of 110 program directors across specialties, only 8 favored a P/F system  Provan JL, Cuttress L, Can Med Assoc J Oct.1, 1995; 153 (7)

Creating a Better Tomorrow 2008 Annual Meeting 199255% 200165% 200575% “ Adequate MSPEs ” Are Data Accurately Reflected? Hunt DD, et. al., Acad Med 2001 Jul;76(7): 727-33 Shea JA, et. al., Acad Med 2008 Mar; 83(3):284-91

Creating a Better Tomorrow 2008 Annual Meeting Are Data Accurately Reflected? We live in a “fantasy land” where all students “will make a fine physician,” & are “above average” “with excellent interpersonal skills.” Dean’s Letter for Adolph Hitler: “A natural leader…good communication skills…assisted in the development of technological advances…likes to find solutions to problems”  Friedman RB, NEJM 1983 308;651-3

Creating a Better Tomorrow 2008 Annual Meeting Are Data Accurately Reflected? Negative information found on transcript not mentioned in Dean’s Letter 34% of time. › Conclusion: “Some deans suppress negative information in their letters and potentially obfuscate the residency selection process.”  Edmond M, et. al. 1999 Acad Med 74(9);1033-5.

Creating a Better Tomorrow 2008 Annual Meeting Are Data Accurately Reflected? Excellent: of superior merit, exceptionally good 56/75 schools used “Excellent” as a category. For >50% of schools, a student described as excellent might be in bottom half of class. For 2 schools, all in “Excellent” category were in the bottom half of the class  Naidich JB, et. al., Acad Rad 2007 14; 1121-6.

Creating a Better Tomorrow 2008 Annual Meeting Are Data Accurately Reflected? Professionalism comments evaluated in 293 MSPEs for 2005 graduates. 70% mentioned professionalism, with fewer than 1% of comments that could be considered negative. › Conclusion: “Most professionalism comments in MSPE’s are generic and somewhat bland…”  Shea JA, et. al., Acad Med 2008 Oct. 83(10 Suppl);S1-4

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? Univ. Rochester looked at 2 graduating classes, divided into: “Outstanding” (upper quartile), “Excellent” (second quartile), “Very Good” (lower 2 quartiles) “Good” (lowest few percentiles) Found “Dean’s Letter rankings were a significant predictor of later performance.”  Lurie SJ, et. al., Teach Learn Med 2007 19(3);251-6

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? At the Uniform Services University, appearing before Standings & Promotions Committee (for any reason) was predictor of below average performance during internship.  Durning SJ, et. al., Teach Learn Med 2008 20(3);267- 72

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? At the Medical University of South Carolina, GPA (preclinical + clinical) + interpersonal score on Step 2CS best predicted internship performance but only accounted for 30% of variance.  Taylor ML, et. al., Acad Med 2005 80(5); 496-501

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? Otolaryngology: “excellent academic performance in medical school”  Calhoun KH, et. al., Otolaryngol Head Neck Surg 1997 116(6 pt1); 647-51 Emergency Medicine: medical school attended, MSPE and “distinctive factors”  Hayden SR, et. al., Acad Emerg Med 2005 12(3); 206-10

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? Radiology: “Noncognitive factors were as important as cognitive factors,” “Objective measures, such as NBME scores, failed to adequately predict residents’ performance.”  Wood PS, et. al., Invest Radiol 1990 25(7);855-9 Radiology: Success on ABR exam predicted by grades and NBME scores. No good predictors of clinical performance.  Boyse TD, et. al., Acad Radiol. 2002 9(4);437-45

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? PM&R: 205 residents at the University of Washington. Clinical residency performance predicted by clerkship honors grades (p=.0001). Probation was predicted by failing a basic science course (p=.0001)  Amos DE, Massagli TL, Acad Med 1996 71(6);678

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? Orthopedics: “Academic score,” using only objective measures, made screening process more objective but didn’t correlate with outcomes of the training program.  Dirschl DR, et. al., Clin Orthop Relat Res 2006 449;44-9 Surgery: “Dean’s letter seems to give the most accurate picture of applicant’s suitability for residency training.”  Naylor RA, et. al., Arch Surg 2008 143(7); 647-52

Creating a Better Tomorrow 2008 Annual Meeting PD’s: Ignore at your own risk! With an edge of annoyance, Hunt asked (Barrows) about Swango. “What kind of guy did you send us?” Barrows said that Hunt should have seen plenty of warning flags in Swango’s dean’s letter. “Well,” Hunt retorted, “I don’t read dean’s letters.” ….Soon after, Hunt called back: he’d found the letter “Oh, my God,” Hunt said. “You’re right. You did tell me.”  Stewart, JB, Blind Eye, 1999, pps. 59-60

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? Surgery: Only Step 2 scores (and not Step 1, overall GPA, AOA status, or 3 rd year clerkship grade) predicted internship performance for 87 graduates from Wash U.  Andriole DA, et. al., Am J Surg 2004 188;161-4 Anesthesia: Best predictor of academic performance number of years spent in another specialty. Step 1 score inversely correlated with in service exam score  Warrick SS, Crumrine RS, J Med Ed 1986 61(7); 591-5

Creating a Better Tomorrow 2008 Annual Meeting What Factors Accurately Predict Residency Performance? Anesthesia: “Selection committee score,” which correlates with Step 1 score, doesn’t correlate with resident performance.  Metro DG, et. al., Anesth Analg 2005 100;502-5 Pediatrics: In the case of 69 residents at UVA, medical school grades, performance on standardized exams, interviews and match list rankings did not predict clinical performance during residency.  Borowitz SM, et. al., Arch Pediaatr Adolesc Med 2000 154;256-60

Creating a Better Tomorrow 2008 Annual Meeting In Conclusion: We need better measures of performance during medical school. Multiple types of evaluation may provide a more accurate picture of performance. It’s about the Match. The best program may not be the best program for a particular student. Honesty is the only policy.

Creating a Better Tomorrow 2008 Annual Meeting In Conclusion: More categories of grading may help students in the Match The MSPE is as accurate a measure as any in predicting residency performance. NBME Step 2 but not NBME Step 1 scores have occasionally been found to predict clinical performance

Creating a Better Tomorrow 2008 Annual Meeting In Conclusion:

Creating a Better Tomorrow 2008 Annual Meeting Question # 5 Do you favor continuing the MSPE in some form? 1.Yes 2.No 3. Unsure

Creating a Better Tomorrow 2008 Annual Meeting Question # 6 If we keep the MSPE, do you favor changing the current format of the MSPE? 1. Yes 2.No

Creating a Better Tomorrow 2008 Annual Meeting Question # 7 Would you remove the unique characteristics section of the MSPE? 1.Yes 2.No

Creating a Better Tomorrow 2008 Annual Meeting Question # 8 Would you remove the clerkship narratives from the MSPE? 1.Yes 2.No

Creating a Better Tomorrow 2008 Annual Meeting Question # 9 Do you favor changing the MSPE release date ? 1. Yes 2.No

Creating a Better Tomorrow 2008 Annual Meeting Question # 10 If you favor changing the MSPE release date, which would be the optimal date? 1. September 1st 2. September 15th 3. October 1st 4.October 15th 5. November 1st 6. January 11th

Creating a Better Tomorrow 2008 Annual Meeting Question # 11 Would you favor a single date for MSPE release and the start of ERAS upload? 1.Yes 2.No

Creating a Better Tomorrow 2008 Annual Meeting Question # 12 Would you favor a uniform release date of Oct 1st for transcripts? 1.Yes 2.No

Creating a Better Tomorrow 2008 Annual Meeting Question # 13 Do you think the GSA steering committee should propose a change in the MSPE, develop a survey on the MSPE, or should we a new advisory group be convened? 1.Propose an MSPE change 2. Develop a survey 3.Convene a new advisory group

Creating a Better Tomorrow 2008 Annual Meeting Thank you for coming!!

Annual Meeting 2008 Creating a Better Tomorrow GSA Transition Forum: Is the MSPE Dead? AAMC Annual Meeting San Antonio, Texas November 1, 2008.

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Annual Meeting 2008 Creating a Better Tomorrow GSA Transition Forum: Is the MSPE Dead? AAMC Annual Meeting San Antonio, Texas November 1, 2008.

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