SAMPLE MSPE

SCHOOL NAME AND LOGO/ADDRESS

Medical School Performance Evaluation

for

APPLICANT NAME

IDENTIFYING INFORMATION

Dr. XYZ is a 2010 graduate of MEDICAL SCHOOL NAME AND LOCATION.

“If the name of the institute is changed now and your degree has a different name, then this is a good place to clarify that.”

NOTEWORTHY CHARACTERISTICS

“Briefly explain three strengths of the applicant with example or achievements like awards/ scholarships. You can use any format to frame the sentences..”

1. Dr. XYZ is …..
2. Dr. XYZ is …..
3. Dr. XYZ is …..

ACADEMIC HISTORY

Date of initial matriculation in medical school	DD-MM-YY
Date of expected graduation from medical school	DD-MM-YY
Please explain any extensions, gap(s), leave(s) or break(s) in the student’s educational program below:	none
Information about the student’s prior, current or expected enrollment in and the month and the year of the student’s expected graduation from dual, joint, or combined degree programs	none
Was the student required to repeat or otherwise remediate any coursework during their medical education? If yes, please explain:	none
Was the student the recipient of any adverse action(s) by the medical school or its parent institution?	none

ACADEMIC PROGRESS

 (Note: Grading in MEDICAL SCHOOL NAME follows the 5-4-3-2 system: 5= Excellent (90-100%); 4= Good (80-89%); 3= Satisfactory (70-79%); and 2= Fail.

Credit is given for few subjects upon successful completion of the rotation.)

“Add a basic line here, summing the entire course experience.”

He/She duly completed his/her rotations to satisfaction, showing good interaction with patients, supervising doctors, and fellow students.

Rotation	Supervisor
Surgery	Dr. XYZ, MS, Ph. D – HOD
Medicine	Dr. XYZ, MS, Ph. D – HOD
Obstetrics	Dr. XYZ, MS, Ph. D – HOD
XYZ	Dr. XYZ, MS, Ph. D – HOD
XYZ	Dr. XYZ, MS, Ph. D – HOD
XYZ	Dr. XYZ, MS, Ph. D – HOD

Practical Training Evaluation

Rotation	Duration	Result
Medical Ambulance Practice	X weeks	Excellent
Nursing assistant practice	X weeks	Satisfactory
XYZ	X weeks	Credit

Comparative performances in pre-clinical and core clinical subjects have been shown in the graphics to follow.

“Simply keep on adding black arrows on the column of performance”

I have given an example of 3 years, similarly you can keep on adding graphs for the number of years and subjects.

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Graphic Representation of Performance in First Year

Graphic Representation of Performance in Second Year

Graphic Representation of Performance in Third Year

Graphic Representation of Performance in Final Exam

ROTATIONS FOR WHICH CREDITS AWARDED

“ Mention all the rotations for which there was no ranking just credit”

1. Psychology and Pedagogic
2. Medical and Biological Ethics
3. Bio-organic Chemistry
4.  Stomatology

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SUMMARY

“ Approx <100 words summary about applicant’s performance, which should emphasize on the strengths and overall personality of the individual.”

Sincerely,

NAME OF DEAN

Dean, Faculty of XYZ

MEDICAL SCHOOL NAME

LOCATION

MEDICAL SCHOOL INFORMATION

MEDICAL SCHOOL NAME:

“Some general information like year of establishment and faculties like…”

1. Faculty of Medicine
2. Faculty of Pediatrics
3. Faculty of Dentistry
4. Faculty of Pharmacy
5. Faculty of Foreign Students

“Approx 100 words about the strengths of the university and it’s contribution to medical field/ facilities provided/ medical staff/ length of the course”

DECLARATION

This MSPE has been compiled and edited by the office of the Dean, MEDICAL SCHOOL NAME, with the aid of the student himself/herself, after verifying all the certificates, awards, and other documentary evidence.

The student is permitted to review the MSPE before its transmission.

NAME OF DEAN

Dean, Faculty of XYZ

MEDICAL SCHOOL NAME

LOCATION

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