Rationale and objectives: Program directors would like to interview the very best students applying to their programs. The summary paragraph of the dean's letter should provide useful information regarding a student's performance in medical school. One frequently found descriptor is excellent. However, its very frequency suggests the word may be loosely used. The purpose of this investigation is to determine the meaning of excellence.
Materials and methods: The descriptor excellent was searched for in the summary paragraph. An effort was made to determine how many medical schools used excellent, how precisely the medical school defined this word, whether numbers were used to define the upper and lower boundaries of excellent, and what other buzzwords were used in the summary paragraphs for students not defined as excellent.
Results: Excellent was the most common descriptor, used by 75% of the medical schools. Defined numeric boundaries were used by 47% of schools. Tabulated results showed that within a school the range of excellence varied from as tight as 20 percentile points to so broad that 65% of the students were classified as excellent. The boundaries of excellent, among different schools, varied from as low as the third to as high as the ninety-second percentile. In half the schools, students described as excellent might be in the bottom half of their class. A total of 28% of the schools used excellent, but without any numeric definition. No school used excellent to describe its best students.
Conclusions: Medical student deans often exaggerate the quality of their graduates by using the word excellent at variance with the dictionary definition of exceptionally good. Inaccurate descriptions by deans of their graduating medical students diminish the value of MSPE.