Biographical Information Form – Class of 2017
for the Medical Student Performance Evaluation- MSPE
(aka the Dean’s Letter)
· Name:
· Phone #:
· Cell Phone #:
· Beeper #:
· E-mail:
PLEASE READ THIS AND FOLLOW DIRECTIONS CAREFULLY
The MSPE is not a letter of recommendation. It is a summary of your medical school achievements. To help us craft the best possible letter, please provide as complete information as possible. Before you fill in this form, check your Student and Personal records to ensure the accuracy of the information. Read all clerkship evaluations, and continue to read your evaluations throughout your Third and Fourth Years.
· Insert “N/A” in sections that do not pertain to you.
· E-Mail the completed Biosketch as an e-mail attachment to Susan Norris, who can also answer any questions about the process (, or 617-638-4902).
· E-Mail your own CV along with the Biosketch to Susan Norris
UNIQUE CHARACTERISTICS: This is the first paragraph of the MSPE, and will reflect the information that you provide. You will draft this paragraph, which will be finalized by your OSA Dean.
Include:
· HIGHLIGHTS of your time here at BUSM
· Any BRIEF relevant background information that you think would be helpful to include
· Evidence of leadership ability
· Brief research and other scholarship (please note, you can include details of your research, mentors etc., on your ERAS CV)
· Any significant challenges or hardships while in medical school.
· Honors, awards, election to Honor Societies (please specify if medical school, graduate school or undergraduate school).
· Significant extracurricular activities while in medical school, commenting on your role (a more complete list can go on your ERAS CV)
Examples:
a. While a medical student, XXX has been involved with the Outreach Van Project, a student-run project that brings medical care, food and supplies to the homeless and underserved populations of Greater Boston, and served as Project Coordinator. She volunteered with the Homeless Health Immersion Experience, a longitudinal elective for preclinical students dedicated to providing weekly clinical experiences with homeless patients at the Boston Healthcare for the Homeless Program. She was selected for the 2012 Summer Research Scholarship Program at Boston University School of Medicine, and joined a research project being conducted by Dr. YY ZZ, examining periodontal disease as a model for inflammation and a risk factor for cardiovascular disease. During her third curricular year, she had the added challenge of dealing with caring for an elderly grandparent who had suffered a stroke.
b. XXX has demonstrated a strong interest in service learning throughout his time as a medical student, volunteering with several community-oriented organizations: the Outreach Van Project, the Student Nutrition Awareness and Action Council, The Other Side of the Bed Program, and The Homeless Health Immersion Experience; he also served in leadership roles in these activities. Also demonstrating his commitment to service, he volunteered with the Office of Alumni Affairs fundraisers, and served as an Admissions Associate for prospective students. His classmates recognized his commitment to service by electing him to the Gold Humanism Honor Society.
Please provide the paragraph (not more than 20 lines) here:
EDUCATION and previous careers (include dates):
· Undergraduate School(s)
· Graduate School (including dual degree information from BU)
· Career/jobs:
Medical School:
Date of Entry:
Date of Expected Graduation
Please indicate the pathway through which you entered medical school e.g. 4-Year, MD/PhD, MD/MPH, MAMS, EMSSP, MMedic, 6-Year, etc.
Please note if you transferred from another medical school
Extended time in Medical School – this information is required: please note reasons if you have taken longer than 4 years, including dual-degrees, LOAs, personal reasons, illnesses, alternate/modified/decelerated curriculum, repeat year. This information is also recorded on your transcript.
Military Branch Health Professions Scholarship: Please note which military branch.
Visa Status: If you are not a US citizen, indicate your current status e.g. Green card, F1, J1, H1-B etc. Indicate the expiry date and the steps you need to take prior to this date.
Felonies: If you have a felony conviction on your record, you are required to make an appointment with Dr. Jackson, Dean of Student Affairs, to discuss how this will affect your residency application, and your career path. Residencies and state licensing boards do conduct criminal record investigations prior to granting a full license or limited license.
PLEASE INDICATE THE FIELD(S) OF MEDICINE THAT YOU ARE CURRENTLY CONSIDERING:
Please answer the following questions (in writing) and come to your meeting with your dean prepared to discuss – 1-3 sentences per answer. This will also help you as you start thinking about your personal statement
1. Where did you grow up?
2. What were important influences on you growing up?
3. Factors that led you to a medical career
4. Any important or unique features about your background that you would like to see reflected in the MSPE?
5. What attributes have best prepared you for residency?
6. What is your most important accomplishment?
7. What are your greatest strengths?
8. What challenges have you faced and overcome, and how have you grown as a result?
9. How to you relate to colleagues and fellow team members?
10. Why would a program director want you in his/her program? What will you bring?
11. What is the most important thing that you want a residency program to know about you?
Research and Scholarly Activities
Research or scholarly activities done during medical school:
(If you have done more than one research project or scholarly activity, please fill out complete information for each project.)
Mentor or PI:
Title of the Project:
Originality:
· Your own idea
· Mentor’s Idea
· Combination
Outcome (list every option):
· Completed/NotCompleted/Terminated
· Written/Not Written
· Submitted/Accepted
· Published, including complete citation
· Presented, including name of meeting and whether oral/poster/abstract)
Publications from research or scholarly activities completed prior to medical school:
(list as many as are applicable)
Complete the following to be reviewed with your OSA Dean. This information is NOT included in the MSPE:
1. Step 1 score:
2. Step 2:
· Practice test results with dates:
CK scheduled? Date?
· End of 3rd year assessment – date? Performance on EOYA 2nd year and 3rd year?
· Date for your CS exam:
· How are you preparing?
3. Who is your FSA? Have you contacted him/her?
4. Have you reviewed the specialty profile on the CiM website? http://www.aamc.org/careersinmedicine