MSPE Student Information Sheet

MSPE Student Information Sheet

(Must be completed and brought with you to MSPE appointment)

Assigned Campus* / MSPE Author’s
Last name / Primary Specialty / Primary Advisor / Parallel Specialty / Parallel Advisor / Match Type ** / Step 2 CK date
(if available)

* Campus: B = Birmingham; H = Huntsville; M = Montgomery; T = Tuscaloosa

** Match Type: You may enter more than one match type. E = Early; R = Regular; C = Couples; M = Military

If you have trouble completing on your own, ask for suggestions from your family and friends.

Full Name
(First Middle Last).
Preferred (First) Name.
List 3-5 noteworthy characteristics, experiences, or achievements.
Consider personal characteristics, experiences, or achievements that you want to share with programs so that they can more holistically review your application. This could include things not captured elsewhere in your residency application or areas that you wish to further emphasize or explain.
Personal
Strengths/Adjectives that describe you
(List 5).
Habits or tendencies you would like to improve
(List 5).
List/Describe Any Difficulties Encountered in Medical School.
Include only difficulties that you feel affected your performance in coursework, clerkships, or on board examinations and that you believe warrant explanation.
Please skip this item If you did not experience difficulties of this nature.
List/Describe Any Interruptions in Medical School (i.e. Leaves of Absence).
List anything else that you feel should be included in your MSPE.

Risk Factors – check all that apply!

Low Board score

 Low class rank

 Step 1 failure

 Preclinical course failure (1)

 Preclinical course failure (2 or more)

 ICM failure

 Clinical course failure (1)

 Clinical course failure (2 or more)

 Professional issue in MSPE

 Leave of absence for any reason other than degree; (e.g. PhD or MPH)