You have emailed the registrar’s office and received one reply:
The reply was one line: “We don’t issue that document.”
You are looking at the MyERAS portal and wondering if you have missed out on the residency application.
But you haven’t! If your medical school will not provide your MSPE documents, ECFMG have got you covered.
However, this is often not explained well. Here is what you need to know.
If you cannot obtain your MSPE from your medical school, you will need to indicate this on the Additional Documents page during your MyERAS application. A neutral placeholder will be added.
This is very important to remember if you are an International Medical Graduate. Many international schools use a grading system and will never have provided a US style evaluation letter.
All you need to do is make sure you correctly flag it and replace the information elsewhere in your file. You will also need a two sentence explanation.
If your medical school will not provide you with an MSPE, you need to indicate this on the Additional Documents page in MyERAS. ERAS Support Services will then add a neutral placeholder letter to your file. If they can provide you with a Dean’s letter then this is acceptable.
Half of the panic comes from the name.
MSPE stands for Medical Student Performance Evaluation. ECFMG explains that it is an evaluation of your performance during medical school compared to your peers. It is simply a new name for the Dean’s letter.
Here is a table to help you understand the difference between these four documents.
| Document | Description | Is it acceptable to use in the MSPE section? |
| MSPE | A structured evaluation from your medical school. Ideally following the AAMC MSPE guidelines. | Yes – this is what ECFMG encourages. |
| Dean’s letter | A traditional letter from your Medical School Dean summarising your record. | Yes – this is acceptable. |
| Neutral placeholder | A short notice from ECFMG stating no MSPE is available. | This will be added by ECFMG once you have flagged it. |
| Letter of Recommendation | A personal recommendation from a physician who has supervised you. | No – MSPE is not a letter of recommendation. |
This means that “my school has no MSPE” is different from “my school can’t write anything”. Find out which applies to you.
An MSPE should:
If it is not in English, a certified translation from a medical school official, government official or professional translation service is required. Only the English version will be submitted.
Before touching MyERAS, speak to your school.
Weak: “Please send my MSPE for ERAS.”
Better: “Could your office issue a Dean’s letter on letterhead, with the school seal and the dean’s signature, confirming my enrollment dates, graduation date and academic standing? I can send a sample format.”
Even if they have never heard of an MSPE, they may still be able to provide you with a letter.
With a placeholder, your experiences, personal statement, and letters are what programs read. We review your whole IMG file and fix the weak areas before a program director sees them.
This is often over complicated.
The AAMC states that residency applicants (IMG) must indicate whether they or their medical school will provide the MSPE to the ERAS documents office at ECFMG. If neither can, you must indicate this on the Additional Documents page.
I would recommend doing this before certifying your application. Buttons can change between seasons so use the current MyERAS User Guide.
Make sure you do not select the placeholder.
Select this when you are unable to obtain the MSPE from your school. Keep a record of your emails with them, though a formal written refusal is not an ECFMG requirement. If they change their mind and agree to provide a letter, contact ERAS Support Services at ECFMG.
Short!
The wording is published by ECFMG. It will state:
The letter reads: “This document is provided in lieu of the applicant’s MSPE.” Please contact the applicant if you have any questions.
There will be no reason given. It will not criticise you or your school.
The AAMC explains that the MSPE is not something you can choose to assign. It will automatically be sent to all the Programs you apply to. This is why you will have a placeholder.
Most people miss this.
The placeholder will prompt the Residency Program Director to ask you about it. Most applicants will not have prepared an answer.
Weak: “My school refused to give me one.”
Better: “My school doesn’t issue MSPEs for any graduate. My transcript documents my academic record, my ECFMG Status Report confirms my certification status, and my clinical letters describe how I performed on the wards.”
Sounds like a conflict.
Honestly, no one has published this.
No official source has published how many people with a placeholder have matched. Any percentages mentioned will be made up.
The 2024 NRMP Program Director Survey states 85% of responding Programs listed the MSPE/Dean’s letter as a factor in who they interview. The average importance was 4.1/5.
The 2026 NRMP Program Director Survey summary states the top factors in who they interview are USMLE Step 2 CK score (89%), passing Step 1 (87%) and specialty specific letters of recommendation (86%). However, the survey response rate was 12.7% so please take this with a pinch of salt.
Programs do look at this area but having a real Dean’s letter will be better than a placeholder. However, the top factors in 2026 are things you cannot influence with a missing MSPE.
If you only do one thing, make sure you have a signed Dean’s letter (on headed paper).
As IMG applicants will not have an MSPE, this information should be provided elsewhere.
| MSPE Information | Where to Provide |
| Course, grades and exams | Medical School Transcript (uploaded via MyIntealth) |
| Clinical performance | Letters of Recommendation from physicians who have supervised you. Ideally from USCE. |
| ECFMG certification status | ECFMG Status Report (uploaded by ECFMG). |
| Exam history | USMLE Transcript (released via MyERAS). |
| Gaps/Unusual Circumstances | Experience and personal statement. |
All of the items on the right are documents you can provide. Make sure you fill them in correctly.
Your letters will now carry more weight.
Letters do not replace the MSPE. Your transcript documents your academic performance, while clinical letters add further evidence of your clinical ability and professionalism.
As you won’t have a school evaluation, programme directors will look at what your supervisors have written. We can help you to choose the right people to write your letters. How to Choose the Right US Letter Writers as an IMG
ERAS Support Services (ECFMG) act as your designated Dean’s office. They have published the following rules:
They will not prioritise your supporting documents. Work backwards from your intended submission date.
The AAMC timeline for ERAS 2027 shows that Programs may start looking at applications and MSPEs from 23rd September 2026. The season ends on 31st May 2027. ECFMG recommends submitting your MSPE and transcript by 11th September 2026.
If you are applying late this season or for ERAS 2028, the order will be the same. Just make sure you check the new dates on the official pages and map them to your IMG ERAS timeline.
If you are still early on, check out the IMG Roadmap to the US Residency Match.
Do not:
Do not do this automatically. The first step will impact everything else. Wait for a reply from the school before selecting the placeholder.
Work backwards from your intended submission date.
| Date | Task | Completed |
| 8+ Weeks Before | Write to the dean and registrar asking for an MSPE or Dean’s letter. | ☐ |
| 6 Weeks Before | Check if your school is using the MyIntealth Entity Portal. | ☐ |
| 4 Weeks Before | Order a certified English translation. | ☐ |
| 2+ Weeks Before | Upload your MSPE/Dean’s letter and transcript in MyIntealth. This will take up to 5 working days. | ☐ |
| Before Certifying | If you have no letter at all, set your MSPE status on the Additional Documents page. | ☐ |
| After Submitting | Check your document status in MyERAS. Practice your two sentence explanation. | ☐ |
6 Rows. If all are ticked, you have covered your missing MSPE.
Weak: Tick upload the night before.
Better: Add a date to each row today. Count in working days.
This explanation will come up again on interview day. Add it to your residency interview prep. It also goes well with your questions to ask a residency programme director.
A long explanation reads like a red flag. We practise the short, factual answer in our mock interviews, so one clear sentence settles it.
Yes. If you cannot obtain an MSPE from your medical school, you will need to indicate this on the Additional Documents page. A neutral placeholder will be added. You can still certify your application and send it to Programs. Each residency programme will decide how much weight they will give to this. The rest of your file will have to work harder.
Yes, for ERAS. ECFMG explain that MSPE is a new name for the Dean’s letter. A Dean’s letter from your medical school is acceptable. However, they encourage schools to follow the AAMC MSPE format. If your school can only provide a traditional Dean’s letter, go for it.
This depends on your school. If you have a copy of your MSPE, you can upload it in the ERAS Support Services section of your MyIntealth Applicant Portal. This will take up to 5 working days. If your school are using the MyIntealth Entity Portal to participate in ERAS, they will have to upload it. You cannot. Ask your dean’s office which applies to you.
It is a short statement. It will state that the document has been provided in lieu of your MSPE and ask them to contact you if they have any questions. There will be no reason given. It will not criticise you or your school. This is why you should have a two line explanation.
Not automatically. No official source has published any information on how many people with a placeholder have matched. No one can give you an honest percentage. Requirements will vary between Programs. Some Programs will list an MSPE/Dean’s letter as a requirement. Check each programme’s website. If the wording is unclear, email the coordinator.
Only if you request it. ECFMG state that your application in MyERAS is separate to your ECFMG Certification. If your school are not in the MyIntealth Entity Portal and you have no other way of obtaining the document, you can request a transfer in MyIntealth. This can take up to 8 working days.
Many IMGs will not have an MSPE. ECFMG have planned for this. Firstly try to obtain a Dean’s letter from your school. If this fails, flag it on the Additional Documents page.
Ensure your transcript, letters and experiences answer the questions that the MSPE would have. The placeholder does not provide any explanation. You have to.
If you want a second pair of eyes on your file before Programs see it, start with our residency interview prep.
Follow IMG Helping Hands for more valuable tips. We aim to guide IMGs through every step of their USMLE journey to help them match into their dream residency.
A placeholder leaves less room for weak spots, so we work on everything you can still influence:
Articles published by IMG Helping Hands are prepared by our team using information from direct experience, publicly available resources, and educational references. AI tools may be used to assist with drafting, proofreading, and formatting; however, all content undergoes review and approval before publication.
The information provided is intended for educational purposes only. Requirements, policies, and processes may change over time. Readers should consult official sources for the most current information.
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