As an international medical graduate (IMG), you’ll encounter three terms as you begin to prepare for a residency: MSPE, Dean’s Letter and Medical School Transcript. Many IMGs believe that these are the same papers. Others believe they need to go to their college and get three different documents. Both are not exactly correct.
Outside the United States, these words are not used in most medical schools and that makes sense of the confusion.
Here’s the easy explanation. Your subjects and marks are listed in your transcript. You will receive a letter from your college to assess your student performance, this letter is called an MSPE. So what about the Dean’s Letter? That’s what the old version of the MSPE used to be called.
Medical Student Performance Evaluation, or MSPE, is a comprehensive evaluation of students’ academic performance. Consider it the official report from medical school about you. The AAMC (Association of American Medical Colleges, who are the ones who operate ERAS, the Electronic Residency Application Service that you use to apply) says that it is a fair and accurate reflection of a student’s experiences, qualities, and academic work.
Who writes it? Typically the dean’s office or the student affairs office at your medical school. They review your academic results, your exam scores and comments from your supervisors during the rotations.
Why is there any program care? A residency program director (the doctor who oversees a residency program, and determines who to interview) can’t learn a lot from the marks. If your transcript displays 75% for medicine, this indicates that you achieved 75% for medicine; that’s fine, but did you get on well with patients? Were you punctual? Were your consultants happy with working with you? The MSPE is an attempt to provide answers to those questions.
There is one thing that many applicants get wrong, so first clear that. The MSPE is a judgemental assessment. Your school tells you what was happening and that includes less successful aspects. Not so with a letter of recommendation (LoR). A doctor that knows you writes it because they wish to help you.
The AAMC recommends an MSPE consist of 6 sections and be no more than seven single-spaced pages long. Here are the topics covered in each section:
Many schools outside the US don’t rank students against each other. Your MSPE can still be accepted without it.
Yes, it is. It is just the old spelling of “Dean’s Letter. The AAMC began addressing guidelines to ensure uniformity of the Dean’s Letter in 1989, and it was renamed Medical Student Performance Evaluation. The new name was explicitly used to make it clear that the letter was intended to assess the student, not to recommend the student.
So what’s different between an old Dean’s Letter and a modern MSPE? Mostly the format. A traditional Dean’s Letter may be only a single paragraph stating that you attended the college and graduated in good standing. A more detailed MSPE is one that adheres to AAMC guidelines. It includes six sections, faculty comments, and comparison data (if available).
Good news here is that The Educational Commission for Foreign Medical Graduates (ECFMG) certifies IMGs and deals with ERAS documents, and will accept a Dean’s Letter from your medical school. But it does urge schools to adhere to AAMC’s MSPE guidelines.
Request the Dean’s Office to provide the information in the AAMC MSPE format. Simply providing them with the AAMC guidelines sometimes is sufficient.
The medical school transcript is the official document containing the results of your studies and your grades.
It is issued by the registrar of the medical school (the office where the official student records are kept) or another office that has authority, such as the examinations department. In Pakistan, for example, it is the official transcript of the college’s affiliated university, and not the college itself, that will release the transcript.
When applying to residency programs, they will review your transcript. Typically, they wish to observe:
The transcript doesn’t explain anything, such as why you took a gap year or repeated an exam. The context is in the MSPE.
Most IMG transcripts will contain:
There are many different formats throughout the country. ECFMG mentions that transcripts can come in the form of mark sheets, among other formats. Some schools provide a percentage. Some grades with letter marks or “pass” and “fail” only. All of these are acceptable for ERAS, but must be official documents.
It is easy to remember these straight if you ask yourself what question each one answer.
The difference between the MSPE and the transcript is essentially. Both can display your grades, but they serve different purposes. The program director will find it easy to check your marks in a minute from your transcript. The MSPE is longer to read since it explains the meaning behind those marks, your clinical performance and where you may have fallen short of the training.
ERAS requires two items: An MSPE (or a Dean’s Letter if you are submitting a Dean’s Letter instead). A transcript. This does not require the Dean’s Letter if you have an existing MSPE.
| Feature | MSPE | Dean’s Letter | Medical school transcript |
| Primary purpose | Evaluates how you performed in medical school | Older name for the MSPE; gives the school’s evaluation of you | Records your subjects and marks |
| Issued by | Medical school (dean’s or student affairs office) | Dean or an authorized school official | Registrar, exams office, or affiliated university |
| Main content | Academic history, clerkship evaluations, noteworthy characteristics, comparative performance | Varies by school; often shorter and less detailed | Subjects, grades, exam results, dates |
| Evaluation style | Written comments with context | Written comments with context | Marks and records only |
| Format | Six sections set by AAMC guidelines | No fixed format | Differs by school and country |
| Accepted in ERAS | Yes | Yes, in place of the MSPE | Yes, as a separate document |
| Do IMGs need it? | Yes, or a Dean’s Letter in its place | Only if your school doesn’t issue an MSPE | Yes |
Each US graduate is supported by his or her own dean’s office. But IMGs do not have this, which is why ECFMG comes in and serves as the office that uploads some of the documents into your ERAS application, the office known as the Designated Dean’s Office. ERAS Support Services uploads three elements to your ERAS application (MyERAS): Your MSPE, Your Medical School Transcript, and Your ECFMG Status Report.
Your other supporting documents go other ways:
For the MSPE & transcript there are two options:
ECFMG will take up to five business days for processing the documents and will not hurry anything up upon request. A message will be displayed in the MyERAS message center if there is a problem with a document.
To find out the status of things, log in to MyERAS and view documents. As long as five business days after upload, your transcript should appear in your “available” status. Pay attention to a recommended submission date every season, which is posted by ECFMG and is typically in September.
Schools take weeks and ECFMG adds five business days. We map your document timeline and check your MyERAS status with you, so nothing stalls before the deadline.
All document other than English must be translated into English. It needs to be signed as correct by a certified person from your medical school, government or a professional translation service. ECFMG requires the submission of the English translations, not the originals.
If you are unable to obtain an MSPE, you should indicate this on the Additional Documents page of MyERAS prior to certifying and submission (certifying means to confirm that all the information you’ve provided is true and final). ECFMG will then insert a neutral placeholder letter with no letter grade instead of your MSPE. This is just a letter instead of your MSPE and requests that programs reach out to you with any questions.
Placeholders make your application to some programs appear complete and they will not consider it until it has an MSPE. It is not a true MSPE, however, and doesn’t provide any commentary on your performance, so good letters of recommendation are even more important here.
This also applies to transcripts. If you can’t get one, mark it on the Additional Documents page and ECFMG adds a placeholder. There’s still one more, though. If your school is NOT a user of the MyIntealth Entity Portal, you may request to have the transcript they already verified for your ECFMG Certification transferred to ECFMG. ECFMG refers to this as a “last resort” and it is not as quick as a standard upload.
When your MSPE carries no commentary, strong US letters do the heavy lifting. Our USCE placements put you where an attending can write one that counts.
Yes. The MSPE is formerly known as Dean’s Letter. ECFMG will consider it, but will strongly recommend that schools use the format of the AAMC’s MSPE.
Many programs require one. When your school does not provide it, ECFMG offers a place-holder to make your application appear complete.
Yes. Simply check the Additional Documents page in MyERAS and indicate that the missing MSPE is included in the submission, and a neutral letter will be added by ECFMG.
Yes. Your transcript includes the subject and marks. Your MSPE assesses all of your work, with comments and context.
Yes, if you have official student copies and your school doesn’t use the MyIntelect Portal for the entities. They are uploaded via MyIntealth Applicant Portal.
No, it will need to be resent for ERAS. If you can’t get a fresh copy, you can request a transfer of the transcript verified for your ECFMG Certification.
Submit an official English translation by your school, government or a professional translation service. Only the translation needs to be submitted.
Your transcript lists the subjects you studied, and the marks which you received. Your MSPE tells about your performance as a medical student. The Dean’s Letter is the same as the MSPE, you just need one of the two. Ask for your documents early, upload it through ECFMG, and regularly check your MyERAS before the deadline to ensure that all your documents appear.
Not certain in which position you’re in along with your ERAS paperwork? IMG Helping Hands helps international medical graduates navigate through the USMLE and Residency Process. Contact team and progress with a clear plan.
The MSPE, transcript, and ECFMG steps trip up IMGs every season. IMG Helping Hands helps you get them right:
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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