To examine the variability among medical schools in ranking systems used in medical student performance evaluations (MSPEs).

The authors reviewed MSPEs from U.S. MD-granting medical schools received by the University of California, Irvine emergency medicine and internal medicine residency programs during 2012-2013 and 2014-2015. They recorded whether the school used a ranking system, the type of ranking system used, the size and description of student categories, the location of the rankingstatement and category legend, and whether nonranking schools used language suggestive of rank.

Of the 134 medical schools in the study sample, the majority (n = 101; 75%) provided ranks for students in the MSPE. Most of the ranking schools (n = 63; 62%) placed students into named category groups, but the number and size of groups varied. The most common descriptors used for these 63 schools' top, second, third, and lowest groups were "outstanding," "excellent," "very good," and "good," respectively, but each of these terms was used across a broad range of percentile ranks. Student ranks and school category legends were found in various locations. Many of the 33 schools that did not rank students included language suggestive of rank.

There is extensive variation in ranking systems used in MSPEs. Program directors may find it difficult to use MSPEs to compare applicants, which may diminish the MSPE's value in the residency application process and negatively affect high-achieving students. A consistent approach to ranking students would benefit program directors, students, and student affairs officers.