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The Medical Student Performance Evaluation (MSPE) provides important information to residency programs. Despite recent recommendations for standardization, it is not clear how much variation exists in MSPE content among schools. We describe the current section content of the MSPE in US allopathic medical schools, with a particular focus on variations in the presentation of student performance. A representative MSPE was obtained from 95.3% (143 of 150) of allopathic US medical schools through residency applications to the Zucker School of Medicine at Hofstra/Northwell in select programs for the 2019–2020 academic year. A manual data abstraction tool was piloted in 2018–2019. After training, it was used to code all portions of the MSPE in this study. The results were analyzed, and descriptive statistics were reported. In preclinical years, 30.8% of MSPEs reported data regarding performance of students beyond achieving "passes" in a pass/fail curriculum. Only half referenced performance in the fourth year including electives, acting internships, or both. About two-thirds of schools included an overall descriptor of comparative performance in the final paragraph. Among these schools, a majority provided adjectives such as "outstanding/excellent/very good/good," while one-quarter reported numerical data categories. Regarding clerkship grades, there were numerous nomenclature systems used. This analysis demonstrates the existence of extreme variability in the content of MSPEs submitted by US allopathic medical schools in the 2019–2020 cycle, including the components and nomenclature of grades and descriptors of comparative performance, display of data, and inclusion of data across all years of the medical education program. [ABSTRACT FROM AUTHOR]