Effect of Change in USMLE Step 1 Grading on Orthopaedic Surgery Applicants: A Survey of Orthopaedic Surgery Residency Program Directors

Abstract

Introduction: Recently, the Federation of State Medical Boards and the National Board of Medical Examiners, cosponsors of the United States Medical Licensing Examination (USMLE), changed the USMLE Step 1 results from a three-digit score to a pass/fail format. The purpose of this study was to analyze the opinions of program directors (PDs) to predict how the evaluation of orthopaedic surgery residency applicants will change following the change. Methods: A 17-question online survey was distributed to PDs via e-mail. This survey covered program demographics, questions regarding the relative importance of various factors for selection of interviews, and perceived changes and effect of the scoring change. Responses were aggregated and analyzed. Results: PDs indicated that the three highest scored factors were (1) failure in prior attempts in USMLE/COMLEX examinations (4.7), (2) audition elective/rotation within your department (4.5), and (3) personal prior knowledge of the applicant (4.1). In addition, 38 PDs (81.1%) anticipate that they will require USMLE Step 2 clinical knowledge scores for interview consideration. Conclusion: Most orthopaedic surgery PDs think that the change in score reporting for the USMLE Step 1 will result in additional requirements and changes in how programs select applicants and do not support the decision.

What Are the Trends in Research Publication Misrepresentation Among Orthopaedic Residency and Fellowship Applicants From 1996 to 2019? A Systematic Review

“…Corresponding to the emphasis orthopaedic program directors place on scholarly activities, the mean number of publications and presentations of orthopaedic surgery residency applicants doubled between 2007 and 2014 [11], and this trend is likely to continue as the United States Medical Licensing Examination Step 1 converted to pass/fail scoring [15,29]. Because the timeline to publication of research projects may be lengthy, many projects may not be published before application deadlines.…”

An Evaluation of Resources Available to Learn About Orthopaedic Surgery Residency Programs

“…However, a recent study by Bernstein et al found that over 48% of programs in the FREIDA database failed to include USMLE Step requirements, and of the 141 programs participating in the ORIN database, most did not report the USMLE Step median or cutoff score 28 . Aside from examination scores, other factors such as performance during away rotations, personal knowledge of the applicant, clerkship grades, letters of recommendation from orthopaedic surgeons, Alpha Omega Alpha status, and research experience will gain significance 26,27 . Mun et al found that 69.3% of orthopaedic surgery program directors surveyed are now advocating for a graded preclinical curriculum 26 .…”

“…As the number of applicants applying to orthopaedic surgery programs rises and the transition of USMLE Step 1 and COMLEX Level 1 to pass/fail, program directors may now place more emphasis on other factors, including USMLE Step 2 and COMLEX Level 2 scores 26,27 . However, a recent study by Bernstein et al found that over 48% of programs in the FREIDA database failed to include USMLE Step requirements, and of the 141 programs participating in the ORIN database, most did not report the USMLE Step median or cutoff score 28 .…”

Differences in Fourth-Year Orthopaedic Away Rotation Opportunities and Fees Among Osteopathic and Allopathic Medical Students 1 Year After the Implementation of the Single Accreditation System

“…Historically, the interview process alone has cost applicants an average of $5,000 to 7,000 and even up to $20,000 14 , 21 . One area of concern some authors have suggested is that students may consider applying for more away rotations because of the transition to the pass/fail USMLE scoring 20 . Inevitably, this could further drive up the cost of the away rotations.…”