Impact of Pass/Fail USMLE Step 1 Scoring on the Internal Medicine Residency Application Process: a Program Director Survey

Choudhary, Arrush; Makhoul, Alan T.; Kumar, Nishant Ganesh; Drolet, Brian C.

doi:10.1007/s11606-020-05984-y

Cited by 13 publications

(11 citation statements)

References 2 publications

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“…The aim of this study was to compare the perceptions among program directors (PDs) in orthopaedics and IM on the change of Step 1 from a graded to a pass/fail exam, and its impact on the residency application process. Some groups have studied PD opinions of the Step 1 pass/fail change; however, to the best of our knowledge, the current study is the first comprehensive survey to directly compare the impact on medicine and a surgical subspecialty [4][5][6][7][8][9][10][11][12]. We chose to study IM PDs because IM has historically been a popular specialty that has had the most number of total applicants.…”

Section: Introductionmentioning

confidence: 99%

A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

et al. 2021

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Background United States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process. Methods A 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association’s Fellowship and Residency Electronic Interactive Database. Results We received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit. Conclusion Orthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.

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Section: Introductionmentioning

confidence: 99%

A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

et al. 2021

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“…This opinion is not unique to otolaryngology; program directors within the fields of radiology, general surgery, internal medicine, anesthesiology, neurological surgery, and other specialties also disagreed with the USMLE Step 1 score reporting change. 6,[11][12][13][14][15] However, this may be an opportunity for all programs, including otolaryngology programs, to develop new algorithms for selecting residents that are more holistic, appropriate, and efficient, which some programs have already initiated. 16,17 To our knowledge, this is the first study that has surveyed otolaryngology house-staff, as well as medical students interested in otolaryngology, on the recent decision to change USMLE Step 1 to pass/fail.…”

Section: Discussionmentioning

confidence: 99%

Otolaryngology Program Director, House-Staff, and Student Opinions: Step 1 Pass/Fail Score Reporting

Kay

Makhoul

Kumar

et al. 2022

Ann Otol Rhinol Laryngol

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Objective(s): To compare otolaryngology program director, house-staff, and medical student perspectives on the score reporting change of USMLE Step 1 to pass/fail. Methods: Separate electronic surveys were sent to program directors of ACGME-accredited otolaryngology programs (Cronbach’s alpha = .87), otolaryngology house-staff (Cronbach’s alpha = .91), and medical students interested in otolaryngology (Cronbach’s alpha = .76). Results: Among the 51 otolaryngology program directors that completed the survey (response rate of 46.8%), 17.6% favored reporting USMLE Step 1 as pass/fail. A majority believed the reporting change would make it more difficult to screen (74.5%) and objectively compare applicants (82.4%). Step 2 CK scores will be more important to most program directors due to the reporting change (83.7%). Of the 93 house-staff that completed surveys, most did not favor the reporting change (61.3%). Over half (54.0%) of the 87 medical students that completed surveys did not support the scoring change, and most (65.5%) did not feel that it would decrease anxiety around residency applications (65.5%). Most house-staff and medical students felt that the scoring change would put non-U.S. MD students at a disadvantage (65.6% of house-staff, 69.8% of medical students). Conclusion: Most survey respondents do not agree with the decision to report Step 1 as pass/fail. Despite its intended goals, most do not believe pass/fail Step 1 reporting will improve medical student well-being and believe it will put certain student populations at a greater disadvantage.

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“…After the initial search, 351 duplicates were removed and 44 were excluded after title and abstract review, 4,[7][8][9][10][11][12][13][14][15] based on inclusion and exclusion criteria. [16][17][18][19][20][21][22][23][24][25] Full-text review was performed on 98 articles, [26][27][28][29][30][31][32][33][34][35] of which 45 studies were included [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] (see Figure, Supplemental Digital Content 5, which illustrates a flow-chart of our literature search, as well as our full search strategies).…”

Section: Study Selectionmentioning

confidence: 99%

“…Twenty-eight studies [7][8][9][10][11][12][13][14][15][16][17][19][20][21][22][23][24][26][27][28][29]32,33,35,41,44,46,48 included in the systematic review examined disagreement among PDs with the Step 1 score change, of which 12 studies 7,9,11,12,[19][20][21][22]24,28,29,41 1).…”

Section: Disagreement With Changementioning

confidence: 99%

Perceptions and Expectations Regarding the Step 1 Score Change Among Surgical and Non-Surgical Program Directors: A Systematic Review and Meta-Analysis

Srinivasan,

Samaan,

Premkumar

et al. 2024

The American Surgeon™

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There are currently no studies examining differences in perceptions and expected impact of the Step 1 score change to pass/fail between surgical and non-surgical program directors (PDs). We conducted a systematic review in May 2023 of PubMed, Scopus, Web of Science, and PSYCInfo to evaluate studies examining PDs’ perspectives regarding the Step 1 score change. We performed random-effects meta-analyses to determine differences in perspectives among surgical and non-surgical PDs. Surgical PDs (76.8% [95% CI, 72.1%-82.0%], I2 = 52%) reported significantly greater rates of disagreement with the score change compared to non-surgical (65.1% [95% CI, 57.9%-73.1%], I2 = 69.7%) ( P = .01). Surgical PDs also reported significantly greater rates of agreement that the score change will increase the difficulty in objectively comparing applicants (88.1% [95% CI, 84.6%-91.7%], I2 = 16.4%), compared to non-surgical (81.0% [95% CI, 75.6%-86.8%], I2 = 72.6%) ( P = .04). There was less heterogeneity among non-surgical PDs (88.7% [95% CI, 86.2%-91.2%], I2 = 0%), compared to surgical (84.7% [95% CI, 79.0%-90.8%], I2 = 67.3%), regarding expected increases in emphasis on Step 2, although the difference in rates of agreement was not statistically significant. Overall, there is significant heterogeneity in the literature regarding expected changes in the residency application review process. Most PDs reported significant disagreement with the score change, greater expected difficulty in objectively evaluating applicants, and greater emphasis on Step 2, with surgical PDs reporting greater rates of disagreement, greater expected difficulty, and heterogeneity regarding expected increases in emphasis on Step 2, compared to non-surgical. Additionally, there is significant heterogeneity in the overall literature regarding expected changes in the residency application review process. Further research is needed to establish evidence-based guidelines that improve the overall residency application process for all stakeholders.

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Impact of Pass/Fail USMLE Step 1 Scoring on the Internal Medicine Residency Application Process: a Program Director Survey

Cited by 13 publications

References 2 publications

A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

Otolaryngology Program Director, House-Staff, and Student Opinions: Step 1 Pass/Fail Score Reporting

Perceptions and Expectations Regarding the Step 1 Score Change Among Surgical and Non-Surgical Program Directors: A Systematic Review and Meta-Analysis

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