Resident Selection in the Wake of United States Medical Licensing Examination Step 1 Transition to Pass/Fail Scoring

Abstract

Introduction: The numeric score for the United States Medical Licensing Examination Step 1 is one of the only universal, objective, scaled criteria for comparing the many students who apply to orthopaedic surgery residency. However, on February 12, 2020, it was announced that Step 1 would be transitioning to pass/fail scoring. The purpose of this study was to (1) determine the most important factors used for interview and resident selection after this change and (2) to assess how these factors have changed compared with a previous report on resident selection. Methods: A survey was distributed to the program directors (PDs) of all 179 orthopaedic surgery programs accredited by the Accreditation Council for Graduate Medical Education. Questions focused on current resident selection practices and the impact of the Step 1 score transition on expected future practices. Results: A total of 78 PDs (44%) responded to the survey. Over half of PDs (59%) responded that United States Medical Licensing Examination Step 2 clinical knowledge (CK) score is the factor that will increase most in importance after Step 1 transitions to pass/fail, and 90% will encourage applicants to include their Step 2 CK score on their applications. The factors rated most important in resident selection from zero to 10 were subinternship performance (9.05), various aspects of interview performance (7.49 to 9.01), rank in medical school (7.95), letters of recommendation (7.90), and Step 2 CK score (7.27). Compared with a 2002 report, performance on manual skills testing, subinternship performance, published research, letters of recommendations, and telephone call on applicants' behalf showed notable increases in importance. Discussion: As Step 2 CK is expected to become more important in the residency application process, current applicant stress on Step 1 scores may simply move to Step 2 CK scores. Performance on subinternships will remain a critical aspect of residency application, as it was viewed as the most important resident selection factor and has grown in importance compared with a previous report.

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

“…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.…”

Do Medical Students Who Participate in a Research Gap Year Produce More Research During Residency?

“…In a recent study that surveyed 78 program directors, research was ranked as the 11th most important factor in evaluating applicants, even below that of personal appearance which ranked 10th. 19 However, a single-center, retrospective study found that 57 of 58 medical students who conducted a research year at their academic institution during medical school successfully matched into orthopaedic surgery—a rate that was significantly higher than the national average during this period (98.3 versus 67.9, P < 0.001). Similarly, it remains unclear whether research years and their associated increased research productivity lead to more residents entering academic positions and continuing to conduct research.…”

Rate of USMLE Step 2 CK Scores Included on Orthopedic Surgery Applications and Associations With Step 1 Score

“…In fact, changes such as these and arguments that standardized testing does not accurately represent what programs should be looking for in applicants are part of the call for reform that lead to the InCUS decision [ 1 , 13 , 14 ]. Nonetheless, as Step 1 transitions to pass/fail and Step 2 CK remains numerically scored, Step 2 CK seems poised to rise in importance, at least according to early survey reports from Orthopedic PDs [ 4 ]. Because of this, we suspect the inclusion of Step 2 CK on applications will increase from 79.3% found in the present study.…”

“…However, given that a significant number of Orthopedic Surgery Program Directors (PDs) have indicated that they currently use Step 1 as an application screening tool, ranging from 83% [ 2 ] to 94% [ 3 ], the impact of eliminating Step 1 scores will likely be profound. Cohn et al [ 4 ] in their survey study of Orthopedic PDs noted that USMLE Step 2 Clinical Knowledge (Step 2 CK) is most likely to increase in importance with this change. Given this, we sought to evaluate the current practice of orthopedic applicants regarding inclusion of Step 2 CK on their applications.…”

“…The fourth year of medical school for orthopedic surgery applicants typically includes orthopedic surgery elective rotations at an applicant’s home program as well as away rotations at chosen programs of interest [ 5 , 6 ]. An increasing number of students have taken to performing a multitude of away rotations [ 5 ] to try and improve their rate of matching as residency PDs frequently rate the away rotation of high importance when formulating their final rank lists [ 4 , 7 ]. Sometime amid rotations, students are required to complete Step 2 of the licensure process including Step 2 CK and Step 2 Clinical Science (Step 2 CS).…”