The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators

Abstract

The United States Medical Licensing Examination (USMLE) Step 1, arguably the most significant assessment in the USMLE examination series, changed from a 3-digit score to a pass/fail outcome in January 2022. Given the rapidly evolving body of literature on this subject, this paper aims to provide a comprehensive review of the historical context and impact of this change on various stakeholders involved in residency selection. For this, relevant keyword-based searches were performed in PubMed, Google Scholar, and Scopus to identify relevant literature. Given the unique history of USMLE Step 1 in the US residency selection process and the score’s correlation with future performance in board-certifying examinations in different specialties, this scoring change is predicted to significantly impact US Doctor of Medicine students, US Doctor of Osteopathic Medicine students, international medical graduates, and residency program directors, among others. The significance and the rationale of the pass/fail change along with the implications for both residency applicants and educators are also summarized in this paper. Although medical programs, academic institutions, and residency organizing bodies across the United States have swiftly stepped up to ensure a seamless transition and have attempted to ensure equity for all, the conversion process carries considerable uncertainty for residency applicants. For educators, the increasing number of applications conflicts with holistic application screening, leading to the expected greater use of objective measures, with USMLE Step 2 Clinical Knowledge likely becoming the preferred screening tool in lieu of Step 1.

How Large Language Models Perform on the United States Medical Licensing Examination: A Systematic Review

“…The United States Medical Licensing Examination (USMLE) is a multi-part professional exam that is mandatory to practice medicine in the United States. It is a rigorous assessment of physicians' knowledge and skills, providing a standardized measure of competence for both domestic and international medical graduates (1)(2)(3)(4). As such, the USMLE has become a critical benchmark for medical education and is increasingly used in research as a standard for testing the capabilities of various healthcare-focused artificial intelligence tools.…”

Importance of Residency Applicant Factors Based on Specialty and Demographics: A National Survey of Program Directors

“…In addition, without a 3-digit-score cutoff or student decision-making not to apply to speci c programs due to a particular 3-digit score, the increasing number of applications each program receives will directly con ict with the holistic application screening because of the burden placed on educators to review many more applications. This may lead to using other objective measures, such as the USMLE Step 2, to become the screening tool of choice 13 .…”

Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on “The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators”

“…As medical students navigating the new landscape of residency selection after the switch to a pass/fail USMLE (United States Medical Licensing Examination) Step 1, we read a recent viewpoint by Ozair et al [1] with great interest. We hope to offer a unique perspective and present additional potential solutions for residency programs and medical schools to consider.…”

“…We agree with the authors' observation that research productivity is now necessary for a successful match with competitive specialties. Ozair et al [1] discussed the disadvantages for international medical graduates (IMGs) and provided a cost-benefit analysis of students trying to maximize research output. We would add that research by medical students relies on access to well-funded research institutions and adequate mentorship.…”

“…As Ozair et al [1] provided recommendations and resources for residency applicants, we would like to offer recommendations for residency programs. To mitigate inequity surrounding research metrics, programs may consider offering year-long, paid fellowships for students without home programs, IMGs, and students with financial needs.…”