Comprehensive Reform and Greater Equity in Applying to Residency—Trainees' Mixed Responses to a Pass/Fail USMLE Step 1

Abstract

Background Pass/fail USMLE Step 1 score reporting may have varying implications for trainees of different demographic and training backgrounds. Objective To characterize the perspectives of a diverse cohort of trainees on the impact of pass/fail Step 1 score reporting. Methods In 2020, 197 US and international medical school deans and 822 designated institutional officials were invited to distribute anonymous electronic surveys among their trainees. Separate surveys for medical students and residents/fellows were developed based on the authors' prior work surveying program directors on this topic. Underrepresented in medicine (UiM) was defined in accordance with AAMC definitions. Descriptive and comparative analyses were performed, and results were considered statistically significant with P < .05. Results A total of 11 633 trainees responded (4379 medical students and 7254 residents/fellows; 3.3% of an estimated 285 000 US trainees). More students favored the score reporting change than residents/fellows (43% vs 31%; P < .001; 95% CI 0–24). Trainees identifying as UiM were more likely to favor the change (50% vs 34%; P < .001; 95% CI 0–32) and to agree it would decrease socioeconomic disparities (44% vs 25%; P < .001; 95% CI 0–38) relative to non-UiM trainees. Nearly twice as many osteopathic and international medical graduate students felt they would be disadvantaged compared to MD students because of pass/fail score reporting (61% vs 31%; P < .001; 95% CI 0–60). Conclusions Trainee perspectives regarding USMLE Step 1 score reporting are mixed. UiM trainees were more likely to favor the score reporting change, while osteopathic and international medical students were less in favor of the change.