Perceived Impact of USMLE Step 1 Score Reporting to Pass/Fail on Otolaryngology Applicant Selection

Abstract

Objectives: Recently, the decision was made to transition the United States Medical Licensing Examination (USMLE) Step 1 score from a three-digit numerical score to a pass/fail system. Historically, Step 1 scores have been important for otolaryngology resident applicant selection. The purpose of this study was to understand and evaluate otolaryngology residency program directors’ (OPDs) opinions on the impact following the change in Step 1 score reporting. Methods: A 22-question survey administered through Qualtrics was sent to 113 academic otolaryngology residency program directors in April 2020. Information about demographics, impressions on the new Step 1 score format, anticipated changes in applicant selection, impact on mental health, and importance of various other factors in selecting applicants were queried. Descriptive statistics were used to analyze survey results. Results: A total of 41 out of 113 (36.3%) OPDs completed this survey. A majority of surveyed OPDs (80.5%) do not support the decision to change Step 1 to a pass/fail system. In the absence of a three digit numeric USMLE Step 1 score, OPDs indicated prioritization of away rotations, letters of recommendation (LORs), personal prior knowledge of the applicant, grades in required clerkship, and class ranking or quartile. 53.7% of OPDs anticipate requiring USMLE Step 2 Clinical Knowledge for interview consideration following this change. Conclusion: OPDs believe a pass/fail Step 1 score will decrease the importance of this exam and that this change will lead to the implementation and evaluation of additional metrics such as a required Step 2 CK score.

Perceptions of Preference Signaling in Orthopaedic Surgery: A Survey of Applicants and Program Directors

“…8 Because most medical schools have migrated to a pass-fail preclinical curriculum, the Step 2 CK examination will serve as the sole, universal, objective, comparative metric for future applicants. Complementary to previous literature suggesting that Step 2 CK scores will function as a surrogate of equal or higher importance to Step 1, 15,21–26 our respondents indicated Step 2 CK performance as either the first or second most important factor for interview consideration. Excellent performance on Step 2 CK is now imperative, whereas in previous years an impressive score was supplemental or partially rectified a poor Step 1 score.…”

“…Ironically, the resultant substantial implications of the Step 2 CK examination may have worsened the preexisting ‘Step mania’ that inspired the initial transition. 23–26,27 Evaluation of data from future match cycles will better delineate the importance of Step 2 CK performance within the orthopaedic match.…”

“…However, both surveyed groups yielded a response rate comparable with similar survey-based research within orthopaedic literature. 15,20,24 In the interest of developing a short-but-informative survey to maximize the value and number of responses, we collected minimal demographic data from our respondents. In addition, the surveyed candidates were applicants of our institution, which may not be representative of applicant pools across the nation.…”

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

“…6 From an otolaryngology standpoint, recent studies have shown that most academic otolaryngologists (department chairs, program directors, and faculty) disagree with changing USMLE Step 1 scoring to pass/fail, believing that it will increase other metrics’ weight (eg, USMLE Step 2 CK, away rotation performance, grades in required clerkship rotations) and put certain student populations at a disadvantage (eg, international, osteopathic, and underrepresented minority students). 7,8 While program directors’ perspectives on the USMLE Step 1 score change have been examined to some extent, comparing the perspectives of medical students interested in otolaryngology, otolaryngology house-staff (resident and fellows), and otolaryngology program directors is needed to better understand the potential implications of the transition to pass/fail score reporting.…”

A Comparison of Otolaryngology Residency Applicants Over Time and to Other Surgical Applicants

“…As such, less standardized factors such as research, other extracurriculars, and clerkship grades are suggested to become increasingly important in the residency application process. [3][4][5] Understandably, building a residency application around numerous criteria may contribute to applicant anxiety about applying to a selective specialty like otolaryngology. 1,3,6 Therefore, it becomes increasingly important to use evidence-based guidance to inform medical students who are considering otolaryngology as their specialty of choice; by highlighting trends in the qualifications of accepted applicants, prospective applicants can use a data-driven approach to focus on areas of their application more beneficial to their match.…”