The next step: Replacing step 1 as a metric for residency application

Abstract

Objective As of January 2022, USMLE Step 1 scores are reported as pass/fail. Historically, Step 1 scores have been a critical component of residency applications, representing one of the few metrics standardized across all applicants independent of the school they attended. In competitive specialties, such as otolaryngology, programs routinely get 100+ applicants for each residency spot and use Step 1 as a screening tool. This study seeks to assess quantifiable metrics in the application that highly competitive residency programs could use for screening in place of Step 1 scores. Methods Otolaryngology applications to an academic medical center for the 2019–20 and 2020–21 ERAS cycles were reviewed. Board scores and quantitative research data were extracted. The relationships between Step 1 score and the other metrics were examined by computing Pearson's correlation coefficients and building regression models. Similar analyses were done separately for three different score tiers defined by Step 1 cutoffs at 220 points and 250 points. Results Step 2 score was the only variable that had meaningful correlation with Step 1 score (R = .67, p < 2.2e−16). No other objective metric such as journal articles, posters, or oral presentations correlated with Step 1 scores. Conclusion Step 1 scores were moderately correlated with Step 2 scores; however, using a Step 2 cutoff instead of a Step 1 cutoff would identify a different cohort of applicants for interview. No other quantifiable application metric had a positive correlation. In future match cycles, highly competitive residency programs will need to adopt new methods to screen candidates. Level of Evidence: Level 3.

A Survey of Otolaryngology Residency Programs on Adapting to the United States Medical Licensing Examination (USMLE) Step 1 Transitioning to Pass/Fail

“…Step 2 CK had a moderate correlation with Step 1 scores, but other metrics such as the number of publications and presentations were found to have no significance [12]. This further supports our findings that by moving to P/F, Step 1 will displace, not alleviate, the stress associated with performing well on a single test.…”

“…Many survey respondents do not support the transition to P/F and do not think it will improve students' well-being [10][11]. One study examined the correlation between Step 1 and other objective applicant factors using two cycles of ENT applications received by their academic institution [12].…”

“…Many survey respondents do not support the transition to P/F and do not think it will improve students’ well-being [ 10 - 11 ]. One study examined the correlation between Step 1 and other objective applicant factors using two cycles of ENT applications received by their academic institution [ 12 ]. Step 2 CK had a moderate correlation with Step 1 scores, but other metrics such as the number of publications and presentations were found to have no significance [ 12 ].…”

Flipping Tradition on Its Head: A Single-Institution Study on United States Medical Licensing Examination Step Order

“…These sentiments are supported by a growing body of evidence indicating Step 2's increasing importance in residency applications. 12 Despite these sentiments, our study revealed that taking the Step examinations out of order is not the students' preference, as the majority reported the traditional order as optimal. One-third opted to follow the traditional path, stating that "taking Step 1 first may improve Step 2 scores" and that "there would be potentially less to review for (Step 2)."…”

“…Many commonly visited USMLE study blogs, such as Yousmle.com and Amboss.com, recommend this strategy, and one-third of participants reported the importance of Step 2 as their primary justification with testimony showing a desire to “(focus) effort on Step 2 because it is the (examination) that is scored.” These sentiments are supported by a growing body of evidence indicating Step 2’s increasing importance in residency applications. 12 …”