A Stepping Stone Toward Necessary Change: How the New USMLE Step 1 Scoring System Could Affect the Residency Application Process

Abstract

Score reporting for the United States Medical Licensing Examination Step 1 will change from a 3-digit number to pass/fail as soon as January 1, 2022. The shift is meant to prevent residency program directors from using Step 1 scores to select applicants for interviews, a purpose for which the exam was not designed. Using Step 1 scores in this way also has put undue stress on medical students applying to residency. However, the score reporting change represents only one stepping stone toward an improved transition from undergraduate to graduate medical education. To enable a more reliable and holistic review of applicants, residency program directors and medical school administrators must promote other standardized evaluation tools and address the hypercompetitive and frenzied state of the residency application process. For example, medical schools should provide program directors with assessments of students' fit and readiness for residency that are not burdensome to understand and compare. In addition, residency programs should implement "traffic rules" to improve the interview process for applicants. These changes will significantly mitigate the burden on all stakeholders. As residents who recently experienced this transition, the authors of this Invited Commentary argue that now is the opportune time to redefine selection criteria and reemphasize the characteristics that truly matter in training competent future physicians.