Abstract
IntroductionThe United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency. In February 2020 the USMLE program announced that the numerical Step 1 scoring would be changed to a binary (Pass/Fail) system. In this study we sought to characterize how this change in score reporting will impact the application review process for emergency medicine (EM) program directors (PD).MethodsIn March 2020 we electronically distributed a validated anonymous survey to EM PDs at 236 US EM residency programs accredited by the Accreditation Council for Graduate Medical Education.ResultsOf 236 EM PDs, 121 responded (51.3% response rate). Overall, 72.7% believed binary Step 1 scoring would make the process of objectively comparing applicants more difficult. A minority (19.8%) believed it was a good idea, and 33.1% felt it would improve medical student well-being. The majority (88.4%) reported that they will increase their emphasis on Step 2 Clinical Knowledge (CK) for resident selection, and 85% plan to require Step 2 CK scores at application submission time.ConclusionOur study suggests most EM PDs disapprove of the new Step 1 scoring. As more objective data is peeled away from the residency application, EM PDs will be left to rely more heavily on the few remaining measures, including Step 2 CK and standardized letters of evaluation. Further changes are needed to promote equity and improve the overall quality of the application process for students and PDs.
Highlights
The United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency
The majority (88.4%) reported that they will increase their emphasis on Step 2 Clinical Knowledge (CK) for resident selection, and 85% plan to require Step 2 CK scores at application submission time
Most program directors (PD) (88.4%) reported that binary Step 1 scoring would increase their emphasis on USMLE Step 2 CK scores
Summary
The United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency. The United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) have served as assessments of medical licensure eligibility.[1] Over time, Step 1 has unintentionally guided undergraduate medical education curriculum and become a primary screening tool for objectively selecting applicants for residency interviews in many specialties.[2,3,4] In an attempt to “reduce the adverse impact of the current overemphasis on USMLE performance in residency screening and selection,” the USMLE program announced in February 2020 that numerical Step 1 scoring would change to a binary system (Pass/Fail) no sooner than 2022.1. During the 2019-2020 application cycle, 3323 applicants applied for 2665 available
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