Ensuring a fair and equitable selection of students to serve society's health care needs.

Correlation has been found between the US Medical Licensing Examination (USMLE) Step 1 examination results and anesthesiology resident success on American Board of Anesthesiology (ABA) examinations. In 2014, the ABA instituted the BASIC examination at the end of the postgraduate year-2 year. We hypothesized a similar predictive value of USMLE scores on BASIC examination success. After the Committee for the Protection of Human Subjects at UTHealth Institutional Review Board approved and waived written consent, we retrospectively evaluated USMLE Step examination performance on first-time BASIC examination success in a single academic department from 2014-2018. Over 5 years, 120 residents took the ABA BASIC examination and 108 (90%) passed on the first attempt. Ten of 12 first-time failures were successful on repeat examination but analyzed in the failure group. Complete data was available for 92 residents (76.7%), with absent scores primarily reflecting osteopathic graduates who completed Comprehensive Osteopathic Medical Licensing Examination of the United States level examinations rather than USMLE. In the failure cohort, all 3 USMLE examination step scores were lower (P < .02). USMLE Step 1 score independently predicted success on the BASIC examination (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.17, P < .001). Although USMLE Step 2 score predicted BASIC examination success (OR 1.10, 95% CI 1.04-1.18, P = .001), this did not remain after adjustment for Step 1 score using multiple logistic regression (P = .11). In multivariable logistical regression, first clinical anesthesia in-training examination score and USMLE Step 1 score were significant for predictors of success on the BASIC exam. In anesthesiology residency training, our preliminary single-center data is the first to suggest that USMLE Step 1 performance could be used as a predictor of success on the recently introduced ABA BASIC Examination. These findings do not support recent action to change USMLE scoring to a pass/fail report.

This retrospective descriptive study compared the academic performance of postbaccalaureate career changer students with that of traditional students during the classroom-based, science-dominated early years of medical school. Earlier studies documented the eventual success of nontraditional medical students, although we found little information specific to the medical school performance of career changers. Our objective was to determine whether postbaccalaureate career changer medical students perform differently from traditionally prepared medical students in the science-dominated early years of medical school classroom education. This study analyzed the admission data and academic performance of medical students at the University of Central Florida College of Medicine across 8 years (N = 630). Differences in performance were assessed using examination grades from the first 2 years of medical school, and US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores. Statistically significant differences were found between traditional and career changer students for all science modules in year 1, and 4 of the 5 modules in year 2. Traditional students performed better on USMLE Step 1. Significant differences between the groups disappeared by USMLE Step 2. Career changer medical students show a small, persistent academic lag in the first 2 years of medical school and on USMLE Step 1 scores. By USMLE Step 2 the difference disappears. Similar undergraduate grade point averages and Medical College Admission Test scores suggest that science exposure, not ability may explain these differences. An unexpected finding is the number of career changer students is not increasing proportional to the proliferation of postbaccalaureate programs in the United States. This study may benefit student advisors and residency directors, and, it is hoped, provide reassurance to career changer students.

This cohort study examines the association between Medical College Admission Test (MCAT) scores, disability status and category, and performance on US Medical Licensing Examination (USMLE) Step 1 and Step 2 CK scores.

The US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores are often used to inform a variety of secondary medical career decisions, such as residency selection, despite the lack of validity evidence supporting their use in these contexts. We compared USMLE scores between non-chief residents (non-CRs) and chief residents (CRs), selected based on performance during training, at a US academic medical center that sponsors a variety of graduate medical education programs. This was a retrospective cohort study of residents' USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores from 2015 to 2020. The authors used archived data to compare USMLE Step 1 and Step 2 CK scores between non-CR residents in each of the eligible programs and their CRs during the 6-year study period. Thirteen programs enrolled a total of 1334 non-CRs and 211 CRs over the study period. There were no significant differences overall between non-CRs and CRs average USMLE Step 1 (239.81 ± 14.35 versus 240.86 ± 14.31; P = .32) or Step 2 scores (251.06 ± 13.80 versus 252.51 ± 14.21; P = .16). There was no link between USMLE Step 1 and Step 2 CK scores and CR selection across multiple clinical specialties over a 6-year period. Reliance on USMLE Step 1 and 2 scores to predict success in residency as measured by CR selection is not recommended.

Following medical school graduates into practice: residency directors' assessments after the first year of residency.

Ensuring access to accommodations on high-stakes examinations is crucial for ensuring equal opportunity for medical students with disabilities (MSWD). To examine the associations between gender, race and ethnicity, disability type, timing of disability diagnosis, and access to specialized disability resource professionals (DRPs) with accommodation requests and approvals on the US Medical Licensing Examination (USMLE) Step 1. A cross-sectional study of MSWD who graduated between 2020 and 2023 was conducted across 9 US MD-granting medical schools. Variables included deidentified student data (ie, gender, race and ethnicity, disability type, and timing of diagnosis, either before or after matriculation) and presence of specialized DRPs. Diagnosis of a disability. The primary outcome was USMLE Step 1 accommodation request and approval. χ2, Fisher exact, and post hoc pairwise tests were used to assess the associations between gender, race and ethnicity, disability type, timing of diagnosis, presence of specialized DRPs, and accommodation requests and approval. Among 295 MSWD in the cohort (189 female [64%]), 41 (15%) identified as Asian, 162 (59%) as White, and 70 (26%) as underrepresented in medicine (URiM; ie, American Indian, Alaska Native, Black or African American, Hispanic, or Native Hawaiian or Pacific Islander). One hundred five students (36%) reported a psychological disability, 167 (58%) received a diagnosis before medical school matriculation, and 120 (41%) requested Step 1 accommodations. A higher proportion of White students requested Step 1 accommodations than Asian students (74 White students [46%] compared with 8 Asian students [20%]). No difference in Step 1 accommodation request rate was found for URiM students compared with White students. Compared with medical students with psychological disability (31 students [30%]), a higher proportion of students with attention-deficit/hyperactivity disorder (36 students [50%]) and chronic health conditions (27 students [53%]) requested Step 1 accommodations. A higher proportion of students who received a diagnosis before medical school (88 students [53%]) requested Step 1 accommodations compared with those who received a diagnosis after medical school matriculation (30 students [25%]). Among the 97 students with known Step 1 accommodation approval status, 67 (69%) received accommodations. Step 1 accommodation approval rates were lowest for medical students with psychological disabilities (14 students [52%]) and attention-deficit/hyperactivity disorder (13 students [52%]) and those who received a diagnosis after matriculation (9 students [43%]). MSWD in schools with specialized DRP support had higher approval rates for Step 1 accommodation requests than MSWD in schools without specialized DRPs (49 students [78%] vs 18 students [53%]). In this cross-sectional study of MSWDs, Asian MSWDs had lower USMLE Step 1 accommodation request rates. Students with psychological disabilities and those who received a diagnosis after matriculation had lower request and approval rates. The presence of specialized DRPs was associated with higher accommodation approval rate. Addressing disparities in USMLE Step 1 accommodations is critical for promoting equity and fostering a more representative health care workforce.

Matching into orthopaedic residency has become difficult, and the US Medical Licensing Examination Step 1 transition to pass/fail scoring has complicated the process. Advisors' ability to mentor students has decreased, and program directors may rely on Step 2 Clinical Knowledge (CK) scores in selecting which candidates to interview. This study aims to offer a method to predict Step 2 CK outcomes based on preadmission and preclinical performance. The study investigated 486 students from a US medical school who enrolled in 2017 and 2018. Data on demographics, preadmission, and preclinical performance were collected. Before model creation, it was found that sex, Medical College Admission Test scores, Comprehensive Basic Science Examination performance, and preclinical curriculum performance produced optimal models. Multivariate ordinal logistic regression models were built to predict probabilities of four outcome levels of Step 2 CK: <235, 235 to 249, 250 to 265, and >265. Finally, nomograms were created to visualize probability calculations. Each model's odds ratios revealed that female sex, higher MCAT scores, and better Comprehensive Basic Science Examination and preclinical performance were associated with an increased likelihood of being in higher Step 2 CK scoring groups. Preclinical performance had a profound effect, especially for those in the top 1/3. Models were successful in assigning higher probabilities to students in higher Step 2 CK scoring groups in more than 80% of instances. Nomograms presented provide examples of how to apply these models to an individual student. This study presents a novel method for predicting probabilities of Step 2 CK outcomes that can be used to mentor students at a time point when Step 1 previously filled this role. It may assist in identifying orthopaedic hopefuls at risk of performing poorly on Step 2 CK and can foster the development of individualized guidance and mitigation strategies.

This survey study of medical residency program directors assesses differences in the relative importance of the US Medical Licensing Examination (USMLE) Step 1 in resident selection following its transition to pass/fail evaluation.

The Relationship Between US Medical Licensing Examination Step Scores and ABR Core Examination Outcome and Performance: A Multi-institutional Study.

Background:Interviews are a critical component of orthopaedic surgery residency selection for both the applicant and the program. Some institutions no longer report Alpha Omega Alpha (AOA) designation or class rank, and US Medical Licensing Examination (USMLE) Step 1 recently switched to pass/fail scoring. During the coronavirus disease 2019 (COVID-19) pandemic, all Accreditation Council for Graduate Medical Education programs conducted virtual interviews and subinternship rotations were restricted. These changes offer significant challenges to the residency match process. The purpose of this study was to examine the residency applicant interview and ranking process at a large urban academic university setting. We hypothesized that large variability exists among evaluations submitted by faculty interviewers and also that applicant academic factors (i.e., USMLE Step 1 score) would show association with final ranking.Methods:We retrospectively reviewed the 2020-2021 and 2021-2022 residency interview cycles, both conducted virtually due to the COVID-19 pandemic. Residency application (i.e., applicant demographic and academic backgrounds) and interview data (i.e., faculty interviewer scores) were recorded. Interobserver reliability among faculty interviewers was calculated. Statistical analysis was performed to determine factors associated with ranking of applicants.Results:There were 195 included applicants from the 2020 and 2021 interview cycles. There was no true agreement of interviewers' scoring of shared applicants (kappa intraclass coefficient range 0-0.2). Applicant factors associated with being ranked include applying to the match for the first time, USMLE Step 1 and 2 scores, educational break (vs. consecutive completion of college and medical school in 4 years each), higher class rank, and greater interviewer scores. Factors associated with better rank included additional degrees (i.e., PhD or MBA), couples match, AOA designation, educational break, underrepresented minority status, and notable attributes (i.e., collegiate athletics or Eagle Scout participation). Factors associated with worse rank included male sex, international medical graduate, prior match history, science major, extended research (i.e., >1 year spent in a research role), and home medical school students.Conclusions:There was significant variability and no reliability at our institution among faculty interviewers' applicant ratings. Being ranked was based more on academic record and interview performance while final rank number seemed based on applicant qualities. The removal of merit-based objective applicant measurements offers challenges to optimal residency applicant and program match.Level of Evidence:III (retrospective cohort study)

IntroductionThe US Medical Licensing Examination (USMLE) Step 1 exam has proven a difficult stressor for medical students during their training, even with the advent of pass-fail scoring. The preparation period before the exam places students at high risk for burnout and depression, leading to impaired exam performance and other serious consequences including suicide. Many medical schools already provide academic support for students during USMLE Step 1 preparation, yet to date, there are no published programs specifically geared towards mental health support during this time.MethodsStudents from the Larner College of Medicine at the University of Vermont developed the “Step-Siblings” program to partner pre-clinical level students preparing for Step 1 (Little Sibs) with clinical-level students (Big Sibs) in an effort to promote near-peer mentorship and support for those studying. Big Sibs were trained to offer emotional support and wellness advice, but specifically not to provide academic counselling. The pilot program was evaluated by student surveys.ResultsOur program successfully paired Little Sibs (n = 125) with Big Sibs (n = 75) several months preceding the Step 1 dedicated study period, achieving the intended effect of reducing burnout and fostering a supportive community during a notoriously isolating and emotionally challenging time. Survey results indicated that a majority of Little and Big Sibs found the program helpful.ConclusionsThis student-driven mentorship model is simple to implement, easily generalizable to other medical schools and other board exams, and bears the lasting benefit of combatting the stress and burnout so prevalent in medical education.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40670-022-01571-4.

Six-year Documentation of the Association between Excellent Clinical Teaching and Improved Studentsʼ Examination Performances

Pass/Fail USMLE Step 1 Scoring—A Radiology Program Director Survey

Physician-patient concordance in sex and race is associated with improved patient outcomes. Studies have explored diversity among ophthalmology residents and faculty, but to our knowledge, not among ophthalmology fellows. To assess diversity by sex and race and ethnicity among fellowship applicants in ophthalmology subspecialties and compare match rates by applicants' sex and underrepresented in medicine (URiM) status. This cohort study examined ophthalmology subspecialty fellowship data from the 2021 San Francisco Match. Applicant characteristics were stratified by sex and URiM status and compared using χ2, Mann-Whitney U, and median tests. For applicants who matched, the percentages of female and URiM applicants were compared among the ophthalmic subspecialties. A multivariable logistic regression model was used to assess the association of applicant characteristics with their match outcomes. Included in the sample were 537 candidates who applied for an ophthalmology fellowship using the 2021 San Francisco Match; 224 applicants (42.6%) were female, and 60 applicants (12.9%) had URiM status. Females and males had similar match rates (70.5% [n = 158] and 69.2% [n = 209], respectively; P = .74), but females had a higher median (IQR) US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) score (248 [240-258] vs 245 [234-254]; P = .01). The pediatric ophthalmology subspecialty had the highest percentage of female matched applicants (67.5%; 27 of 40 matched applicants), while the retina subspecialty had the highest percentage of males (68.9%; 84 of 122 matched applicants). URiM applicants had lower match rates (55.0%, n = 33) than non-URiM applicants (72.2%, n = 293; P = .007). The URiM applicants had lower median (IQR) scores on the USMLE Step 1 (238 [227-247]) compared with Asian applicants (246 [235-254]) and White applicants (243 [231-252]; P = .04). Additionally, URIM applicants submitted fewer median (IQR) applications (10 [1-23]) than Asian (21 [8-37]) and White (17 [8-32]; P = .001) applicants and completed fewer interviews (median [IQR], 2 [0-11]) than Asian (median [IQR], 12 [3-18]) and White applicants (median [IQR], 8 [1-14]; P = .001). Among matched fellows in each subspecialty, URiM applicants comprised 13.9% (n = 11) in glaucoma, 10% (n = 4) in pediatric ophthalmology, 7.3% (n = 6) in cornea, and 6.6% (n = 8) in retina. Ophthalmology subspecialty fellowship match rates were lower for URiM vs non-URiM applicants in 2021. Underrepresentation of females exists in the retina subspecialty, while racial and ethnic differences exist in all ophthalmology subspecialty fellowships examined. Monitoring trends in fellowship diversity over time should help inform where targeted efforts could improve diversity.

The purpose of this study was to explore whether useful regression models could be developed to predict student performance on the US Medical Licensing Examination (USMLE) Step 1, using pre-matriculation data and student performance outcomes available as early in the curriculum as possible. Additionally, we sought to determine if we could establish a model by which we could identify students who may need supplemental instruction early in the curriculum. Regression modeling revealed that a fairly strong predictive relationship exists when combining certain internally developed summative assessments and the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) with pre-matriculation variables. However, in our best regression model, > 40% of the overall variance in Step 1 scores could not be explained by the model. As a consequence, we propose using this type of modeling to facilitate timely deployment of student services to support individual students who are struggling. Future studies will focus on understanding what additional human factors fill this gap including student motivation, affect, and the factors that help students become “expert learners” (e.g., interactions with senior students, identification of test preparation materials).