Impact of Step 1 Score Cutoffs on Radiation Oncology Residency Application Pool Diversity

Abstract

Step 1 score cutoffs are used as a surrogate of intelligence and success to screen out applicants by many radiation oncology (RO) programs. The impact of this practice on RO applicant pool diversity is unknown. We hypothesize that increasing Step 1 score cutoffs for resident application screening disproportionately impacts underrepresented minorities (URMs) and decreases the diversity of the residency application pool. Electronic Residency Application Service (ERAS) applications submitted to our institution between 2015 – 2018 match cycles were reviewed. Age, sex, number of languages spoken, median household income based on permanent address zip codes, race/ethnicity, and Step 1 scores were collected. Groupings by characteristics were age <25 vs. 25 – 30 vs. >30, sex female vs. male, race/ethnicity by Caucasian vs. Asian vs. Hispanic vs. Black/African American vs. Hawaiian/Pacific vs. American/Alaskan Native vs. prefer not to state, and household income <$50,000 vs. $50,000 - $100,000 vs. >$100,000. Relative impact of Step 1 score cutoffs to each subgroup was recorded, and ordinal logistic regression analysis was done to evaluate the association between applicant characteristics and Step 1 scores grouped as <220 vs. 220 – 239 vs. >239. 810 applicants with Step 1 scores ranging 188 – 275 were collected, representing nearly 90% of all applicants during the 2015 – 2018 ERAS cycles. Step 1 score cutoffs disproportionately impacted (p<0.001) applicants who were older than 30 (220: -24.5% vs -4.5%, 240: -54.3% vs -22.7%), female (240: -50.1% vs -30.6%), multilingual (220: -17.7% vs -8.6%, 240: -54.4% vs -28.9%), and URM, most notably Black (220: -35% vs -5.9%, 240: -72.5% vs -27.4%) and Hispanic (220: -24.3% vs -5.9%, 240: -54.1% vs -27.4%). Household income was not associated with Step 1 score cutoffs. Step 1 score cutoff screens reduce the diversity of the RO applicant pool. Further evaluation of practices that counter the stated American Society of Clinical Oncology (ASCO) and American Society of Therapeutic Radiation Oncology (ASTRO) diversity missions should be pursued to improve understanding of barriers and biases in the RO application process.