Implications of United States Medical Licensing Examination Step 1 Becoming Pass/Fail on the Integrated Plastic Surgery Match.

Abstract

There has been much conversation surrounding the United States Medical Licensing Examination’s recent decision to transition Step 1 score reporting from a three-digit numeric score to a pass/fail outcome.1 Integrated plastic surgery is one of the most competitive matches for medical students.2 To be successful in the plastic surgery match, applicants must have strong board scores, extensive research experience, and numerous volunteer opportunities.2,3 Historically, Step 1 scores have provided an estimate for competitiveness for students.4 This change in scoring will effectively remove this means for self-selection. With a pass/fail system, students will have one less component with which to differentiate themselves from their peers. This may generate disadvantages to students attending U.S. medical schools outside of the top 40 in National Institutes of Health funding who previously had the opportunity to demonstrate their academic potential with an achievement-based standardized examination. With no numeric score for Step 1, naturally programs will have to seek other ways to differentiate students. At this point, Step 2 Clinical Knowledge will remain a numeric score, and consequently programs may use this to replace the importance of Step 1. However, Step 2 Clinical Knowledge is usually taken after the completion of the third year of medical school. Given the time delay for grading national board examinations, many students may not receive their scores until just before applications are due, which could leave students without enough time to estimate their competitiveness. Currently, many students delay taking Step 2 Clinical Knowledge until after applications are submitted to complete several away rotations as is expected in this specialty. Subsequently, the timing of these rotations could also be affected. The United States Medical Licensing Examination upholds that, across specialties, Step 1 scores positively correlate with specialty board pass rates.1 This is important for programs to consider, as board pass rates can have an impact on accreditation and program reputation. With the absence of Step 1 scores, programs may choose to put more weight into research experiences and productivity. Many students currently elect to take a year or more of dedicated research time within medical school.5 If programs were to place a higher emphasis on research, students completing their medical education in 4 years with no time off would be at an inherent disadvantage, not given the opportunity to equalize their applications with a strong performance on Step 1. A new form of applicant self-selection may occur based on research experience, similar to what has occurred in Canada after the implementation of a pass/fail scoring system.4 Similarly, without the standardized comparison of applicants provided by a uniform examination, equal comparisons of students between medical schools will be more difficult to achieve. This may lead to significant disadvantage for students coming from medical schools deemed to be less prestigious and limit these students’ opportunity for upward mobility. Although the termination of numeric Step 1 scores is a recent decision, it is important for programs to be proactive when considering factors for assessing future applicants and the effects that this change may have on the applicant pool at large. DISCLOSURE Neither of the authors has a financial interest to declare in relation to the content of this article. No funding was received for this work.