States Medical Licensing Examination Step Research Articles

Which Application Factors Are Associated With Outstanding Performance in Orthopaedic Surgery Residency?

Identifying ideal candidates for orthopaedic surgery residency is difficult. Data available for applicant selection are evolving; preclinical grades and the Alpha Omega Alpha (AOA) honors society are being phased out at some medical schools. Similarly, three-digit United States Medical Licensing Examination (USMLE) Step 1 scores have been eliminated. There is renewed interest in improving resident selection to provide a diverse, comprehensive educational opportunity that produces orthopaedic surgeons who are prepared for practice. We sought to identify whether (1) academic achievements, (2) letters of recommendation, (3) research activity, and (4) miscellaneous factors available on Electronic Residency Application Service (ERAS) applications were associated with outstanding residency performance. Ten faculty members (22% of all full-time faculty) with extensive educational involvement for at least 7 years, whose expertise covered all subspecialty departments at an urban, academic orthopaedic surgery residency program, were given an anonymous survey on the performance of the four most recent classes of residency graduates (24 residents). This survey was developed due to the lack of a validated residency outcomes tool or objective metrics for residency performance. The evaluated criteria were decided upon after discussion by a relatively large group of academic orthopaedic surgeons considering the factors most important for graduating orthopaedic residents. The faculty were selected based on their long-term knowledge of the residency, along with their diversity of specialty and backgrounds; there were no nonresponders. Faculty graded each resident on a scale from 1 to 10 (higher is better) on six criteria: surgical technical skills, research productivity, clinical knowledge, professionalism, personality, and fellowship match. The mean of the faculty ratings made by all faculty for all six criteria was calculated, producing the overall residency performance score. Factors available on each resident's ERAS application were then correlated with their overall residency performance score. Categorical ERAS factors, including AOA status, five or more honors in core clerkships, at least three exceptional letters of recommendation, collegiate athletics participation, expertise with a musical instrument, and research (6-year) track residents, were correlated with overall residency performance score via point biserial analysis. Continuous ERAS factors including USMLE Step 1 and Step 2 scores, number of publications before residency, number of research years before residency, medical school ranking, and number of volunteer experiences were correlated with overall residency performance score via Pearson correlation. USMLE Step 1 three-digit scores were evaluated despite their recent elimination because of their historic importance as a screening tool for residency interviews and for comparison to USMLE Step 2, which retains a three-digit score. Application factors with a p < 0.2 on univariate analysis (five or more honors in core clerkships, at least three exceptional letters of recommendation, research track residents) were included in a stepwise linear regression model with "overall residency performance score" as the outcome variable. All p values < 0.05 were considered significant. The mean overall residency performance score was 7.9 ± 1.2. Applicants with at least five honors grades in core clerkships had overall residency performance scores 1.2 points greater than those of their peers (95% confidence interval (CI) 0.3 to 2.0; p = 0.01, Cohen ƒ 2 = 0.2, representing a small effect size). ERAS applications including at least three exceptional letters of recommendation were associated with a 0.9-point increase in residency performance (95% CI 0.02 to 1.7; p = 0.046, Cohen ƒ 2 = 0.1, representing a small effect size). Participation in the residency research (6-year) track was associated with a 1-point improvement in residency performance (95% CI 0.1 to 1.9; p = 0.03, Cohen ƒ 2 = 0.2, again, representing a small effect size). Together, these three factors accounted for 53% of the variance in overall residency performance score observed in this study. Past clinical excellence, measured by core clerkship grades and exceptional letters of recommendation, is associated with slightly improved overall orthopaedic residency performance scores. Applicants meeting both criteria who also complete a research track residency may perform substantially better in residency than their counterparts, as these three factors accounted for half of all the variance observed in the current study. Although minimum requirements are necessary, traditionally used screening factors (such as USMLE scores, AOA status, medical school rank, and number of publications) may be of less utility in identifying successful future residents than previously thought. Level III, therapeutic study.

Stepping back: Impact of pass-fail Step 1 scoring on dermatology applicants.

The United States Medical Licensing Examination (USMLE) Step 1 recently transitioned to a pass-fail system from their three-digit scoring system. The implications of this change will ultimately influence medical students, residency programs, and, most importantly, patients. This article seeks to address some of the varying ethical and practical effects of this conversion to a pass/fail examination.

Vascular surgery integrated resident selection criteria in the pass or fail era

ObjectivesVascular surgery integrated residency (VSIR) programs are highly competitive; however, criteria for resident selection remain opaque and non-standardized. The already unclear selection criteria will be further impacted by the impending transition of the United States Medical Licensing Examination (USMLE) Step 1 from numeric scores to a binary pass/fail outcome. The purpose of this study was to investigate the historical and anticipated selection criteria of VSIR applicants. MethodsThis was a cross-sectional, nationwide, 59-item survey that was sent to all VSIR program directors (PDs). Data was analyzed using the Fisher exact test if categorical and the Mann-Whitney U test and the Kruskal-Wallis test if ordinal. ResultsForty of 69 PDs (58%) responded to the survey. University-based programs constituted 85% of responders. Most VSIR PDs (65%) reported reviewing between 101 to 150 applications for 1 to 2 positions annually. Forty-two percent of the responding PDs reported sole responsibility for inviting applicants to interview, whereas 50% had a team of faculty responsible for reviewing applications. On a five-point Likert scale, letters of recommendation (LOR) from vascular surgeons or colleagues (a person the PD knows) were the most important objective criteria. Work within a team structure was rated highest among subjective criteria. The majority of respondents (72%) currently use the Step 1 score as a primary method to screen applicants. Regional differences in use of Step 1 score as a primary screening method were: Midwest (100%), Northeast (76%), South (43%), and West (40%) (P = .01). PDs responded that that they will use USMLE Step 2 score (42%) and LOR (10%) to replace USMLE Step 1 score. The current top ranked selection criteria are letters from a vascular surgeon, USMLE Step 1 score and overall LOR. The proposed top ranked selection criteria after transition of USMLE Step 1 to pass/fail include LOR overall followed by Step 2 score. ConclusionsThis is the first study to evaluate the selection criteria used by PDs for VSIR. The landscape of VSIR selection criteria is shifting and increasing transparency is essential to applicants’ understanding of the selection process. The transition of USMLE Step 1 to a pass/fail report will shift the attention to Step 2 scores and elevate the importance of other relatively more subjective criteria. Defining VSIR program selection criteria is an important first step toward establishing holistic review processes that are transparent and equitable.

Pilot Study: Increasing Confidence in Obstetrics and Gynecology Applicants Through a Prep Course Prior to Audition Rotations.

Introduction: As more medical schools schedule the United States Medical Licensing Examination (USMLE) Step 1 after the completion of clinical rotations in their curriculum, students are finding themselves increasingly removed from the clinical setting prior to their audition rotations. In the military, these audition rotations are important for matching into competitive specialties, such as Obstetrics and Gynecology (Ob-Gyn). This pilot study explores the confidence and audition readiness of prospective candidates through their participation in an Ob-Gyn preparatory course.Methods: Rising fourth year medical students applying for an Ob-Gyn residency attended an in-person review session. It consisted of four interactive presentations addressing rotation resources, labor and delivery triage, postpartum care, laparoscopic anatomy review, and concluded with a resident question and answer panel. These attendees completed a pre- and post-course survey on Google Forms. Categorical answers were recorded as response frequency and Likert scales were converted into a 5-point system for analysis.Results: A 100% response rate from attendees revealed pre-course 81.8% confidence in performing well on an audition rotation with only 27% feeling prepared in terms of their medical knowledge. After completion of the course, all participants reported increased medical knowledge and recommended the course to other students.Conclusions: Preparatory courses for Ob-Gyn residency candidates can increase confidence and preparedness for audition rotations and, ultimately, internship. As the residency application process becomes more competitive, departments can take steps such as hosting a preparatory course to best assist their students into matching and provide skills that they can practice heading into internship.

Impact of the Step 1 Scoring Change on the Upcoming Application Cycle.

The recent transition of United States Medical Licensing Examination Step 1 to a pass–fail system was intended to promote student wellness. However, some have raised concerns for increased emphasis on subjective measures of performance.1 Among plastic surgery residency program directors (PDs), perceptions of the change have largely been negative.2 While long-term effects have been considered, in the immediate future, a mixture of students with numeric and passing scores will create a challenge for programs comparing applicants. In total, 40% of PDs (n = 36) completed a survey about anticipated short-term effects of the scoring change. Respondants compared the use of Step 1 in applicant evaluation in the upcoming application cycle (2022–2023) with the most recent cycle (2021–2022). (See Table, Supplemental Digital Content 1, which displays the survey questions, https://links.lww.com/PRSGO/C107.) As anticipated, numeric Step 1 scores will continue to factor into evaluations in the short term, but Step 2 scores will be of increased importance. In the next cycle, more programs will give Step 2 greater or equal weight than Step 1 (19% and 53%, respectively, up from 11% and 44%) and fewer will give Step 1 greater weight than Step 2 (28% down from 44%). Notably, a minority of PDs (11%) stated that they will no longer consider numeric Step 1 scores (Table 1). Table 1. - Relative Importance of Step 1 and Step 2 in Upcoming Application Cycles Current Application Cycle (n = 36) Upcoming Application Cycles (n = 32*) Relative weight of Step 1 and Step 2 for determining interview invitations Step 1 > Step 2 16 (44%) 9 (28%) Step 2 > Step 1 4 (11%) 6 (19%) Equally weighted 16 (44%) 17 (53%) Cutoff score for Step 1 No cutoff score 18 (50%) 17 (53%) 221–230 3 (8%) 2 (6%) 231–240 6 (17%) 4 (13%) 241–250 9 (25%) 7 (22%) >250 0 (0%) 2 (6%) Cutoff score for Step 2† No cutoff score 28 (78%) 14 (45%) 221–230 1 (3%) 7 (23%) 231–240 2 (6%) 7 (23%) 241–250 4 (11%) 2 (6%) >250 1 (3%) 1 (3%) *Four PDs responded that they will no longer consider numeric Step 1 scores in evaluating applicants.†One PD did not give a cutoff score range for Step 2 in upcoming application cycles (n = 31). In the next application cycle, twice as many of the programs surveyed will institute Step 2 cutoff scores. In the most recent cycle, 22% of PDs endorsed using a Step 2 cutoff score, while 55% anticipate having a cutoff in the next cycle. The majority of anticipated cutoff scores for Step 2 were between 221–230 (23%) and 231–240 (23%) (Table 1). Historically, mean Step 2 scores have been higher than mean Step 1 scores (eg, 256 versus 249 for matched plastic surgery applicants in 2020).3 Identical Step 2 cutoffs may in practice be more inclusive than prior Step 1 cutoffs. Similar to previous reports, letters of recommendation and previous knowledge of the applicant were ranked as the most important factors for applicant evaluation. (See Table, Supplemental Digital Content 2, which displays rankings of factors, https://links.lww.com/PRSGO/C108.)4,5 Half of PDs (53%) stated that research would carry greater weight in the next cycle (Table 2). When presented with hypothetical scenarios, a strong Step 1 score remained beneficial to applicants, whereas a low Step 1 score may not be detrimental in many cases. While 69% of PDs answered that an applicant with a high Step 1 score would be at an advantage over an applicant with a pass, only 47% of PDs stated that an applicant with a low Step 1 score would be at a disadvantage compared to a pass (Table 2). Table 2. - Hypothetical Scenarios for Applicant Evaluation and Relative Importance of Research Question PD Response (%) Do you anticipate that research experiences like research fellowships will carry more significant weight than in the past? 19 (53) With comparable Step 2 scores, will an applicant with a low Step 1 score be at a disadvantage relative to an applicant with a pass for a Step 1 score? 17 (47) With comparable Step 2 scores, will an applicant with a high Step 1 score be at an advantage relative to an applicant with a pass for a Step 1 score? 25 (69) This study suggested a gradual shift in emphasis from Step 1 to Step 2, although some programs may immediately stop considering Step 1. Importantly, over half of PDs would not view a low Step 1 score negatively. For these programs, a low Step 1 score may be considered similar to a pass. Those who performed strongly on Step 1 will benefit in most cases from having taken the examination before the switch. Disclosure The authors have no financial interest to declare in relation to the content of this article.

Assessing the Impact of Changes to USMLE Step 1 Grading on Evaluation of Neurosurgery Residency Applicants in the United States: A Program Director Survey

Neurosurgery (NS) is among the most selective specialties in the United States. As the United States Medical Licensing Examination (USMLE) Step 1 transitions to a binary pass/fail score, residency programs face unclear challenges in screening and evaluating applicants. The aim of this study is to provide insights into the perceived impact of changes to the USMLE Step 1 grading in the applicant selection process. We created a survey using questions regarding NS program demographics, the perceived predictive abilities of Step 1 and Step 2 clinical knowledge (CK), and several factors that programs consider when assessing applicants. We queried program directors (PDs), program coordinators (PCs), and assistant PDs at 117 NS residency programs. Respondents were asked to rank these factors in order of importance for selection at their respective training program. We used descriptive statistics and a Wilcoxon matched-pairs signed-rank test to evaluate the effects of these changes using STATA17. A total of 35 (30%) residency programs responded with 26 (74%) completing the factor ranking questions. 86% (95% confidence interval, 71.5%-94.3%) disagreed that the changes will better prepare students clinically. USMLE Step 2 CK scores, class rank, and away rotations saw significant increases in priority in the absence of a graded Step 1, whereas letters of recommendation and surrogates for research productivity saw notable, but not significant, changes after adjusting for multiple testing. Reporting binary Step 1 grades marks a significant shift in assessing applicants for NS residency by emphasizing Step 2 CK, class rank, and research productivity.

To Wait or Two Weeks: The Relationship Between Step 2 CK Scores and the Length of Dedicated Study Time Within a Longitudinal Interleaved Clerkship Curriculum.

Introduction: Graduate medical education program directors report that United States Medical Licensing Examination (USMLE) Step 2 CK exam scores will likely have greater importance in the future selection of residents due to USMLE Step 1 transitioning to a pass/fail score as early as January 2022. With emphasis moving to the Step 2 exam, it is important to examine factors that maximize student Step 2 CK performance, such as third-year curriculum models and exam timing. This study analyzes whether or not Step 2 performance is affected by a specific length of dedicated study time within a Longitudinal Interleaved Clerkship (LInC) curriculum.Methods: A regression model was used to predict Step 2 scores for 102 students using previous performance measures. Actual and predicted scores were compared to indicate which students overperformed or underperformed on Step 2. A t-test was used to compare the mean difference between predicted and actual performance of students who had two weeks or less of dedicated study time for Step 2 CK versus students who had a longer dedicated study period. Results: Students who completed Step 2 with two weeks or less of dedicated study significantly overperformed (t(100)=2.06, p=0.042) on the exam (Mean=1.61, SD=9.21) compared to students who had more than two weeks of dedicated study (Mean=-1.67, SD=6.44) in a LInC curriculum.Conclusion: Although studies of Step 2 preparation time have shown the importance of taking Step 2 soon after completion of clinical rotations, this study adds a specific timeframe. Our findings show that a dedicated study period of two weeks or less for Step 2 CK within a LInC curriculum is associated with better performance. This study was limited to a LInC curriculum and may not apply to other clinical year curricula.

Predictive Factors of Research Productivity among Ophthalmology Residents: A Benchmark Analysis.

Introduction Positive and negative associations between prior publications and future research productivity is described in other fields, but no such analysis exists for ophthalmology. We conducted a study to determine characteristics of residents exhibiting research productivity during residency. Methods Using San Francisco Match and Program Web sites, a roster of ophthalmology residents in 2019 to 2020 was compiled, and publication data was collected via PubMed and Google Scholar on a random sample of 100 third-year residents. Results The median number of publications generated by ophthalmology residents before residency is 2 (range 0-13). Thirty-seven, 23, and 40 residents had zero, one, and two or more papers published during residency, respectively, with a median of 1 (range 0-14). On univariate analysis, compared with residents who published zero or one paper, those who published ≥ 2 were more likely to have more preresidency publications (odds ratio [OR] 1.30; p = 0.005), attend a top-25 ranked residency program by multiple metrics including Doximity reputation (OR 4.92; p < 0.001), and have attended a top-25 ranked medical school program by U.S. News and World Report (OR 3.24; p = 0.03). However, on adjusted analyses, the only factor that remained significant for predicting publications in residency was whether the residency program attended was top 25 ranked (OR 3.54; p = 0.009). Discussion/Conclusion With the advent of the United States Medical Licensing Examination Step 1 pass/fail system, greater emphasis will be placed on other metrics, including research. This is the first benchmark analysis examining factors predictive of publication productivity in ophthalmology residents. Our study suggests that the residency program attended, not the medical school attended or prior publication history, plays an influential role in the number of publications produced during residency, highlighting the importance of factors to support research on the institutional level, such as mentorship and funding, rather than historical factors in research productivity by the resident.

Perceived Barriers to Increasing Diversity within Oculofacial Plastic Surgery.

Purpose Physician diversity is limited in ophthalmology and oculofacial plastic surgery. Determination of barriers within the application process for oculofacial plastic surgery may help target efforts to improve the recruitment of underrepresented groups. This study aimed to illuminate perceived barriers to increasing diversity in oculofacial plastic surgery trainees, according to the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellows and fellowship program directors (FPDs). Methods During the month of February 2021, we sent surveys out to 54 current oculofacial plastic surgery fellows and 56 FPDs at 56 oculofacial plastic surgery programs recognized by the ASOPRS nationwide using a 15-question Qualtrics survey. Results Sixty-three individuals (57%) responded to the survey: 34 fellows (63%) and 29 FPDs (52%). Eighty-eight percent of fellows and 68% of FPDs identified as non-underrepresented in medicine (UiM). Forty-four percent of fellows and 25% of FPDs identified as men. FPDs most commonly noted, "Not enough minorities applying to our program" and "The objective data (Ophthalmic Knowledge Assessment Program score, United States Medical Licensing Examination Step scores, clinical honors, Alpha Omega Alpha status, letter of recommendation) for minority applicants often do not meet the threshold required to offer an interview or to be ranked to match" as barriers. Among fellows, the lowest-rated considerations when applying to oculofacial plastic surgery were "Racially/ethnically diverse faculty" and "Perceptions of minority candidates by fellowship programs," whereas "Likelihood of matching in program of choice" was ranked highest in considerations. Fellows identifying as men indicated greater concern for "Financial factors related to fellowship (e.g., loans, salary, cost of living, or cost of interviewing)" compared to fellows identifying as women who noted greater concern for "Program or preceptor acceptance of starting or having a family during fellowship." Conclusion Responses from FPDs suggest that efforts focused on recruiting and supporting diverse students to medicine and ophthalmology, mentoring applicants interested in oculofacial plastic surgery, and restructuring the application process to decrease bias, may improve diversity within the subspecialty. The lack of UiM representation in this study, 6% fellows and 7.4% FPDs identified as UiM, shows both the stark underrepresentation and the need for further research into this topic.

Relative Importance of Applicant Characteristics in Ophthalmology Residency Interview Selection: A Survey of Program Directors.

Introduction Ophthalmology residency positions remain competitive. A lack of clarity regarding which residency selection criteria are prioritized by program directors can heighten the stress associated with the match process. While surveys of program directors in several other medical specialties have been conducted to identify the most important residency selection criteria, there is limited data on selection criteria used by ophthalmology residency program directors. The purpose of our study was to survey ophthalmology residency program directors to identify the current state of interview selection decisions-the factors currently considered most important in determining whether to extend an interview invitation to residency applicants. Methods We developed and distributed a Web-based questionnaire to all U.S. ophthalmology residency program directors. Questions evaluated program demographics and the relative importance of 23 different selection criteria used by ophthalmology residency program directors when evaluating applicants for residency interviews (Likert scale 1-5, with 1 being "not important" and 5 being "very important"). Program directors were also asked to identify the one factor they felt was most important. Results The overall residency program director response rate was 56.5% (70/124). The selection criteria with the highest average importance scores were core clinical clerkship grades (4.26/5) followed by letters of recommendation (4.06/5), and United States Medical Licensing Examination (USMLE) Step 1 score (4.03/5). The most frequently cited single most important factor for interview selection was core clinical clerkship grades (18/70, 25.7%), with USMLE Step 1 score (9/70, 12.9%) and rotations at the program director's department (6/70, 8.6%) also commonly reported. Conclusion Our results suggest that core clinical clerkship grades, letters of recommendation, and USMLE Step 1 scores are deemed the most important selection criteria by ophthalmology residency program directors as of a 2021 survey. With changes in clerkship grading for many medical schools and changes in national USMLE Step 1 score reporting, programs will face challenges in evaluating applicants and the relative importance of other selection criteria will likely increase.

Navigating a High-Stakes Assessment in Medical School: Students’ Lived Experiences During a Stressful Period of Preparation

ABSTRACT Students who aim to become practicing physicians in the United States are required to demonstrate their competence with a variety of assessments during medical school, including those required to obtain a license to practice medicine. The specific challenges and stressors associated with the preparation for successful completion of licensure assessments is not well understood. To better understand students’ experiences in preparation for United States Medical Licensing Examination (USMLE) Step 1, as part of the Re-examining Exams: NBME Effort on Wellness (RENEW) research initiative, a series of eight focus groups were conducted with 33 medical school students who took the exam and received their score. The results provide a retrospective understanding of the lived experiences of aspiring medical professionals and their perceptions of the impact of a high-stakes licensure examination.

Applicant Characteristics Associated with Retina Fellowship Match from 2010–2019

To describe trends in the surgical and medical retina fellowship match and applicant characteristics associated with matching in retina fellowship. Retrospective study. Ophthalmology fellowship applicants who applied through the San Francisco (SF) Match. Publicly available SF Match data were used to describe trends in the number of programs participating and positions offered, filled, and left vacant in the retina fellowship match from 2014 to 2019. Deidentified applicant data for match cycles from 2010 to 2017 were stratified by match status, and characteristics were compared across groups. Trends in matched applicant characteristics were evaluated using linear regression on log-transformed variables. Multivariable logistic regression was used to determine applicant characteristics that were associated with a successful match. Match status. From 2014 to 2019, the number of programs participating, positions filled, and positions left vacant in the retina fellowship match increased from 101 to 119 (P= 0.010), 118 to 123 (P= 0.078), and 18 to 37 (P= 0.045), respectively. Compared with unmatched applicants, matched applicants were more likely to have graduated from a top 10 residency program, US residency, or medical school; hold a United States (US) visa (J-1, H-1B, or O1); distribute more applications; complete more interviews; rank more programs; and score higher on the United States Medical Licensing Examination (USMLE) Step examinations 1-3. Matched applicants completed a median of 10 interviews. After controlling for potential covariates, graduating from a US residency (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.48-2.92), a top 10 residency (OR, 1.74; 95% CI, 1.07-2.84), having an allopathic medical degree (MD; OR, 2.39; 95% CI, 1.08-5.33), completing more interviews (OR, 1.28; 95% CI, 1.23-1.33), and scoring higher on USMLE Step 3 (OR, 1.01; 95% CI, 1.01-1.03) were associated with matching into a retina fellowship. Although the number of programs participating and positions offered in the retina fellowship match are increasing, the number of positions filled remained relatively stagnant. Factors associated with matching in both medical and surgical retina included graduating from a US and top 10-ranked residency program, having an MD, completing more interviews, and scoring higher on USMLE Step3.

There Is More to "Thank You" Than Meets the Eye.

Sometimes I blush when a patient says, “Thank you.” As a medical student, I constantly feel thankful to patients for the opportunity to be part of their care, so I feel a little embarrassed if a patient thanks me first. I also worry that patients may feel obligated to be thankful when the opposite is true—it is my privilege to be involved in their care. Recently, I had a short foray as a patient. After several appointments and mounting pain, I accepted that I had to go to the emergency department for an urgent (but not serious) medical procedure. I was exhausted, worried about setting foot in the emergency room in the midst of a COVID-19 surge, and plagued with stress about how I should have been studying for the United States Medical Licensing Examination Step 1 all day instead. In the emergency department, I was swiftly assigned a bed. I laid on my side wondering if I could squeeze in a nap, but to my surprise, a resident came over quickly. I could have sat up, but before I could manage the painful maneuver, he crouched down to my eye level. I thought about the number of times I had been in his position, squatting precariously in a narrow space, wondering if the patient noticed my awkward positioning. I will never worry about that again; speaking to him directly, as I lay curled up on my side, felt natural and comforting. The procedure was painful. I cried and felt embarrassed. Through puffy eyes I sobbed, “I’m sorry!”—a phrase I had heard so many patients say when they did not need to. The attending physician replied that it was okay, I could cry as loud as I needed, and invited me to scream. When the procedure was over, we discussed follow-up instructions, and I admitted to feeling distressed about managing my recovery while studying for Step 1. She looked at me with soft eyes and said, “I’m so sorry … that is so hard.” The words were simple, but her voice communicated her true sympathy. As we wrapped up, my tears were still flowing. I felt overwhelmed with gratitude and blurted out, “Thank you so much!” The warm words bubbled up spontaneously from deep inside. I felt grateful for how the team listened, did not dismiss my outside stressors, and spent precious moments helping me heal. My gratitude was magnified by vulnerability. Usually, I feel control over my body. But then suddenly, I depended on these physicians for care. Saying thank you was a tiny action that I could contribute, and it helped me grasp a sliver of agency. Giving thanks was emotionally soothing because it helped our interaction feel more reciprocal; the exchange of gratitude was an unconscious recognition of partnership. For the first time, I truly empathized with patients in their moments of thanks. As a patient myself, I did not think about the surface-level embarrassment that I had worried about as a student. I did not feel obliged to be thankful, and it certainly did not matter whether the people I thanked were learners or not. My gratitude was not motivated by acknowledgment; it was driven by the profound emotion I felt after caring interactions and my desire for reciprocity. Next time a patient thanks me, I will not let self-conscious worries diminish their words. True thankfulness reflects deep humanistic connection and is unburdened by the hierarchies of medicine. Gracefully appreciating gratitude from others is an important lesson in the art of building a patient relationship. In the future, I will look patients in the eye and fully appreciate that solidification of partnership in the departing moments of a connection. Acknowledgments: The author wishes to thank Dr. Kunal Bailoor, Jean Torres, and Elena Lorenzana.

More Signal, Less Noise: The Electronic Residency Application Program Supplemental Application in Radiology Match

Radiology recruitment is under unprecedented stress because of overapplication [1] compounded by remote interviews during the coronavirus 2019 disease (COVID-19) pandemic [2]. Since its inception in 2001, the Electronic Residency Application Program (ERAS) made applying to residency programs easy, which led to explosive growth of applications [3] and prevented program directors from performing in-depth application reviews, relying instead on the United States Medical Licensing Examination (USMLE) Step 1 score and geographic location filters [4].

Current Views on the New United States Medical Licensing Examination Step 1 Pass/Fail Format: A Review of the Literature.

Residency programs have historically used numerical Step 1 scores to screen applicants, making it a career-defining, high-stakes examination. Step 1 scores will be reported as pass/fail starting in January 2022, fundamentally reshaping the residency application review process. This review aimed to identify opinions of physicians and medical students about the new format, identify arguments in support of or against the change, and determine the implications of this change on the residency selection process. A comprehensive PubMed review was performed in May 2021 to identify articles that discussed the new Step 1 format. Non-English and duplicate articles were excluded. Data collected from each article included publication year, specialty, subjects, and key findings. A total of 81 articles were included, 26 of which discussed the impact of the new format within surgical fields (32.1%). Remaining articles discussed the implications within the medical community as a whole (n=33, 40.7%) and nonsurgical fields (n=22, 27.2%). Studies suggest Program Directors will rely on Step 2 Clinical Knowledge (CK) scores, medical school reputation, applicant familiarity, Dean's letters, recommendation letters, and research in lieu of numerical Step 1 scores. In addition, concerns have been raised that the new format will disadvantage international, osteopathic, and minority applicants while increasing stress surrounding Step 2 CK. Within the medical community, there are concerns that Step 2 CK will be used to substitute Step 1 and that resident diversity will diminish due to the new Step 1 format. Holistic candidate consideration will be increasingly important.

The Validity of MCAT Scores in Predicting Students' Performance and Progress in Medical School: Results From a Multisite Study.

This is the first multisite investigation of the validity of scores from the current version of the Medical College Admission Test (MCAT) in clerkship and licensure contexts. It examined the predictive validity of MCAT scores and undergraduate grade point averages (UGPAs) for performance in preclerkship and clerkship courses and on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge examinations. It also studied students' progress in medical school. Researchers examined data from 17 U.S. and Canadian MD-granting medical schools for 2016 and 2017 entrants who volunteered for the research and applied with scores from the current MCAT exam. They also examined data for all U.S. medical schools for 2016 and 2017 entrants to regular-MD programs who applied with scores from the current exam. Researchers conducted linear and logistic regression analyses to determine whether MCAT total scores added value beyond UGPAs in predicting medical students' performance and progress. Importantly, they examined the comparability of prediction by sex, race and ethnicity, and socioeconomic status. Researchers reported medium to large correlations between MCAT total scores and medical student outcomes. Correlations between total UGPAs and medical student outcomes were similar but slightly lower. When MCAT scores and UGPAs were used together, they predicted student performance and progress better than either alone. Despite differences in average MCAT scores and UGPAs between students who self-identified as White or Asian and those from underrepresented racial and ethnic groups, predictive validity results were comparable. The same was true for students from different socioeconomic backgrounds, and for males and females. These data demonstrate that MCAT scores add value to the prediction of medical student performance and progress and that applicants from different backgrounds who enter medical school with similar ranges of MCAT scores and UGPAs perform similarly in the curriculum.

Educational Outcomes of a 4-Year MD-MPH Dual-Degree Program: High Completion Rates and Higher Likelihood of Primary Care Residency.

In 2007, University of Texas Health Science Center Houston School of Public Health at San Antonio (UTHealth SPH) and UT Health San Antonio Long School of Medicine (LSOM) designed and implemented a 4-year dual MD and Master of Public Health (MPH) program. Dual MD-MPH programs wherein students can receive both degrees within 4 years are unique, and programmatic evaluation may have generalizable implications for accredited MD-MPH programs. Demographic information was collected from UTHealth SPH and LSOM student data. The primary outcome variable was MD-MPH program completion in 4 years. Comprehensive Basic Science Examination (CBSE) scores, United States Medical Licensing Examination Step 1 and Step 2 scores, and successful primary care residency match data were compared between MD-MPH and MD-only students. Family medicine, internal medicine, obstetrics-gynecology, and pediatrics were considered primary care residencies, and an analysis excluding obstetrics-gynecology was also conducted. Of 241 MD-MPH students enrolled 2007-2017, 66% were women, 22% Hispanic, and 10% African American. Four-year MD-MPH program completion occurred for 202 (93% of eligible) students; 9 (4.1%) received MD only, 3 (1.4%) received MPH only; and 4 (1.8%) received neither. MD-MPH students' median CBSE score was 2 points lower than for MD-only students (P = .035), but Step 1 and 2 scores did not differ. Primary care residency match was more likely compared with MD-only students, both including and excluding obstetrics-gynecology (odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.31, 2.33; and OR: 1.36; 95% CI: 1.02, 1.82, respectively). The 4-year MD-MPH program retains and graduates a socioeconomically and racial/ethnically diverse group of students with a 93% success rate. MD-MPH graduates were more likely to pursue primary care residency than non-dual-degree students, which may have implications for addressing population health disparities.

Vascular Surgery Integrated Resident Selection Criteria in the Step 1 Pass/Fail Era: A National Survey of Program Directors

Vascular surgery integrated residency (VSIR) programs are highly competitive; however, criteria for resident selection remain opaque and nonstandardized. The already unclear selection criteria will be further impacted by the impending transition of the United States Medical Licensing Examination (USMLE) step 1 from numeric scores to a binary pass/fail outcome. The purpose of this study is to investigate the historical and anticipated evaluation rubric of VSIR applicants.

The Effects of the United States Medical Licensing Examination STEP 1 Pass/Fail Scoring Change for Obstetrics and Gynecology Residency Applicants [A58

INTRODUCTION: The National Board of Medical Examiners (NBME) recently approved the transition of the United States Medical Licensing Examination (USMLE) STEP 1 exam from a three-digit numeric scoring to a pass/fail format, effective January 26, 2022. The change will ideally result in a more holistic review of residency applicants, but the realized impacts remain to be seen. We aimed to examine the implications of the scoring change on future obstetrics and gynecology residency applicants. METHODS: Surveys were distributed to obstetrics and gynecology residency program directors (PD) for all 291 Accreditation Council for Graduate Medical Education-accredited residency programs. The survey assessed their viewpoints about the STEP 1 exam and asked respondents to rank the importance of variables used in assessment of potential applicants before and after the change to pass/fail. The survey was approved by the University of Alabama at Birmingham Institutional Review Board. RESULTS: We received 70 responses (response rate=24.0%). While most (60%) PDs believe that STEP 1 scores do not accurately predict a resident’s clinical performance, the majority (68.6%) disagreed that students will be better prepared clinically following the change to pass/fail. Clerkship grades were ranked as the most important variable in evaluating applicants both before and after the transition to pass/fail. Number of abstracts/presentations/publications and volunteer experiences saw the greatest increases in rank of importance with pass/fail as opposed to before. CONCLUSION: Despite the shortcomings of the STEP 1 exam in predicting clinical performance and the opportunity for more holistic review, obstetrics and gynecology PDs are skeptical of a transition to pass/fail scoring. The change will necessitate that alternative variables play a greater role in evaluation of residency applicants.

Perspectives of Orthopedic Surgery Program Directors on the USMLE Step 1 Scoring Change.

The orthopedic surgery residency application process is highly competitive, and residency programs rely on objective measures, such as the United States Medical Licensing Examination (USMLE) Step 1 score, to assist in applicant selection. To deemphasize standardized test scores and improve student well-being, governing bodies have elected to change the Step 1 examination to a pass/fail grading system beginning in 2022. Given the utility of Step 1 in the orthopedic surgery residency application process, this change will significantly affect how applicants are assessed. To determine how this change will affect the process, we developed and validated a 19-item anonymous electronic survey and invited program directors (PDs) from orthopedic surgery residency programs accredited by the Accreditation Council for Graduate Medical Education to respond. The 86 surveys that were completed represented a 43.2% response rate (86 of 199). Only 4.7% of orthopedic surgery PDs believe that this change is a good idea, and 91.7% of PDs believe that the change will make it more difficult to compare applicants objectively. In addition, 90.7% of PDs report that they will increase emphasis on the Step 2 CK (clinical knowledge) examination in comparing residency applicants for their program, with 90.4% of PDs reporting that they will require students to submit their Step 2 scores via the Electronic Residency Application Service. These results indicate that changing the Step 1 scoring to pass/fail is unpopular among orthopedic surgery PDs. Further, losing the numeric Step 1 score will increase reliance on Step 2 scores and emphasis on less objective measures, such as where an applicant attended medical school. [Orthopedics. 2022;45(5):e257-e262.].