Abstract
Purpose
The transition of USMLE Step1 to pass/fail has brought many questions and uncertainties for medical students and residency programs. This study assesses the perceptions of both students and faculty on this policy change and residency matching.
Methods
An IRB-approved survey was distributed to our medical students and faculty, who participate in residency interviews and ranking of residency applicants of different specialties; general surgery, orthopedic and plastic surgery, ob-gyn, dermatology, emergency medicine, and psychiatry. The survey included both open- and closed-ended questions. Data were analyzed descriptively and qualitatively.
Results
A total of 36.2% (181/500) students responded; 68.0% were interested in highly competitive specialties. The response rate for faculty was 40.3% (23/57). A higher number of students (58.6%) were in favor of pass/fail, primary reason being less pressure and stress; 73.9% of faculty were opposed, the primary reason being an inability to stratify applicants. Students believed that Step2 scores (92.5%), clerkship honors (74.4%), and research (77.5%) would be more important for residency applications. While faculty members agreed with clerkship honors (66.6%) and Step 2 scores (60.0%), they included away rotations (53.3%) as one of the factors influencing their ranking list. Students (70.0%) feared that their school’s name/prestige would carry higher weight on interview offers and rank list; only 33.33% of faculty agreed. Faculty suggested students prepare a sincere personal statement, get excellent recommendations, and perform high-quality research to stand out.
Conclusions
While students and faculty disagreed on favoring pass/fail Step 1, they shared common concerns on resulting stress and difficulties for students interested in highly competitive specialties and/or from less prestigious schools. Both groups stated that Step 2 score and clerkship honors could now play a major role but warranted further clarification on the stratification of the residency selection process.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Not applicable.
References
Judy George. No More Numerical Scores for USMLE Step 1 Exam | MedPage Today. MedPageToday. Published 2020. https://www.medpagetoday.com/hospitalbasedmedicine/graduatemedicaleducation/84914. Accessed 28 Apr 2023.
Giordano C, Hutchinson D, Peppler R. A predictive model for USMLE step 1 scores. Cureus. 2016;8(9): e769.
Blamoun J, Hakemi A, Armstead T. Perspectives on transitioning step 1 of the united states medical licensing examination to a pass/fail scoring model: defining new frameworks for medical students applying for residency. Adv Med Educ Pract. 2021;12:149. https://doi.org/10.2147/AMEP.S296286.
Murphy B. With no USMLE Step 1 scores, challenges and opportunities arise. American Medical Association. https://www.ama-assn.org/medical-students/usmle-step-1-2/no-usmle-step-1-scores-challenges-and-opportunities-arise. Accessed 26 Dec 2023.
Wagner JG, Schneberk T, Zobrist M, et al. What predicts performance? A multicenter study examining the association between resident performance, rank list position, and United States medical licensing examination step 1 scores. J Emerg Med. 2017;52(3):332–40. https://doi.org/10.1016/J.JEMERMED.2016.11.008.
McCaskill QE, Kirk JJ, Barata DM, Wludyka PS, Zenni EA, Chiu TT. USMLE step 1 scores as a significant predictor of future board passage in pediatrics. Ambul Pediatr. 2007;7(2):192–5. https://doi.org/10.1016/J.AMBP.2007.01.002.
National Resident Matching Program, Data Release and Research Committee: Results of the 2018 NRMP Program Director Survey; 2018.
Charting Outcomes in the Match: Senior Students of U.S. MD Medical Schools. National Resident Matching Program. 2022;3:14. www.nrmp.org. Accessed 6 Sept 2023.
McGaghie WC, Cohen ER, Wayne DB. Are United States medical licensing exam step 1 and 2 scores valid measures for postgraduate medical residency selection decisions? Acad Med. 2011;86(1):48–52.
Sutton E, Richardson JD, Ziegler C, Bond J, Burke-Poole M, McMasters KM. Is USMLE Step 1 score a valid predictor of success in surgical residency? Am J Surg. 2014;208(6):1029–34. https://doi.org/10.1016/J.AMJSURG.2014.06.032.
Nagasawa DT, Beckett JS, Lagman C, et al. United States medical licensing examination step 1 scores directly correlate with american board of neurological surgery scores: a single-institution experience. World Neurosurg. 2017;98:427–31. https://doi.org/10.1016/J.WNEU.2016.11.091.
Alterman DM, Jones TM, Heidel RE, Daley BJ, Goldman MH. The predictive value of general surgery application data for future resident performance. J Surg Educ. 2011;68(6):513–8. https://doi.org/10.1016/J.JSURG.2011.07.007.
Thompson RH, Lohse CM, Husmann DA, Leibovich BC, Gettman MT. Predictors of a successful urology resident using medical student application materials. Urology. 2017;108:22–8. https://doi.org/10.1016/J.UROLOGY.2017.06.046.
Wolfson RK, Fairchild PC, Bahner I, et al. Residency program directors’ views on research conducted during medical school: a national survey. Acad Med. Published online April 21, 2023. https://journals.lww.com/academicmedicine/Abstract/9900/Residency_Program_Directors__Views_on_Research.430.aspx. Accessed 3 June 2023.
Huq S, Khalafallah AM, Botros D, et al. Perceived impact of USMLE Step 1 pass/fail scoring change on neurosurgery: program director survey. J Neurosurg. 2020;133(3):928–35. https://doi.org/10.3171/2020.4.JNS20748.
Green M, Jones P, Thomas JXJ. Selection criteria for residency: results of a national program directors survey. Acad Med. 2009;84(3):362–7.
Baniadam K, Elkadi S, Towfighi P, Aminpour N, Sutariya R, Chen HC. The impact on medical student stress in relation to a change in USMLE step 1 examination score reporting to pass/fail. Med Sci Educ. 2023;33(2):401–7. https://doi.org/10.1007/s40670-023-01749-4.
Girard AO, Qiu C, Lake IV, Chen J, Lopez CD, Yang R. US medical student perspectives on the impact of a pass/fail USMLE step 1. J Surg Educ. 2022;79(2):397–408. https://doi.org/10.1016/J.JSURG.2021.09.010.
Raborn LN, Janis JE. Current views on the new United States medical licensing examination step 1 pass/fail format: a review of the literature. J Surg Res. 2022;274:31–45. https://doi.org/10.1016/j.jss.2022.01.002.
Makhoul AT, Pontell ME, Ganesh Kumar N, Drolet BC. Objective measures needed—program directors’ perspectives on a pass/fail USMLE step 1. N Engl J Med. 2020;382(25):2389–92. https://doi.org/10.1056/NEJMP2006148/SUPPL_FILE/NEJMP2006148_DISCLOSURES.PDF.
Jaikumar V, Raju B, Jumah F, et al. Gearing Up for the US medical licensing examination step 1 pass/fail transition, evaluating the role of research productivity as an alternative during the neurosurgical residency selection process: an overview. World Neurosurg. 2023. https://doi.org/10.1016/j.wneu.2023.04.051.
Acknowledgements
Both WO and HJ have equal contribution
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors have nothing to disclose.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Owens, W., Jaworski, H., Tuttle, R. et al. USMLE step 1 transition to pass/fail: perception of medical students and residency program faculty. Global Surg Educ 3, 12 (2024). https://doi.org/10.1007/s44186-023-00205-6
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s44186-023-00205-6