W. K. Haynes3, O. U. Patel3, K. G. Burge3, I. S. Yadav3, N. J. Van Wagoner2, B. L. Corey1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2University Of Alabama at Birmingham, Division Of Infectious Diseases, Birmingham, Alabama, USA 3University Of Alabama at Birmingham, School Of Medicine, Birmingham, Alabama, USA
Introduction:
In February 2020, the National Board of Medical Examiners (NBME) announced that the United States Medical Licensing Examination (USMLE) Step 1 would change from a 3-digit score to Pass/Fail (P/F). Step 1 has been considered one of the most important metrics for a medical student’s residency application, especially for those applying to competitive surgical specialties. With this change, USMLE Step 2 CK is expected to take on increased importance as the only objective measure for medical students applying to general surgery residency. The purpose of this study was to (1) assess the views of general surgery program directors on the change and (2) determine how the change will impact residency selection criteria.
Methods:
A survey was distributed to the program directors of all 330 general surgery residency programs accredited by the Accreditation Council for Graduate Medical Education. Questions asked about current practices in selecting applicants and how changing Step 1 to P/F would impact the selection crieria presented in the table below. Multiple choice and ranking questions were analyzed using non-overlapping 95% confidence intervals.
Results:
A total of 60 program directors (18.1%) completed the survey. 80.0% of program directors surveyed agreed that medical schools should share NBME clerkship exam scores after Step 1 becomes pass/fail (p<0.05), and 56.7% agreed that a medical school’s rank will be considered more after Step 1 becomes pass/fail (p<0.05). In contrast, 68.3% disagreed when asked if students would be better prepared clinically after the change (p<0.05). Regarding selection criteria, although Step 2CK was ranked in the top quartile of most important factors when evaluating applicants, it was not ranked significantly higher by program directors after the change. In fact, there was no significant difference in the ranking of any of the 16 selection criteria listed in the survey post P/F Step 1.
Conclusion:
After the change of Step 1 to P/F, medical school rank will have a larger impact on selection criteria. Additionally, shelf exam scores may provide a valuable objective measure of applicants if medical schools decide to share them with residency programs. Finally, our results do not suggest that Step 2 CK will be of any greater importance after the change when compared to other selection criteria used by surgery program directors in previous years.
