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. 2021 Mar;131(3):E738-E743.
doi: 10.1002/lary.29072. Epub 2020 Sep 3.

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process

Khodayar Goshtasbi  1 , Mehdi Abouzari  1 , Tjoson Tjoa  1 , Sonya Malekzadeh  2 , Naveen D Bhandarkar  1
Affiliations

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process

Khodayar Goshtasbi et al. Laryngoscope. 2021 Mar.

Abstract

Objectives: To investigate how the decision to report United States Medical Licensing Examination (USMLE) Step 1 score as pass/fail will influence future otolaryngology residency application and match processes.

Study design: Survey study.

Methods: An anonymous and voluntary survey approved by the Otolaryngology Program Directors Organization was administered to academic faculty members from April 24, 2020 through May 19, 2020.

Results: Two hundred fifty-seven surveys were received from department chairs (17.5%), program directors (24.1%), associate program directors (12.5%), and department faculty (45.9%). USMLE Step 1 has been the most heavily weighted metric for offering interviews (44.0%), and it has correlated with residents' medical knowledge (77.0%) and in-service performance (79.8%) but not with surgical skills (57.6%) or patient care (47.1%). In total, 68.1% disagreed with the decision to make USMLE Step 1 pass/fail. This change is anticipated to lead to an increase in significance of USMLE Step 2 CK (89.1%), core clerkship grades (80.9%), elective rotation at the respective institutions (65.7%), Alpha Omega Alpha and other awards (64.6%), and letters of recommendation (63.8%). The new scoring is also anticipated to especially benefit students from top-ranked schools (70.8%), increase medical students' anxiety/uncertainty regarding obtaining interview invites (59.1%), and negatively affect international (51.4%), doctor of osteopathic medicine (45.9%), and underrepresented students (36.9%). Indication that USMLE Step 2 CK will significantly increase in weight varied according to department position (P = .049), geographic region (P = .047), years of practice (P < .001), and residency program size (P = .002).

Conclusion: Most academic otolaryngologists disagreed with changing USMLE Step 1 scoring to pass/fail and believe that it will increase other objective/subjective metrics' weight and put certain student populations at a disadvantage.

Level of evidence: N/A. Laryngoscope, 131:E738-E743, 2021.

Keywords: USMLE Step 1, residency application, residency interviews, step 2 CK, pass/fail, elective rotation, letter of recommendation.

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Conflict of interest statement

Conflicts of Interest: None

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