Applicant Familiarity Becomes Most Important Evaluation Factor in USMLE Step I Conversion to Pass/Fail: A Survey of Plastic Surgery Program Directors

Abstract

Background: In 2020, Step 1 of the United States Medical Licensing Examination (USMLE) changed to a pass/fail reporting. Step 1 has been one of the main factors for both inviting applicants for interviews and for ranking in Plastic Surgery. Due to this change, we hypothesize that Step 2 CK - currently the only remaining, universal quantitative metric - will become the main factor in the residency selection process.

Methods: A survey-based cross-sectional study of United States (US) integrated plastic surgery program directors (PSPDs) investigated the factors that would assume importance following the change in the reporting pattern.

Results: Respondents reported that personal prior knowledge of the applicant, Letters of recommendation (LORs), Step 2 CK scores, and away rotation at the institution of interest would become the most important factors (median ratings of 5, 4.5, 4.5, 4.5, respectively on a 5-point Likert scale). Eighty-three percent of respondents were strongly dissatisfied with the conversion to pass/fail reporting. LOR's received the highest ranking (median,1; IQR,1-2) as the component used for offering away rotations after the implementation of the pass/fail reporting, followed by the applicant's medical school (median, 3; IQR, 3-4), and grades obtained during medical school (median,3; IQR,1.75-4). Standardized assessment during rotations are recommended by 67% of PSPDs.

Conclusions: Future emphasis will be placed primarily on subjective metrics, including applicant familiarity. Step 2 CK, LORs, and away rotation at the institution of interest are other factors of importance. PSPDs welcome the adoption of objective assessments of patient care and medical knowledge to improve the current selection process.

Keywords: USMLE Step 1; exam; medical student; residents; score; surgery; surgical education; test.