Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May 30;8(2):e22.00140.
doi: 10.2106/JBJS.OA.22.00140. eCollection 2023 Apr-Jun.

Removing or Only Moving a Barrier? Screening Applications with US Medical Licensing Examination Step 2CK Instead of Step 1 May Benefit Women but Not Underrepresented Minorities in Orthopaedics

William H Huffman  1 , Steven R Ayotte  1 , Mitchell A Johnson  1 , Cara A Cipriano  2
Affiliations
Review

Removing or Only Moving a Barrier? Screening Applications with US Medical Licensing Examination Step 2CK Instead of Step 1 May Benefit Women but Not Underrepresented Minorities in Orthopaedics

William H Huffman et al. JB JS Open Access. .

Abstract

Most orthopaedic surgery program directors report using a minimum score cutoff for the US Medical Licensing Examination Step 1 examination when evaluating residency applicants. The transition to a Pass/Fail grading system beginning in the 2022-2023 application cycle will alter applicant evaluation in the interview selection process. The impact of this change, particularly on women and underrepresented minority (URM) applicants, remains unclear. This study was designed to evaluate how a shift to screening applications using Step 2 Clinical Knowledge (CK) instead of Step 1 scores could impact selection for residency interviews.

Methods: We reviewed all 855 Electronic Residency Application Service applications submitted to the University of Pennsylvania's orthopaedic surgery residency program in the 2020-2021 cycle. Applicant age, sex, medical school of graduation, self-identified race, and permanent zip code were evaluated for association with Step 1 and Step 2CK scores using a 2-sample t test. A multivariable linear regression analysis was conducted to understand the predictive value of demographic features and medical school features on Step 1 and 2CK scores.

Results: Multivariable linear regression revealed both Step 1 and 2CK scores were lower for applicants of URM status (Step 1: p < 0.001; Step 2CK: p < 0.001) and from international medical schools (p = 0.043; p = 0.006). Step 1 scores but not Step 2CK scores were lower for applicants who were women (p < 0.001; p = 0.730), ≥30 years of age (p < 0.001; p = 0.079), and from medical schools outside the top 25 in National Institutes of Health (NIH) funding or US News and World Report (USNWR) ranking (p = 0.001; p = 0.193).

Conclusions: Conversion of Step 1 grading to Pass/Fail may reduce barriers for groups with lower average Step 1 scores (URM, female, ≥30 years of age, and from institutions with lower NIH funding or USNWR rankings). However, if Step 2CK scores replace Step 1 as a screening tool, groups with lower Step 2CK scores, notably URM applicants, may not experience this benefit.

Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A517).

Figures

Fig. 1
Fig. 1
Percentages of orthopaedic surgery applicants, US medical school graduates, US medical school enrollees, and US population estimates by self-identified sex and race/ethnicity.
Fig. 2
Fig. 2
Percentage of applicants above USMLE Step 1 cutoffs by self-identified race/ethnicity. URM = underrepresented minority, and USMLE = US Medical Licensing Examination.
Fig. 3
Fig. 3
Percentage of applicants above USMLE Step 2CK cutoffs by self-identified race/ethnicity. CK = Clinical Knowledge, URM = underrepresented minority, and USMLE = US Medical Licensing Examination.
See this image and copyright information in PMC

References

    1. Trikha R, Keswani A, Ishmael CR, Greig D, Kelley BV, Bernthal NM. Current trends in orthopaedic surgery residency applications and match rates. J Bone Joint Surg Am. 2020;102(6):e24. - PubMed
    1. ERAS Statistics. AAMC. Accessed January 14, 2023. https://www.aamc.org/data-reports/interactive-data/eras-statistics-data.
    1. Residency Data & Reports. NRMP. Accessed January 3, 2022. https://www.nrmp.org/match-data-analytics/residency-data-reports/.
    1. Schrock JB, Kraeutler MJ, Dayton MR, McCarty EC. A cross-sectional analysis of minimum USMLE Step 1 and 2 criteria used by orthopaedic surgery residency programs in screening residency applications. J Am Acad Orthop Surg. 2017;25(6):464-8. - PubMed
    1. Cohn MR, Bigach SD, Bernstein DN, Arguello AM, Patt JC, Ponce BA, Beal MD, Kogan M, Dyer GSM; Collaborative Orthopaedic Educational Research Group. Resident selection in the wake of United States Medical Licensing Examination Step 1 transition to pass/fail scoring. J Am Acad Orthop Surg. 2020;28(21):865-73. - PubMed