Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews

Area of Science:

• Medical Education
• Residency Admissions
• Health Equity

Background:

• The United States Medical Licensing Examination (USMLE) Step 1 score is a key metric in residency program applicant screening.
• Previous research indicates potential disparities in medical licensing examination performance across racial groups.
• Understanding the impact of these scores on interview selection is crucial for fair admissions processes.

Purpose of the Study:

• To evaluate if the USMLE Step 1 score disproportionately excludes African-American applicants from internal medicine residency interviews.
• To quantify the impact of USMLE Step 1 score thresholds on interview invitations for African-American versus non-African-American applicants.

Main Methods:

• A survey of 259 internal medicine residency programs (69% response rate) assessed the use of USMLE Step 1 scores for interview selection.
• A cohort of 626 non-African-American and 47 African-American applicants from the Electronic Residency Application Service (ERAS) database was analyzed.
• Rejection rates were calculated based on incremental USMLE Step 1 score thresholds (180-215).

Main Results:

• 92% of surveyed residency programs utilize USMLE Step 1 scores in their interview selection process.
• African-American applicants had a significantly higher proportion of scores falling below each tested threshold (p <.05).
• Depending on the score threshold, African-American applicants were 3 to 6 times less likely to be offered an interview.

Conclusions:

• The use of USMLE Step 1 scores in residency application screening significantly disadvantages African-American students.
• This screening practice results in a greater proportion of African-American applicants being denied interview opportunities.
• Residency programs should critically assess the role of USMLE Step 1 scores to ensure equitable selection processes.