The Value of Numerical USMLE Step 1 Scores in Radiology Resident Selection

In response to a recent proposal to change scoring on the United States Medical Licensing (USMLE) Step 1 exam to pass/fail, we sought to determine the value of numerical Step 1 scores in predicting success in our radiology residency program.

Residency applications for 157 residents entering the program between 2005 and 2017 were retrospectively reviewed. Biographical (gender, sports participation, advanced degree), undergraduate (school, major), and medical school (grades, USMLE Step 1 score, Alpha Omega Alpha membership, letters of recommendation, publications) data were recorded. Multivariate regression analysis was used to examine the relationship between these application factors and subsequent performance as a radiology resident, as determined by completion of the program without requiring corrective action, select Accreditation Council for Graduate Medical Education milestones, and selection as chief resident.

Corrective action was required for 7% (n = 12) of residents. Of the predictor variables, only Step 1 score was associated with the need for corrective action (p < 0.001). The interpretation of exams milestone was associated with higher Step 1 scores (p = 0.001) and number of medical school clerkship honors (p = 0.008). Selection as chief resident was associated with sports participation (p = 0.04), and clerkship honors (p = 0.02).

Numerical USMLE Step 1 scores are predictive of successful completion of radiology residency training without the need for corrective action, and of accelerated competence in the interpretation of exams milestone. Continued reporting of numerical Step 1 scores would be valuable in selection of radiology residents.