Predicting Academic Performance during Plastic Surgery Residency: Can Step 2 Scores Reliably Replace Step 1?

Area of Science:

• Medical Education
• Surgical Training
• Physician Assessment

Background:

• The United States Medical Licensing Examination (USMLE) Step 1 is transitioning to a pass/fail system.
• This change impacts how medical school graduates are evaluated for residency program selection.
• Plastic surgery residency programs face challenges in assessing applicant qualifications.

Purpose of the Study:

• To evaluate the impact of the USMLE Step 1 pass/fail transition on plastic surgery residency program directors' selection criteria.
• To determine if USMLE Step 2 Clinical Knowledge (CK) can serve as a viable alternative selection metric.
• To assess the correlation between USMLE scores and in-residency performance.

Main Methods:

• An online survey was distributed to ten collaborative integrated plastic surgery program directors.
• Data collected included USMLE Step 1, Step 2 CK, In-Service, and written board scores for 80 graduated integrated residents.
• Statistical analysis was performed to correlate scores with in-residency performance metrics.

Main Results:

• Both USMLE Step 1 and Step 2 CK scores demonstrated a high correlation with In-Service performance percentiles (p < 0.001).
• Step 2 CK scores showed a similar correlation with In-Service performance compared to Step 1 (rho 0.359 vs. 0.355).
• Program directors reported a significant increase in the perceived importance of Step 2 CK following the Step 1 transition.

Conclusions:

• USMLE Step 2 CK scores correlate similarly with plastic surgery In-Service performance as Step 1 scores.
• While USMLE scores may not perfectly predict residency performance, Step 2 CK can be utilized as an objective screening tool.
• This provides programs with a metric to differentiate between plastic surgery applicants in the evolving assessment landscape.