Innovation in Resident Selection: Life Without Step 1

The announcement of Step 1 shifting to a Pass/Fail metric has prompted resident selection committees (RSCs) to pursue objective methods of evaluating prospective residents. Regardless of the program's specialty or affiliated hospital/school, RSCs universally aim to recognize and choose applicants who are an "optimal fit" to their programs.¹ An optimal fit can be defined as a candidate who thrives in the clinical and academic setting, both contributing to and benefiting from their respective training environments.

The objective of this scoping review is to evaluate alternative, innovative methods by which RSCs can evaluate applicants and predict success during residency. Objective methods include: Step 2 scores, Traditionally Used Metrics (core clerkship scores), interview performance, musical talent, sports involvement, AOA membership, research publications, unprofessional behavior, Dean's letters, Rank list, judgement testing, and specialty-specific shelf exams.^13-15.

A scoping review was performed in compliance with the guidelines indicated by the PRISMA Protocol for scoping review.¹⁸ 9308 results were identified in the original PubMed search for articles with the key words "Resident Success". Abstract screening and application of inclusion and exclusion criteria yielded 97 articles that were critically appraised via review of full manuscript.

Of the articles that focused on personality traits, situational judgement testing, and specialty specific pre-assessment, all of them demonstrated some level of predictability for resident success. Standardized Letter of Recommendations, Traditionally Used Metrics, and STEP 2 did not show a unanimous consensus in demonstrating predictability of a resident's success, this is because some articles suggested predictability and some articles disputed predictability.

The authors found personality traits, situational judgement testing, and specialty specific assessments to be predictive in selecting successful residents. Further research should aim to analyze exactly how RSCs utilize these assessment tools to aid in screening their large and competitive applicant pools to find residents that will be successful in their program.