The next step: Replacing step 1 as a metric for residency application

Area of Science:

• Medical Education
• Residency Admissions
• Otolaryngology

Background:

• USMLE Step 1 scores shifted to pass/fail in January 2022, impacting residency applications.
• Historically, Step 1 served as a standardized metric for screening applicants in competitive specialties.
• Otolaryngology programs face high applicant volumes, necessitating effective screening tools.

Purpose of the Study:

• To identify quantifiable metrics that can substitute USMLE Step 1 scores for screening in otolaryngology residency applications.
• To assess the correlation between Step 1 scores and other application components.

Main Methods:

• Analysis of otolaryngology residency applications from 2019-20 and 2020-21 ERAS cycles.
• Extraction of board scores and quantitative research data.
• Statistical analysis using Pearson's correlation coefficients and regression models.

Main Results:

• USMLE Step 2 scores demonstrated a moderate correlation with Step 1 scores (R = .67).
• No significant correlation was found between Step 1 scores and other objective metrics like publications or presentations.
• Analysis across different Step 1 score tiers (cutoffs at 220 and 250) was performed.

Conclusions:

• Step 2 scores correlate with Step 1, but using it as a cutoff would select a different applicant pool.
• No other quantifiable metrics reliably correlate with Step 1 performance.
• Highly competitive residency programs require new screening strategies post-Step 1 pass/fail transition.