Perceptions of the Emergency Medicine Resident Selection Process by Program Directors Following the Transition to a...

Area of Science:

• Medical Education
• Graduate Medical Education
• Emergency Medicine

Background:

• The United States Medical Licensing Examination (USMLE) Step 1 transitioned to a pass/fail scoring system in January 2022.
• Historically, USMLE Step 1 scores were heavily weighted by program directors (PDs) in evaluating medical student competitiveness.

Purpose of the Study:

• To assess Emergency Medicine (EM) PDs' perceptions of the USMLE Step 1 pass/fail transition.
• To determine EM PDs' opinions on the predictive validity of USMLE examinations for resident performance.

Main Methods:

• A survey with ranking and multiple-choice questions was distributed to EM PDs.
• Statistical analysis was performed using R studio and MATLAB, with P < 0.05 considered significant.

Main Results:

• Only 10.5% of responding PDs viewed USMLE Step 1 as predictive of clinical performance, compared to 31.6% for Step 2 CK.
• The top quartile of resident selection criteria, including standardized letters of evaluation, away rotations, clerkship grades, and Step 2 CK scores, remained unchanged.

Conclusions:

• EM PDs perceive Step 2 CK as a more accurate predictor of resident success than the pass/fail Step 1.
• The shift to pass/fail for USMLE Step 1 may not significantly alter established resident selection practices.