Medical student non-modifiable risk factors and USMLE Step 1 exam score

Area of Science:

• Medical Education
• Health Equity
• Psychosocial Factors in Medicine

Background:

• Equitable opportunities in the medical graduate workforce are crucial for diversity.
• USMLE Step 1 scores have been a traditional threshold for residency screening.
• Non-modifiable risk factors may influence applicant success.

Purpose of the Study:

• To investigate the relationship between USMLE Step 1 scores and non-modifiable risk factors.
• To explore the prevalence of Adverse Childhood Experiences (ACEs) among medical students.
• To assess the impact of ACEs on meeting residency interview score thresholds.

Main Methods:

• A voluntary survey of the OHSU SOM class of 2021 assessed Step 1 scores and risk factors.
• Non-modifiable factors included ACEs, URiM status, sex, gender, family income, guardian education, discrimination, and home environment.
• Descriptive statistics and unadjusted risk ratios were used for analysis.

Main Results:

• The mean Step 1 score was 230. 28.2% reported ACEs ≥ 3, 13.6% were URiM, and 65.4% were female.
• URiM, female, and discrimination-experiencing students were more likely to have ACEs ≥ 3.
• Students with ACEs ≥ 3 were less likely to meet a Step 1 threshold of 220 for interviews.

Conclusions:

• This study is the first to link USMLE Step 1 scores with ACEs.
• URiM status, female sex, and experiencing discrimination correlate with higher ACEs.
• Findings inform equity considerations for Step 2CK scores and residency interviews post-Step 1 pass/fail transition.