Effect of the USMLE Step 1 Grading Change on Orthopedic Surgery Residency Applications: National Resident Matching...

This study evaluated differences in orthopedic surgery residency applicant statistics in the 2024 National Resident Matching Program (NRMP) Charting Outcomes, the first report to include applicants with a pass/fail designation on the United States Medical Licensing Examination (USMLE) Step 1.

Data were collected from the NRMP reports, which are released every 2 to 3 years, for 2011, 2014, 2016, 2018, 2020, 2022, and 2024. The number of research items (abstracts, presentations, and publications), USMLE Step 2 scores, volunteer experiences, and work experiences for matched and unmatched applicants were recorded. Linear regression analyses were performed with data from before 2024 to predict expected outcomes for the 2024 match. The percentage of change was calculated for each characteristic of matched and unmatched applicants.

In 2024, a statistically significant increase was seen in the observed number of research items per matched applicant (23.8) compared with the predicted number (18.4; P=.009). The observed mean USMLE Step 2 score (257) for matched applicants was lower than the expected score (259.3), but was still higher than the 2022 score of 256 and the unmatched applicant score of 246. Volunteer and work experiences decreased to the lowest of any report since 2011.

Since the USMLE Step 1 examination became pass/fail, research productivity significantly increased and work and volunteer experiences decreased. These changes may reflect a perceived increased emphasis on research productivity because of the grading change or may be the result of various causes, including an increase in the number of applicants who take research gap years. [Orthopedics. 2025;48(3):e139-e146.].