Converting USMLE Step 1 to Pass or Fail: The Potential Impact on Applicants Who Are Female or From Underrepresented...

Area of Science:

• Medical Education
• Residency Admissions
• Health Equity

Background:

• The United States Medical Licensing Examination (USMLE) Step 1 transitioned to a pass/fail scoring system in January 2022.
• This change, alongside the increasing use of USMLE Step 2 scores for residency screening, aimed for holistic applicant reviews.
• The specific impact of these scoring changes on diverse applicant groups remains unclear.

Purpose of the Study:

• To investigate the effects of USMLE scoring changes on female candidates and applicants from underrepresented groups (URM).
• To analyze how the shift to pass/fail for USMLE Step 1 influences the competitive landscape for residency applications.

Main Methods:

• A retrospective cross-sectional study analyzed data from 2021-2022 residency applications at a single institution.
• Included were applicants from US medical schools with both USMLE Step 1 and Step 2 scores.
• Comparisons focused on score differences between USMLE Step 1 and Step 2 for female vs. male and URM vs. non-URM candidates.

Main Results:

• Female candidates showed significantly greater score improvements between USMLE Step 1 and Step 2 compared to male candidates (P < .001).
• Underrepresented minority (URM) candidates exhibited smaller score differences between USMLE Step 1 and Step 2 compared to non-URM candidates (P < .005).

Conclusions:

• The pass/fail transition for USMLE Step 1 may offer advantages to female applicants in residency screening.
• Conversely, this scoring change could negatively impact URM applicants.
• Careful evaluation of these evolving application dynamics is crucial for achieving equitable representation in residency programs.