Shifts in Scholarly Productivity Following Implementation of USMLE Step 1 Pass/Fail Reporting: Implications for General Surgery Residency Application
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Nathaniel Huhta1, Megan Moore1, Alain Elian1
1Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan.
Objective:
Following the transition of the United States Medical Licensing Examination (USMLE) Step 1 from a 3-digit numerical score to pass/fail reporting in January 2022, the emphasis of scholarly productivity on residency applicant selection may have evolved. However, this change remains unclear. This study aims to evaluate changes in research productivity and scholarly activity (primary outcomes), as well as additional academic metrics (secondary outcomes), among general surgery residency applicants after the USMLE scoring.
Design:
This is a retrospective single-institution study comparing Electronic Residency Application Service (ERAS) applications submitted to an academic general surgery residency program before (Group A: 2015-2021) and after (Group B: 2022-2024) implementation of pass/fail Step 1 reporting. Scholarly activity was categorized as (1) poster and oral presentations, (2) peer-reviewed journal articles and abstracts (published and unpublished), and (3) online publications. Groups were compared using Chi-square or Fisher's exact tests for categorical variables and parametric or nonparametric tests for continuous variables, as appropriate.
Setting:
General surgery program at a single hybrid academic/community center.
Participants:
A total of 7,458 general surgery residency applicants were included: 5,503 (73.8%) in Group A and 1,955 (26.2%) in Group B.
Results:
Among the 7458 general surgery applicants, 41% were female. Compared with Group A, applicants in Group B demonstrated significantly higher mean numbers of oral and poster presentations (5.44 vs 3.56, p < 0.001), journal articles and abstracts (4.95 vs 2.74, p < 0.001), and online publications (2.09 vs 0.25, p < 0.001). Group B also had higher mean (SD) USMLE Step 2 scores (243 [14] vs 237 [15], p < 0.001).
Conclusions:
Following the transition to pass/fail Step 1 reporting, general surgery residency applicants demonstrated increased research productivity and higher Step 2 scores, suggesting a potential shift toward strengthening objective academic metrics to maintain competitiveness.