Securing Interviews as an Underrepresented Applicant Post-USMLE Pass/Fail: A National Survey of Competitive Residency Directors

Abstract

Abstract Background In January 2022, the United States Medical Licensing Examination (USMLE) changed Step-1 score reporting to pass/fail.Objective To report selection criteria important to residency program directors (PDs) and whether they believe pass/fail scoring will impact underrepresented in medicine (URM), international (IMG), or osteopathic (OG) residency applicants.Methods A Qualtrics survey was sent between August, 2022 – January, 2023 to 1,141 US PDs from specialties with traditionally low match rates: dermatology, ophthalmology, otolaryngology, orthopedic surgery, neurosurgery, interventional radiology, diagnostic radiology, radiation oncology, thoracic surgery, vascular surgery, plastic surgery, and urology. Contact information was obtained from AMA, FRIEDA, or program websites.Results We received 433 responses (38%). When asked to anticipate the difficulty student groups will face matching into their specialty, PDs reported: for URM, 24.0% increased, 46.0% unchanged, and 30.0% decreased, OG, 49.19% increased, 44.58% unchanged, and 6.23% decreased; for IMG, 56.35% increased, 39.72% unchanged, and 3.93% decreased. When asked to rank the most important selection factors, the top two responses were Step-2 CK score and away rotation participation at their site.Conclusion PDs overwhelmingly believed match difficulty would either increase or remain unchanged for OG (93.77%) and IMG (96.07%). In contrast, 76.0% reported difficulty for URM students would either decrease or remain unchanged. Paradoxically, PDs ranked Step-2 CK score and away rotation participation as the most important selection factors. Although the intention may be to dismantle barriers for URM applicants, enhanced emphasis on Step 2CK and away rotations place additional socioeconomic and standardized exam barriers.