Publishing under Pressure: Ophthalmology Research Productivity after adoption of Step 1 Pass/Fail

Background The transition of the USMLE Step 1 exam to pass/fail scoring has increased the emphasis on research productivity in competitive specialties such as urology and neurosurgery, yet its impact on ophthalmology bears further investigation. Additionally, the San Francisco Match provides no publicly available data on the research output of matched ophthalmology residency applicants, highlighting a critical gap in understanding the academic profiles of these candidates. Purpose: To evaluate the relationship between the USMLE Step 1 transition and pre-residency research productivity of matched ophthalmology residents and assess the potential role of medical school NIH funding level on publication metrics. Methods: This retrospective cohort study analyzed the research output of 485 ophthalmology residents from the classes of 2026 (pre-Step 1 transition) and 2028 (post-Step 1transition). Residents with MD/PhDs or gap years were excluded. PubMed-indexed publications were sourced by count, authorship, specialty relevance, citation rate, and type for each resident. Using Mann-Whitney U tests, group differences were compared, with total publications serving as the primary outcome. Results: Compared to the pre-transition cohort, residents in the post-Step 1 transition cohort produced more total publications (mean ± SD, 2.50 ± 4.01 vs. 3.06 ± 4.38 p = 0.011), first-authorships (1.02 ± 2.10 vs 1.30 ± 2.44 p = 0.006), and in-specialty publications (1.09 ± 1.74 vs. 1.73 ± 2.53 p < 0.001). Logistic regression analysis revealed that post-transition status (OR = 1.88; 95% CI, 1.25-2.82) and high NIH funding (OR = 2.70; 95% CI, 1.79-4.08) were significant predictors of having at least one publication. Conclusion: The Step 1 transition coincided with an increase in the overall number of PubMed indexed publications produced by residents in the class of 2028 prior to starting residency. This trend is consistent with previously reported patterns of medical student research productivity prior to the Step 1 transition. Differences in research productivity were observed across medical schools with varying levels of NIH funding, with students from top-funded institutions producing more publications on average than their peers from less-resourced schools. In the absence of a scored Step 1, these findings highlight the need for residency programs to contextualize research productivity within the opportunities available to students.