Overemphasis of USMLE and Its Potential Impact on Diversity in Otolaryngology

Objective Applicant demographics during the 2019‐2020 residency cycle were evaluated to determine if strict utilization of United States Medical Licensing Examination (USMLE) scores in applicant selection could lead to a restriction in diversity. Study Design Cross‐sectional study. Setting Otolaryngology residency applicants to a single institution. Methods A total of 381 applicants were analyzed by age, gender, applicant type, race/ethnicity, USMLE scores, permanent zip code, and graduating medical school. Results Among applicants, 37% were women; 9% were ≥30 years of age; 12% were underrepresented minorities (URMs); 71% to 81% had above‐average socioeconomic surrogate markers; 22% were from a top 25 US News & World Report –ranked institution; and 81% were from an institution with an otolaryngology residency program. There was no increase in applicants who identified as URM from the 2015‐2020 cycles. Multivariable regression analysis showed that applicants who were international medical graduates, URMs, and ≥30 years of age had lower Step 1 and Step 2 scores ( P <. 05). Applicants who identified as women had a lower Step 1 score, and those from top 25 National Institutes of Health–funded institutions had a higher Step 1 score; however, there was no difference when Step 2 scores were compared ( P >. 05). Conclusion Our data suggest that in the pre–USMLE Step 1 pass/fail setting, strict adherence to USMLE scores may lead to disproportionally low recruitment of applicants who are women, ≥30 years of age, URMs, and from institutions without an otolaryngology residency program. We must implement measures against overemphasizing the absolute values of USMLE scores for a true holistic review of applicants, specifically to prevent an overemphasis on the USMLE Step 2 score.