Key result
Only 4.7% of orthopedic surgery program directors believe the USMLE Step 1 pass/fail change is a good idea, and 90.7% report they will increase emphasis on Step 2 CK scores.
Why the study?
The USMLE Step 1 is changing to a pass/fail grading system, but it was unclear how this change would affect the orthopedic surgery residency application process.
Cross-Sectional (n=86)
Yes
The transition of USMLE Step 1 to pass/fail scoring is highly unpopular among orthopedic surgery program directors and is expected to shift objective evaluation weight to Step 2 CK scores.
May shift orthopedic applicant preparation toward Step 2 CK; leaves open effects on selection equity and outcomes.
The orthopedic surgery residency application process is highly competitive, and residency programs rely on objective measures, such as the United States Medical Licensing Examination (USMLE) Step 1 score, to assist in applicant selection. To deemphasize standardized test scores and improve student well-being, governing bodies have elected to change the Step 1 examination to a pass/fail grading system beginning in 2022. Given the utility of Step 1 in the orthopedic surgery residency application process, this change will significantly affect how applicants are assessed. To determine how this change will affect the process, we developed and validated a 19-item anonymous electronic survey and invited program directors (PDs) from orthopedic surgery residency programs accredited by the Accreditation Council for Graduate Medical Education to respond. The 86 surveys that were completed represented a 43.2% response rate (86 of 199). Only 4.7% of orthopedic surgery PDs believe that this change is a good idea, and 91.7% of PDs believe that the change will make it more difficult to compare applicants objectively. In addition, 90.7% of PDs report that they will increase emphasis on the Step 2 CK (clinical knowledge) examination in comparing residency applicants for their program, with 90.4% of PDs reporting that they will require students to submit their Step 2 scores via the Electronic Residency Application Service. These results indicate that changing the Step 1 scoring to pass/fail is unpopular among orthopedic surgery PDs. Further, losing the numeric Step 1 score will increase reliance on Step 2 scores and emphasis on less objective measures, such as where an applicant attended medical school. [ Orthopedics . 2022;45(5):e257–e262.]
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White-Dzuro et al. (2022) conducted a cross-sectional in Orthopedic surgery residency application (n=86). USMLE Step 1 scoring change to pass/fail was evaluated on Perspectives on the USMLE Step 1 scoring change. Only 4.7% of orthopedic surgery program directors believe the USMLE Step 1 pass/fail change is a good idea, and 90.7% report they will increase emphasis on Step 2 CK scores.
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