Matching Into Integrated Plastic Surgery: The Impact of USMLE Step 1 Transition to Pass/Fail: Did the 2019 Predictions Come True in 2024?

Background: The first class of integrated plastic surgery residency applicants with pass/fail (P/F) step 1 assessments occurred during the 2023-2024 Match cycle. This study analyzes the results of a 2024 postmatch survey to program directors (PDs) regarding the impact of the conversion to P/F step 1 scoring and compares the results to the 2019 survey that attempted to predict how this conversion would influence decision-making when it was initially announced. Methods: A 26-item survey evaluating PDs' perspectives on applicant characteristics and the application process following P/F step 1 scoring was distributed March 2024. Data were analyzed using summary tables, marginal homogeneity tests, and Mann-Whitney U tests. Results: Thirty-seven plastic surgery PDs completed the survey (response rate = 46.3%). The top 3 most important metrics for determining applicant interview invitations after step 1 P/F conversion were participation in an away rotation, letters of recommendation, and involvement in research, while ultimately match rank list order emphasized quality of the applicant's interview. A total of 68.1% of PDs agree that it was more difficult to differentiate applicants without a numerical step 1 score. A total of 51.5% of PDs reported using step 2 clinical knowledge scores to screen applicants. PDs' opinions on factors influencing the 2023-2024 Match cycle did not significantly change from predictions studied in 2019. Conclusions: Program directors felt that in the 2023-2024 cycle, it was more difficult to differentiate between applicants, leading to increased emphasis on other characteristics such as away rotations, letters of recommendation, step 2 clinical knowledge scores, and research. There was no difference from what was predicted.