Racial Bias in Using USMLE Step 1 Scores to Grant Internal Medicine Residency Interviews

PURPOSE: To determine whether the United States Medical Licensing Examination (USMLE) Step 1 score, commonly used in screening residency applicants for interviews, eliminates a greater proportion of African-American applicants from the interview process at an internal medicine residency program. METHOD: A survey of internal medicine residency programs was performed to determine the prevalence of using USMLE Step 1 scores to grant interviews. A cohort of applicants was analyzed by constructing a database of USMLE Step 1 scores from the Electronic Residency Application Service (ERAS) database of applications from U.S., Canadian, and osteopathic medical schools to one residency program in 2000. Each applicant was classified as African American or non-African American. Rejection rates were then calculated for each five-point increment from a hypothetical threshold rejection score of <180 to <215. RESULTS: Responses were received from 259 residency programs (69%), and 92% used the USMLE Step 1 score in deciding which applicants to interview. A cohort of 626 non-African-American and 47 African-American applicants was analyzed. The proportion of applicants below each incremental threshold score was significantly higher for African-American applicants (p <.05 at each level). Depending on the threshold score used, an African-American applicant was three to six times less likely to be offered an interview. CONCLUSIONS: When USMLE Step 1 scores are used to screen applicants for a residency interview, a significantly greater proportion of African-American students will be refused an interview.