USMLE step 1 transition to pass/fail: perception of medical students and residency program faculty

Abstract

Purpose The transition of USMLE Step1 to pass/fail has brought many questions and uncertainties for medical students and residency programs. This study assesses the perceptions of both students and faculty on this policy change and residency matching. Methods An IRB-approved survey was distributed to our medical students and faculty, who participate in residency interviews and ranking of residency applicants of different specialties; general surgery, orthopedic and plastic surgery, ob-gyn, dermatology, emergency medicine, and psychiatry. The survey included both open- and closed-ended questions. Data were analyzed descriptively and qualitatively. Results A total of 36.2% (181/500) students responded; 68.0% were interested in highly competitive specialties. The response rate for faculty was 40.3% (23/57). A higher number of students (58.6%) were in favor of pass/fail, primary reason being less pressure and stress; 73.9% of faculty were opposed, the primary reason being an inability to stratify applicants. Students believed that Step2 scores (92.5%), clerkship honors (74.4%), and research (77.5%) would be more important for residency applications. While faculty members agreed with clerkship honors (66.6%) and Step 2 scores (60.0%), they included away rotations (53.3%) as one of the factors influencing their ranking list. Students (70.0%) feared that their school’s name/prestige would carry higher weight on interview offers and rank list; only 33.33% of faculty agreed. Faculty suggested students prepare a sincere personal statement, get excellent recommendations, and perform high-quality research to stand out. Conclusions While students and faculty disagreed on favoring pass/fail Step 1, they shared common concerns on resulting stress and difficulties for students interested in highly competitive specialties and/or from less prestigious schools. Both groups stated that Step 2 score and clerkship honors could now play a major role but warranted further clarification on the stratification of the residency selection process.