Potential Impact of a Pass or Fail United States Medical Licensing Exam Step 1 Scoring System on Radiology Residency Applications

Acad Radiol. 2020 Nov 5;S1076-6332(20)30603-6. doi: 10.1016/j.acra.2020.10.016. Online ahead of print.


Rationale and objectives: To assess the anticipated impact of the change in United States Medical Licensing Examination Step 1 scoring from numerical to pass or fail on the future selection of radiology residents.

Materials and methods: An anonymous electronic 14-item survey was distributed to 308 members of the Association of Program Directors in Radiology and included questions regarding the anticipated importance of various application metrics when Step 1 becomes pass or fail. Secondary analyses compared responses based on the current use of a Step 1 scoring screen.

Results: Eighty eight respondents (28.6% [88/308]) completed the survey. Most (64% [56/88]) noted that the United States Medical Licensing Examination Step 2 Clinical Knowledge (CK) score will likely be one of the top three most important factors in assessing applicants, followed by class ranking or quartile (51% [45/88]) and the Medical Student Performance Evaluation/Dean's Letter (42% [37/88]). Over 90% (82/88) of respondents anticipate potentially or definitively requiring Step 2 CK scores before application review, and 50% (44/88) of respondents anticipate extending interview invites at a later date to receive Step 2 CK scores. These results did not significantly differ between programs who currently use a Step 1 scoring screen and those who do not.

Conclusion: As Step 1 transitions from a numerical score to pass or fail, radiology residency program directors will likely rely on Step 2 CK scores as an objective and standardized metric to screen applicants. Further investigation is needed to identify other objective metrics to evaluate applicants before Step 1 becomes pass or fail.

Keywords: Residency selection; USMLE Step 1.