Emergency Medicine Program Directors' Perspectives on Changes to Step 1 Scoring: Does It Help or Hurt Applicants?

West J Emerg Med. 2021 Dec 20;23(1):15-19. doi: 10.5811/westjem.2021.3.50897.


Introduction: The United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency. In February 2020 the USMLE program announced that the numerical Step 1 scoring would be changed to a binary (Pass/Fail) system. In this study we sought to characterize how this change in score reporting will impact the application review process for emergency medicine (EM) program directors (PD).

Methods: In March 2020 we electronically distributed a validated anonymous survey to EM PDs at 236 US EM residency programs accredited by the Accreditation Council for Graduate Medical Education.

Results: Of 236 EM PDs, 121 responded (51.3% response rate). Overall, 72.7% believed binary Step 1 scoring would make the process of objectively comparing applicants more difficult. A minority (19.8%) believed it was a good idea, and 33.1% felt it would improve medical student well-being. The majority (88.4%) reported that they will increase their emphasis on Step 2 Clinical Knowledge (CK) for resident selection, and 85% plan to require Step 2 CK scores at application submission time.

Conclusion: Our study suggests most EM PDs disapprove of the new Step 1 scoring. As more objective data is peeled away from the residency application, EM PDs will be left to rely more heavily on the few remaining measures, including Step 2 CK and standardized letters of evaluation. Further changes are needed to promote equity and improve the overall quality of the application process for students and PDs.

MeSH terms

  • Accreditation
  • Educational Measurement
  • Emergency Medicine*
  • Humans
  • Internship and Residency*
  • Licensure
  • Students, Medical*
  • United States