Research Article|Articles in Press

Impacts of USMLE Step 1 Scoring Change on EM Applicant Screening



      The United States Medical Licensing Examination (USMLE) Step 1 has been used as a screening tool for residency selection. In February 2020, Step 1 numerical scoring changed to pass/fail.


      To survey emergency medicine (EM) residency program attitudes towards the new Step 1 scoring change and to identify important applicant screening factors.


      A 16-question survey was distributed through the Council of Residency Directors in Emergency Medicine (CORD) Listserv from November 11- December 31, 2020. Given the Step 1 scoring change, the survey questioned the importance of EM rotation grades, composite standardized letters of evaluation (cSLOE), and individual standardized letters of evaluation (iSLOE), using a Likert scale. Descriptive statistics of demographics and selection factors were performed along with a regression analysis.


      Of the 107 respondents, 48% program directors, 28% assistant/associate program directors, 14% clerkship directors, and 10% other role. Sixty (55.6%) disagreed with pass/fail Step 1 scoring change and of those, 82% believed that numerical scoring was a good screening tool. The cSLOE, EM rotation grades, and interview were the most important selection factors. Residencies with ≥50 residents had 5.25 odds (95% CI 1.25, 22.1; p=0.0018) and those who ranked cSLOE as the most important selection factor had 4.90 odds (95% CI 1.125, 21.37; p=0.0343) of agreeing with pass/fail scoring.


      Most EM programs disagree with pass/fail scoring of Step 1 and will most likely use Step 2 score as a screening tool. The cSLOE, EM rotation grades, and the interview are the most important factors, respectively.


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