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EM Program Directors “Pass” on Binary Step 1 Scoring System

February 1, 2022

Written by Rebecca White

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Most emergency medicine residency program directors disapprove of the change in USMLE Step 1 scoring process to a binary system. Respondents will rely more heavily on Step 2 score and letters of evaluation, which may perpetuate disparities within the application process.

Why does this matter?
In the residency application process, there are few data points available to compare applicants objectively. United States Medical Licensing Examination (USMLE) Step 1 was one of those standardized metrics that is now scored in a binary (pass/fail) manner starting January 26, 2022. How will this change impact the application review process for emergency medicine (EM) program directors (PDs)?

An Epic Fail?
In this study, a validated electronic survey was distributed to EM PDs at 236 accredited programs. A total of 121 PDs responded (51.3%), and 72.7% of respondents believed binary Step 1 scoring would increase difficulty of objectively comparing applicants. About one-third (33.1%) felt it would benefit medical student well-being, and 19.8% were in favor of the change overall. The majority (88.4%) noted that their attention to Step 2 Clinical Knowledge (CK) score would increase, and 85% plan to require CK score with application submission. Only 14.9% believed the change would combat socioeconomic disparities amongst applicants.

This study is limited by sampling bias, though results are thought-provoking. Given the predicted increased emphasis on Step 2 score and letters of evaluation, a more holistic application review is not likely. Further modifications should be considered to ultimately promote equity and quality within the application process.

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.

Reviewed by Clay Smith

What are your thoughts?