A Survey of Otolaryngology Residency Programs on Adapting to the United States Medical Licensing Examination (USMLE) Step 1 Transitioning to Pass/Fail

Lydia C Yang; Andrew Bonner; Om U Patel; William Haynes; Kaitlin Burge; Ishant Yadav; Nicholas J Van Wagoner; Benjamin J Greene; Jessica W Grayson

doi:10.7759/cureus.45227

A Survey of Otolaryngology Residency Programs on Adapting to the United States Medical Licensing Examination (USMLE) Step 1 Transitioning to Pass/Fail

Cureus. 2023 Sep 14;15(9):e45227. doi: 10.7759/cureus.45227. eCollection 2023 Sep.

Authors

Lydia C Yang¹, Andrew Bonner¹, Om U Patel¹, William Haynes¹, Kaitlin Burge¹, Ishant Yadav¹, Nicholas J Van Wagoner², Benjamin J Greene¹, Jessica W Grayson¹

Affiliations

¹ Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA.
² Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA.

Abstract

Objectives In February 2020, the National Board of Medical Examiners (NBME) announced that the United States Medical Licensing Examination (USMLE) Step 1 licensing examination would change from a numerical score to Pass/Fail (P/F). After implementation, many believe that USMLE-Step 2-Clinical Knowledge (CK) will become an important metric for students applying to otolaryngology (ENT). The purpose of this study is to determine factors important to resident selection after these changes. Methods A survey containing 15 questions related to resident selection practices and how changing USMLE Step 1 to P/F would impact future resident selection was designed. It was distributed to all ENT residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Results Forty percent of programs responded; 66% (95% confidence interval (CI): 51.1%-78.4%) felt that changing Step 1 scoring would not lead to students being more prepared for clinical rotations; 55% believe class rank will increase in significance (95% CI: 35.7%-64.3%). There was also an increase in the importance of Step 2 CK, which had a mean ranking of 10.67 prior to changes in Step 1 scoring and increased to 7.80 after P/F. Conclusions The changes in Step 1 scoring will likely lead to increasing importance of other objective measures like class rank or Step 2 CK. This may defeat the intended purpose put forth by the NBME. Therefore, further guidance on measures correlated with student performance as a resident will be integral to the selection process.

Keywords: clinical knowledge; medical student exams; otolaryngology residency; pass/fail usmle step 1; step 1 change; united states medical licensing examination (usmle); usmle step 2 ck.