Plastic Surgery Program Directors' Perspectives on Pass/Fail USMLE Step 1 Scoring
Alan T. Makhoul, B.A.1; Nishant Ganesh Kumar, M.D.2; Matthew E. Pontell, M.D.3; Jeffrey E. Janis, M.D.4; Anna R. Schoenbrunner, M.S., M.D.4; Lawrence O. Lin, M.D.4; Paige N. Hackenberger, M.D.4; Brian C. Drolet, M.D.5
1Vanderbilt University School of Medicine, Nashville, TN, 2Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, 3Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 4Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH, 5Department of Plastic Surgery, Department of Biomedical Informatics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
Background: As early as 2022, results of the USMLE Step 1 will be reported as pass/fail. This scoring change was intended to be the first in series of reforms aimed at reducing overemphasis on USMLE performance in the residency application process. This study assesses the perspectives of plastic surgery residency program directors (PDs) regarding the impact of binary Step 1 scoring
Methods: After institutional review board exemption, the survey instrument was iteratively revised through pre-pilot testing. The instrument was pilot tested, and internal validity was assessed by computation of Cronbach’s alpha (0.87). In March 2020, we invited 103 PDs of integrated (n=80) and independent (n=54) plastic surgery residency programs to participate in an anonymous electronic survey. PDs who direct both program types (n=31) were included only once. Two follow-up email requests were sent to non-respondents
Results: 64 responses were obtained (response rate = 62%), including 40 integrated PDs, 8 independent PDs, and 16 dual-program PDs. Most PDs (81%) do not believe the scoring change is a good idea. A majority (83%) believe the change will make objective comparison of applicants more difficult, and 53% anticipate the importance of an applicant’s medical school will increase. Most (58%) do not believe changing Step 1 will decrease socioeconomic disparities in the application process. 16% expect the change will improve student well-being. Over half (53%) believe there will be more students applying to plastic surgery residency as a result of the change. Most programs (83%) will now require applicants to submit Step 2 Clinical Knowledge (CK) scores with their application, and 88% expect Step 2 CK scores will be of greater importance in the application process. 5% believe Step 2 CK should also be made pass/fail
Conclusion: Most plastic surgery PDs do not support the change to pass/fail Step 1 scoring. As Step 2 CK will retain a numerical score, it will likely replace Step 1 in the plastic surgery residency application process. Additional reforms are needed to improve equity and transparency in the transition from undergraduate medical education to plastic surgery residency.
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