Background: Starting no earlier than January 2022, Step 1 of the United States Medical Licensing Examination (USMLE) will change from a three-digit numeric score to reporting a pass/fail outcome. With the absence of a scored Step 1, internal medicine residency programs will need to utilize another method to screen applicants for an interview. The purpose of this study was to investigate internal medicine residency program directors’ perceptions on the change of Step 1 from a graded to a pass/fail exam.
Methods: We obtained publicly available contact information for program directors at all active internal medicine residency programs through the American Medical Association’s Fellowship and Residency Electronic Interactive Database. Using the 2018 National Resident Matching Program Director survey, a modified, 27-item, validated survey was distributed through REDCap to 548 U.S. internal medicine residency program directors in the United States. All program directors with valid email addresses were included. This study was exempted by the College of Medicine’s Institutional Review Board.
Results: 123 (22.45%) program directors responded to the survey. A majority do not support the pass/fail change (73.99%), and feel that the transition to pass/fail did not involve all stakeholders (78.87%). Most believe that a greater importance will now be placed on Step 2 Clinical Knowledge (CK) exam results (87.81%), personal knowledge of the applicant (66.67%), grades in required clerkships (66.67%), audition elective/rotation with their own department (64.22%), letters of recommendation from medicine faculty that they recognize/know (56.10%), Medical Student Performance Evaluation/Dean’s Letter (52.03%), and graduation from a highly-regarded U.S. medical school (51.22%). While most believe that allopathic students attending highly-regarded schools will be advantaged (55.28%), a majority also believe that international medical graduates (82.93%), allopathic students who do not attend a highly-regarded medical school (63.42%), and osteopathic students (52.03%) will be disadvantaged. Due to the pass/fail transition, more than half of program directors (51.22%) believe that schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a medical student can submit (54.47%). Most (56.91%) believe medical students will adapt to the pass/fail transition by applying to more residency programs.
Conclusions: Internal medicine program directors mostly disagree with the pass/fail Step 1 transition. Residency programs will need to reevaluate how applicants are evaluated once the scored Step 1 is no longer available. Other factors, such as Step 2 CK score, personal knowledge of the applicant, grades in clerkships, and audition rotations will now be emphasized more heavily.
