Expected Impact of the Pass/Fail Scoring System for USMLE Step 1 on the Plastic Surgery Residency Selection Process: A National Survey of Plastics Program Directors

Background: Traditionally, the United States Medical Licensing Examination (USMLE) Step 1 3-digit score has been used as a metric to stratify plastic surgery residency candidates. The transition to a pass/fail exam may impact the manner in which integrated plastic surgery residency program directors (PS-RPD) evaluate candidates. It may also limit opportunities for applicants to differentiate themselves from their counterparts. Methods: A 14-question survey was distributed via email to 76 PS-RPDs collected from the American Medical Association (AMA) residency program site, FRIEDA. It was sent three times from March 3 - March 14, 2020. McNemar tests were performed on the current metrics of evaluation in comparison to metrics expected to be used in the absence of a 3-digit Step 1 score, assuming a P < 0.05 level for statistical significance. Results: Of the 76 integrated plastics programs surveyed, 24 PS-RPDs responded (31.6% response rate); 91.3% of PS-RPDs strongly disagree or disagree that Step 1 should be pass/fail; 78.3% of PS-RPDs strongly disagree or disagree that diversity will increase. The top five evaluation metrics PS-RPDs expect to utilize following the transition to pass/fail are: letters of recommendation (87.0%; CI 72% - 100%; p=0.500), Step 2 score (78.3%; CI 60% - 96%; p=0.001), research (56.5%; CI 35% - 78%; p=0.125), elective rotation (56.5%; CI 35% - 78%; p=1.000), and personal knowledge of the applicant (52.2%; CI 30% - 74%; p=0.500). Conclusions: In the absence of a Step 1 score, PS-RPDs may require more holistic metric(s) to evaluate the best fit for their program. This study found that PS-RPDs expect their candidate evaluation process to remain highly similar with the only statistically significant change being an increased emphasis on the candidate's Step 2 score.