Radiology residents’ medical school prestige could gain an “outsized influence” in their selection process following a forthcoming policy change, according to a new study in JACR.
U.S. Medical Licensing Examination organizers recently announced plans to deemphasize the importance of numerical scores on the Step 1 exam, transitioning to a pass-fail system. Those involved hope to reduce residency programs’ overemphasis on these three-digit scores when selecting candidates, among other reasons.
However, radiologists are concerned this shift will place more weight on residents’ medical school of choice. The licensing exam will still provide a numeric score for the Step 2 examination. And based on a survey of more than 200 radiology residency program leaders, this second score will likely only supplant Step 1 scores as decisionmakers weigh different candidates.
“Our findings suggest that the Step 2 examination could effectively replace the Step 1 as a decisive metric in resident selection, as feared by many program directors,” Charles Maxfield, MD, with Duke University Medical Center’s Department of Radiology, and more than 20 co-authors wrote Aug. 2. “This would undermine the stated intentions of the USMLE scoring change: It would only delay, rather than alleviate, medical student anxiety resulting from a high-stakes examination.”
To reach their conclusions, Maxfield et al. designed a discrete choice experiment, modeling radiology resident selection in various scenarios. They administered the test to 212 faculty involved in resident selection across 14 U.S. radiology departments between August and November of last year. Participants were asked to choose between hypothetical pairs of applicants, with a model used to assess the weights of these different attributes.
When a numerical Step 1 score was provided, medical school (odds ratio of 2.35), Black or Hispanic race or ethnicity (2.04) and Step 1 score (1.8) were the most influential attributes. But when Step 1 was reported as a “pass,” the applicant’s medical school grew in influence (2.78), with a “significant Increase” in the Step 2 score’s significance. Meanwhile, researchers found little change in the relative influence of race or ethnicity, gender, class rank or clerkship honors.
Maxfield and co-authors believe medical students, schools, residency programs and USMLE parent organizations will need to develop strategies in anticipation of this change. Exam co-sponsors the Federation of State Medical Boards and the National Board of Medical Examiners have said the new pass-fail policy will take effect no earlier than Jan. 1, 2022.
“Our intention is not to suggest a program’s approach to resident selection, but rather to inform resident selectors on which parts of a holistic review might tend to gain added influence with the change in available applications metrics,” the authors advised. “All stakeholders must acknowledge the desire for objective measures of academic performance but appreciate the dangers of excessive emphasis on any single metric. Residency programs should devote additional resources to provide thorough, holistic reviews of all applicants, seeking evidence of academic excellence beyond medical school pedigree and Step 2 test scores.”
You can read much more about their findings in the Journal of the American College of Radiology here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.