Medical Education Takes a Step in the Right Direction: Where Does That Leave Students?

The Impact of United States Medical Licensing Examination Step 1 Transitioning To Pass/Fail on Medical Student Perception of Research Needed to Match Into One's Preferred Specialty

Purpose To evaluate how the transition of United States Medical Licensing Examination (USMLE) Step 1 to a pass/fail scoring influenced medical student perceptions of the importance of research required to match into their preferred residency specialty. Methods A 14-item survey was distributed by e-mail to medical students at one medical school in the southeastern United States in November of 2021. Responses were compared between medical students taking USMLE Step 1 pass/fail in the future and medical students taking USMLE Step 1 for a three-digit score. Results A total of 168 medical students responded to the survey with 98 respondents who planned on taking USMLE Step 1 pass/fail (45 first-year medical students (MS1) and 53 MS2) and 70 respondents who took USMLE Step 1 for a numerical score (37 MS3 and 33 MS4). There were no differences in how each cohort scored the level of importance of research in matching into their preferred residency specialty (p=0.10); however, those taking USMLE Step 1 pass/fail believe an average of 4.6 research experiences are necessary to match into their preferred residency, compared to only 3.4 research experiences for those who took it for a numerical score (p=0.04). Conclusion No statistically significant difference in the perceived importance of research in matching into one's preferred residency specialty was found between cohorts. However, the pass/fail cohort believes they will need more research experiences to match their chosen specialty than the numerical score cohort. Results could indicate that students participate in more research and extracurricular activities to be more competitive for residency applications.

Improving self-directed learning ability of medical students using the blended teaching method: a quasi-experimental study

BACKGROUND

Self-directed learning (SDL) is one of the most important abilities for medical students in terms of their future clinical medical practice. During the blended teaching process, teachers can design a variety of learning activities to cultivate students' SDL abilities. This study aimed to assess the differences between the SDL abilities of medical students using blended and traditional didactic teaching.

METHODS

This study included 239 medical students from eight administrative classes. The students were divided into two groups: (1) the experimental group (EG), which included 119 students from four administrative classes, and (2) the control group (CG), which included 120 students from the remaining four classes. From February to July 2022, blended teaching methods were applied to the EG group, and SDL abilities were assessed in comparison to the CG group receiving traditional didactic teaching methods.

RESULTS

At the end of the semester, significant differences (p < 0.05) were observed between EG and CG in all six SDL ability factors. Furthermore, when k-means cluster analysis was used to analyze the learning behavior of students in the EG after classifying them as comprehensive, interactive, and passive types, significant differences were observed in all six Self-directed learning factors of students with the comprehensive type, whereas significant differences were observed in four factors (setting learning goals and plans, self-monitoring and regulation, information processing, and communication and cooperation) of students with the interactive type. For students with passive type, only one factor of SDL (information processing) showed significant improvement. There were on differences between comprehensive, interactive, and passive types of CG.

CONCLUSION

The blended teaching approach is better than the conventional didactic teaching for cultivating clinical medical students' SDL abilities.

Does Masked Interviewing Encourage Holistic Review in Residency Selection? A Mixed-Methods Study

Problem: Medical educators increasingly champion holistic review. However, in U.S. residency selection, holistic review has been difficult to implement, hindered by a reliance on standardized academic criteria such as board scores. Masking faculty interviewers to applicants' academic files is a potential means of promoting holistic residency selection by increasing the interview's ability to make a discrete contribution to evaluation. However, little research has directly analyzed the effects of masking on how residency selection committees evaluate applicants. This mixed-methods study examined how masking interviews altered residency selection in an anesthesiology program at a large U.S. academic medical center. Intervention: During the 2019-2020 residency selection season in the University of Pennsylvania's Department of Anesthesiology & Critical Care, we masked interviewers to the major academic components of candidates' application files (board scores, transcripts, letters) on approximately half of interview days. The intent of the masking intervention was to mitigate the tendency of interviewers to form predispositions about candidates based on standardized academic criteria and thereby allow the interview to make a more independent contribution to candidate evaluation. Context: Our examination of the masking intervention used a concurrent, partially mixed, equal-status mixed-methods design guided by a pragmatist approach. We audio-recorded selection committee meetings and qualitatively analyzed them to explore how masking affected the process of candidate evaluation. We also collected independent candidate ratings from interviewers and consensus committee ratings and statistically compared ratings of candidates interviewed on masked days to ratings from conventional days. Impact: In conventional committee meetings, interviewers focused on how to reconcile academic metrics and interviews, and their evaluations of interviews were framed according to predispositions about candidates formed through perusal of application files. In masked meetings, members instead spent considerable effort evaluating candidates' "fit" and whether they came off as tactful. Masked interviewers gave halting opinions of candidates and sometimes pushed for committee leaders to reveal academic information, leading to masking breaches. Higher USMLE Step 1 score and higher medical school ranking were statistically associated with more favorable consensus rating. We found no significant differences in rating outcomes between masked and conventional interview days. Lessons learned: Elimination of academic metrics during the residency interview phase does not straightforwardly promote holistic review. While critical reflection among medical educators about the fairness and utility of such metrics has been productive, research and intervention should focus on the more proximate topic of how programs apply academic and other criteria to evaluate applicants.

USMLE Step 1 Pass/Fail is Here: Are Plastic Surgery Applicants Really Better Off?

OBJECTIVE

As of January 26, 2022, the United States Medical Licensing Examination(USMLE) Step 1 score reporting will be changed from a numeric scoring system to pass/fail. Although the new scoring policy is expected to benefit medical students, there is concern that it will also amplify preexisting disadvantages and worsen disparities for students applying in the already-competitive plastic surgery match. Whether the reporting change will tangibly benefit applicants to plastic surgery has yet to be elucidated.

DESIGN

A cross-sectional survey was distributed to medical students and graduates via social media platforms. Data were analyzed using Student t test and Chi-squared statistic, with an alpha level set at 0.05.

SETTING

Data collection and analysis was performed at Johns Hopkins University School of Medicine.

PARTICIPANTS

This study included a sample of 120 American Medical Trainees (AMTs) and International Medical Trainees (IMTs) who are interested in plastic surgery.

RESULTS

The plurality of respondents were against the new Step 1 score reporting (AMT: 40.7%; IMT: 44.3%), but differences existed between AMTs when compared to IMTs, especially regarding opinions about the reporting change on stress levels and competitiveness of highly competitive specialties. Regardless of training status, respondents felt that the pass/fail scoring system would increase their likelihood to engage with more research, dual apply, prioritize studying for Step 2 CK, and consider a dedicated research year.

CONCLUSIONS

While a pass/fail reporting system for Step 1 may alleviate some stress for medical trainees, other issues arise that may perpetuate disparities and bias against students with little resources in the field of plastic surgery. Residency programs should offer anticipatory guidance regarding prioritization of aspects of application to ease this psychosocial and financial pressure, as well as help students reorganize their constrained time.

The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators

The United States Medical Licensing Examination (USMLE) Step 1, arguably the most significant assessment in the USMLE examination series, changed from a 3-digit score to a pass/fail outcome in January 2022. Given the rapidly evolving body of literature on this subject, this paper aims to provide a comprehensive review of the historical context and impact of this change on various stakeholders involved in residency selection. For this, relevant keyword-based searches were performed in PubMed, Google Scholar, and Scopus to identify relevant literature. Given the unique history of USMLE Step 1 in the US residency selection process and the score's correlation with future performance in board-certifying examinations in different specialties, this scoring change is predicted to significantly impact US Doctor of Medicine students, US Doctor of Osteopathic Medicine students, international medical graduates, and residency program directors, among others. The significance and the rationale of the pass/fail change along with the implications for both residency applicants and educators are also summarized in this paper. Although medical programs, academic institutions, and residency organizing bodies across the United States have swiftly stepped up to ensure a seamless transition and have attempted to ensure equity for all, the conversion process carries considerable uncertainty for residency applicants. For educators, the increasing number of applications conflicts with holistic application screening, leading to the expected greater use of objective measures, with USMLE Step 2 Clinical Knowledge likely becoming the preferred screening tool in lieu of Step 1.

Impact of Satisfactory/Unsatisfactory Grading on Student Motivation to Learn, Academic Performance, and Well-Being

Satisfactory/unsatisfactory (S/U) grading is often proposed to ameliorate stress by reducing the competitive nature of letter grading. Though explored considerably in human medical programs, minimal literature focuses on the veterinary school setting. The purpose of this study was to evaluate the impact of S/U grading on veterinary students' motivation to learn, academic performance, and well-being. Cornell University's COVID-19 pandemic response provided a unique opportunity to compare S/U and letter grading on the same population of students during a single pre-clinical foundation course, with the first half being graded S/U (spring semester 2020), returning to letter grades in the second half (fall semester 2020). Students were retroactively surveyed on the effect of S/U vs. letter grading on their overall educational experience and well-being, with 67.8% class participation. The majority of respondents (71.3%) stated that S/U grading had a positive impact on their overall learning experience. More than half (53.8%) perceived that they learned the same amount of information and had the same level of motivation (58.8%), even though most (61.3%) stated that they spent less time preparing for S/U assessments than letter grade assessments. Positive impact factor effects for S/U grading included decreased stress, more time for self-care, improved learning, and increased learning enjoyment. S/U grading did not negatively impact academic performance. In conclusion, this study demonstrates that, in our particular study population and setting, S/U grading conferred well-being and learning experience advantages to students without any reduction in motivation for learning or academic performance.

Relative Importance of Applicant Characteristics in Ophthalmology Residency Interview Selection: A Survey of Program Directors

Introduction Ophthalmology residency positions remain competitive. A lack of clarity regarding which residency selection criteria are prioritized by program directors can heighten the stress associated with the match process. While surveys of program directors in several other medical specialties have been conducted to identify the most important residency selection criteria, there is limited data on selection criteria used by ophthalmology residency program directors. The purpose of our study was to survey ophthalmology residency program directors to identify the current state of interview selection decisions—the factors currently considered most important in determining whether to extend an interview invitation to residency applicants.

Methods We developed and distributed a Web-based questionnaire to all U.S. ophthalmology residency program directors. Questions evaluated program demographics and the relative importance of 23 different selection criteria used by ophthalmology residency program directors when evaluating applicants for residency interviews (Likert scale 1–5, with 1 being “not important” and 5 being “very important”). Program directors were also asked to identify the one factor they felt was most important.

Results The overall residency program director response rate was 56.5% (70/124). The selection criteria with the highest average importance scores were core clinical clerkship grades (4.26/5) followed by letters of recommendation (4.06/5), and United States Medical Licensing Examination (USMLE) Step 1 score (4.03/5). The most frequently cited single most important factor for interview selection was core clinical clerkship grades (18/70, 25.7%), with USMLE Step 1 score (9/70, 12.9%) and rotations at the program director's department (6/70, 8.6%) also commonly reported.

Conclusion Our results suggest that core clinical clerkship grades, letters of recommendation, and USMLE Step 1 scores are deemed the most important selection criteria by ophthalmology residency program directors as of a 2021 survey. With changes in clerkship grading for many medical schools and changes in national USMLE Step 1 score reporting, programs will face challenges in evaluating applicants and the relative importance of other selection criteria will likely increase.

Perceptions of the Universal Interview Offer Day in the Orthopaedic Surgery Residency Interview Process

INTRODUCTION

The American Orthopaedic Association's Council of Orthopaedic Residency Directors recommended implementing a universal offer day (UOD) in the 2020 residency match. Although this decision was an attempt to benefit applicants, it is important to assess how this endeavor was perceived.

METHODS

Questionnaires for applicants and program directors asked about the perception of the UOD and the experience with it. Responses were included from 383 applicants (43% response rate) and 84 program directors (45% response rate).

RESULTS

Applicant Survey: Most of the students (81.5%) were worried or very worried about the interview offer process. Most of the applicants (64.0%) stated that the UOD decreased their stress. The majority (93.2%) indicated that they would like to see the UOD continue in future years. Program Director Survey: Most of the program directors (83.1%) mentioned that they would like to see the UOD continued, and 86.8% indicated that they would participate in a similar process if implemented in future cycles.

DISCUSSION

Benefits of a standardized interview offer date include decreased stress and fewer clinical interruptions. Advantages can also extend to scheduling conflicts and over-interviewing. These favorable results, along with positive experiences from other specialties implementing a UOD, encourage the continued use of this approach for offering interviews.

DATA AVAILABILITY

N/A.

TRIAL REGISTRATION NUMBERS

N/A.

Evaluation of Predictors for Successful Residency Match in General Surgery

OBJECTIVE

To determine predictive factors for a successful residency match among general surgery applicants from 2018 to 2021.

DESIGN

A retrospective cross-sectional study of general surgery applicants who matched and went unmatched in match years 2018 to 2021. Applicant characteristics, geographic connections to a program, and away rotations were compared among matched and unmatched applicants.

SETTING

Data were sourced from the Texas Seeking Transparency in Applications to Residency initiative for general surgery applicants.

PARTICIPANTS

All fourth-year medical students applying in the 2018 to 2021 cycles at participating U.S. medical schools were eligible to respond to the Texas Seeking Transparency in Applications to Residency survey. This study included a total of 1,425 general surgery applicants.

RESULTS

Of 1,425 general surgery applicants, 88% matched and 12% went unmatched. Significant predictors for a successful match included Step 1 Score ≥237 (odds ratio (OR) 1.59 [95% CI 1.15-2.19]; p = 0.005); Step 2 CK Score ≥252 (OR 1.88 [95% CI 1.36-2.60]; p < 0.001); ≥3 Honored Clerkships (OR 1.84 [95% CI 1.33-2.53]; p < 0.001); Honors in General Surgery Clerkship (OR 1.73 [95% CI 1.33-2.53]; p = 0.001); AOA membership (OR 2.14 [95% CI 1.34-3.42]; p = 0.001); ≥4 abstracts, posters, or publications (OR 1.66 [95% CI 1.20-2.30]; p=0.002); and ≥1 peer-reviewed publications (OR 1.52 [95% CI 1.09-2.12]; p = 0.014). On average, matched applicants completed more away rotations than unmatched applicants (p = 0.004). Overall, 36% of matched applicants reported a geographic connection to the program where they matched.

CONCLUSIONS

We found that Step 2 CK score, research productivity, honored clerkships, AOA status, and away rotations are significant predictors for successfully matching into general surgery residency. Medical schools can encourage students to prepare a holistic application incorporating variables quantified in this study in preparation for the Step 1 reporting change.

The US Medical Licensing Examination Step 1 Scoring Change: A Survey of Orthopaedic Surgery Residency Applicants From the 2019 to 2020 Match Cycle

INTRODUCTION

The USMLE Step 1 examination has been used as an objective measure for comparing residency applicants. Recently, the National Board of Medical Examiners and the Federation of State Medical Boards decided that the USMLE Step 1 examination will transition to a pass/fail result starting no earlier than 2022. The purpose of this study was to investigate the perspective of medical students who applied for orthopaedic surgery residency positions during the 2019 to 2020 interview cycle on the USMLE scoring change, and the potential effect this change may result in for future applicants and the residency selection process.

METHODS

A 15-item anonymous web-based survey was sent to 1,090 orthopaedic surgery residency applicants from four regionally diverse residency programs. The survey elicited attitudes toward the transition of the Step 1 examination to pass/fail and perspectives this change may or may not have on the residency selection process.

RESULTS

Responses were received from 356 applicants (32.7%). The majority (61.6%) disagreed with the change to pass/fail scoring, and 68.5% do not believe that the change will decrease stress levels in medical students. For interview invitations, respondents chose Step 2 clinical knowledge, letters of recommendation, and performance on away rotations as the most influential factors in the absence of a Step 1 score.

CONCLUSION

Most of the students surveyed who applied for an orthopaedic surgery residency position during the most recent application cycle disagreed with the National Board of Medical Examiner/Federation of State Medical Board decision to change Step 1 to pass/fail and feel that this change may have disadvantage in certain student groups while either increasing or having no effect on medical student stress.

LEVEL OF EVIDENCE

IV.

US Medical Student Perspectives on the Impact of a Pass/Fail USMLE Step 1

OBJECTIVE

The purpose of this study is to (1) gather US medical student attitudes regarding pass or fail score reporting of the USMLE Step 1 exam and (2) investigate the impact of this new policy on specialty interest and redistribution of efforts to enhance individual competitiveness.

DESIGN

This is a cross-sectional analysis of US medical students surveyed from July to October 2020. Surveys were administered on social media and via medical school email list serv. Data were analyzed using Student t test and Chi-squared statistic, alpha = 0.01.

SETTING

Data analysis was conducted at Johns Hopkins University in Baltimore, Maryland.

PARTICIPANTS

This study included a sample of 852 students enrolled in US medical schools.

RESULTS

The plurality of students (39.0%) was in favor of the new policy; 30.9% of students were opposed. Students interested in highly competitive specialties (HCS) and students who scored 240 or higher on Step 1 ("high scorers") were more likely to oppose the policy compared with HCS-disinterested students and students who scored below 240 ("sub-240 scorers"). If students were to hypothetically take Step 1 with pass or fail scoring, most students report that they would dedicate less time studying than they had for the numerical exam (72.7%) and more time preparing for Step 2 CK (70.5%) and conducting research in HCS (59.6%). Sub-240 scorers would be more likely to apply to a more competitive specialty (44.4%). Nearly half of HCS-interested post-Step 1 students would be more likely to dual apply (48.7%), the majority of which were also high scorers (89.5%).

CONCLUSIONS

Students expressed polarized opinions regarding pass or fail Step 1 score reporting. Time spent studying for Step 1 may be displaced toward Step 2 CK and research. Residency programs in both HCS and non-HCS can expect an increase in applicant pool size and diversity.

What Does Honors Mean? National Analysis of Medical School Clinical Clerkship Grading

OBJECTIVE

Medical Student Performance Evaluation (MSPE) letters provide critical comparative information about clerkship performance, and are a crucial part of the surgical residency application. The elimination of USMLE Step 1 numeric reporting increases the importance of transparency, standardization, and accessibility of comparative information reported on the MSPE. The objective of our study was to measure the variability in clerkship grade reporting on the MSPE from US medical schools, particularly focusing on the highest (honors) grades.

DESIGN, SETTING, AND PARTICIPANTS

We identified representative MSPE letters from US medical schools and recorded the percentage of honors for 5 core clerkships. We grouped medical schools according to medical school rankings, geographic region, and number of grading categories RESULTS: Of 122 medical schools, 106 schools (87%) reported their grading scheme and percent honors. The most commonly used grading scheme was a 4-tier system (51/122; 42%). The percentage of honors was highly variable (from 1-91%) and did not vary by region. However, schools in the top 20 research ranking were less likely to report grade comparisons (30% vs. 10%), and more likely to award more students honors in 4 of the 5 clerkships. Schools in the top 20 primary care ranking were more likely to award more honors in the medicine clerkship.

CONCLUSIONS

There is significant variability in the number of grading tiers used and the percentage of students awarded honors across US medical schools. Factors that correlated to higher grades included schools with higher rankings, and higher ranked schools were less likely to report comparative information at all.

Health Advocacy and Training Perceptions: a Comparison of Medical Student Opinions

BACKGROUND

The American Medical Association considers health advocacy to be a core aspect of a physician's responsibility, which has sparked medical schools to institutionalize training. However, there is little information regarding student perspectives on advocacy education.

PURPOSE

To evaluate medical student opinions on advocacy education and to determine similarities and differences across classes.

METHODS

In this qualitative study, four focus groups were conducted with five to eight students from each medical school class. Students were randomly selected from rosters and received an email to participate. Sessions were audiotaped and transcribed, and demographic data was obtained. Investigators reviewed transcripts independently and identified important items in each transcript then consolidated common themes into groups. These themes were integrated into concept map representations.

RESULTS

Of those contacted, 25 (16%) students chose to participate in focus group sessions. All participants who responded to questionnaires (n = 24) identified advocacy in medicine as very important. Definitions of advocacy varied among students and classes. Common themes in all focus groups included feeling overwhelmed by advocacy due to lack of time, lack of perceived prioritization in medical education, feelings of imposter syndrome, and inability to align individual views with healthcare systems. Another common theme was frustration that students learned of advocacy through didactic sessions rather than engagement in advocacy work.

CONCLUSIONS

All participating students identified advocacy as an important aspect of medicine, yet students felt inadequately prepared to participate in advocacy work. This reveals an opportunity to improve upon the formal education needed to engage in advocacy.

General Surgery Residency Application Evaluation in a USMLE Step 1 Pass/Fail World: A Retrospective Comparison

Introduction The United States Medical Licensure Exam (USMLE) Step 1 has been used as both a licensing exam and a way for residency programs to evaluate applicants. It has had significant impact upon the match process over time. With the 2020 decision to make the exam pass/fail due to its unclear validity as an evaluation for future physician performance, programs will go through the match without the Step 1 score. We set out to better understand the effects of the exam score on our selection process, with the hypothesis that without the step 1 score, the ranking of our applicants would be significantly altered. Methods We performed a retrospective analysis of applications to a single General Surgery residency program with 4 categorial residents per year at a physician led, academic, tertiary care medical center from 2017-2020. Important applicant factors including USMLE Step 1 and 2, AOA status, science grades, clerkship scores, audition rotations, volunteer activities, research activities, letters of recommendation, and personal statements were given points and evaluated through our equation, the sum of which was used to create a rank list and offer interviews. The standard deviation of scores was calculated with and without Step 1, and the distribution of scores compared. The range and average of applicants' change in point scores were examined. Results The applications of 653 students were reviewed. After removal of USMLE step 1 points, 40% of all applicants decreased in rank, 35% remained the same, and 24% increased. Specifically, 18.8% of the top third dropped to the middle third, and 11.7% of the bottom third jumped to the middle third, while the middle third changed little (0.2% dropped and 0.9% jumped out of middle third). The points given for USMLE step 1 created a wider distribution of scores with a negative skewness, suggesting there were more applicants below the mean than above. After removing those points, applicants' scores had a narrower distribution and skewness closer to 0, showing fewer upper outliers and more applicants near the mean. Conclusions The USMLE Step 1 score significantly affected the evaluation of applicants, and the removal of it from the recruitment criteria tightened applicant rankings. The elimination of the USMLE Step 1 score in the assessment of applicants will allow for its replacement with variables that better reflect the core values of residency programs.

Plastic Surgery Subinternships: Current Perspectives and Future Considerations

Subinternships are an important feature of the integrated plastic and reconstructive surgery residency application process. In our experience, there exists institutional heterogeneity in how subinterns are evaluated, how they are given feedback, and how their performance is compared across institutions. In this report, we conducted standardized interviews with 9 past and present integrated plastic and reconstructive surgery residency program directors, eliciting their expert opinions on current limitations of subinternships as a method of medical student education and evaluation. There near-unanimous agreement that subinternships were an important tool for evaluating the intangible traits of subinterns, with emphasis on teamwork, work ethic, and preparation for cases. However, our respondents suggested that subinterns lack direct feedback about real-time subinternship performance, and that there is a lack of transparency to subinterns regarding the quality of letters of recommendation. In the current system of subinternship evaluation, the letter-writer's reputation possibly overshadows the subintern's actual performance, which can be unfair to the student. We encourage the academic plastic and reconstructive surgery community to work toward more consistent and equitable evaluation of subinterns to the benefit of both residency applicants and programs.

Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey

Phenomenon: Because of its importance in residency selection, the United States Medical Licensing Examination Step 1 occupies a critical position in medical education, stimulating national debate about appropriate score use, equitable selection criteria, and the goals of undergraduate medical education. Yet, student perspectives on these issues and their implications for engagement with health systems science-related curricular content are relatively underexplored. Approach: We conducted an online survey of medical students at 19 American allopathic medical schools from March-July, 2019. Survey items were designed to elicit student opinions on the Step 1 examination and the impact of the examination on their engagement with new, non-test curricular content related to health systems science. Findings: A total of 2856 students participated in the survey, representing 23.5% of those invited. While 87% of students agreed that doing well on the Step 1 exam was their top priority, 56% disagreed that studying for Step 1 had a positive impact on engagement in the medical school curriculum. Eighty-two percent of students disagreed that Step 1 scores should be the top item residency programs use to offer interviews. When asked whether Step 1 results should be reported pass/fail with no numeric score, 55% of students agreed, while 33% disagreed. The majority of medical students agreed that health systems science topics were important but disagreed that studying for Step 1 helped learn this content. Students reported being more motivated to study a topic if it was on the exam, part of a course grade, prioritized by residency program directors, or if it would make them a better physician in the future. Insights: These results confirm the primacy of the United States Medical Licensing Examination Step 1 exam in preclinical medical education and demonstrate the need to balance the objectives of medical licensure and residency selection with the goals of the broader medical profession. The survey responses suggest several potential solutions to increase student engagement in health systems science curricula which may be especially important after Step 1 examination results are reported as pass/fail.

Perspectives on Transitioning Step 1 of the United States Medical Licensing Examination to a Pass/Fail Scoring Model: Defining New Frameworks for Medical Students Applying for Residency

For years, the USMLE Step 1 has acted as an unofficial "concours" for medical students applying to residency positions in the United States. The three-digit numeric score has been used to rank thousands of applicants without any evidence of validity. The USMLE will soon change score reporting to a pass/fail outcome. The main reason given was to address the concerns about its effects on the well-being of the students and medical education. It is argued that time for change has come. The authors discuss the various viewpoints of the stakeholders and the effects of this change on applicants and potential changes on the undergraduate medical curriculum. Furthermore, this article discusses several metrics that can be utilized in the application process in lieu of the USMLE Step 1. Additionally, some novel key metrics in the application process are identified, and their unique dynamic and adaptive characteristics are deliberated. Finally, the benefits of a transparent and holistic process are strongly advocated.

Reporting of Research by Matched Otolaryngology Residency Applicants

OBJECTIVES

Matching to an otolaryngology residency program is a competitive process for medical students, and research performed by students is considered as a factor for granting interviews by program directors. Because abstracts, presentations and publications are all reported in combination by the National Resident Matching Program's "Charting Outcomes in the Match" (ChOM) and may be weighted differently by PDs, we specifically investigated the number of publications by past applicants accepted to top otolaryngology residency programs.

METHODS

The top 25 otolaryngology residency programs were identified using Doximity, sorting by reputation. Current residents were determined from the programs' websites. Using PubMed, each resident's number of publications, authorship status, and journal type were recorded.

RESULTS

A total of 24 programs were included in the final analysis and the average number of manuscripts was 2.76 ± 4.01. The mean number of publications in otolaryngology journals was 1.03 ± 1.91.

CONCLUSIONS

The difference between the investigated average number of publications (2.76) and those published by ChOM (10.4) represent a discrepancy due to the lack of delineation between abstracts, presentations and publications. The reported numbers for research may lead medical students to pursue alternate measures to increase their own research. Some options, such as adding a research year are not universally accessible. A clearer and more detailed approach to reporting research statistics would be beneficial to both applicants and PDs for otolaryngology programs.