Association of USMLE Step 1 Pass/Fail Reporting with Interview and Match Outcomes

Abstract

OBJECTIVE

To investigate interview and match outcomes of medical students who received pass/fail USMLE reporting vs medical students with numeric scoring during the same period.

DESIGN

Retrospective analysis of a cross-sectional survey-based study.

SETTING

United States 2023 residency match.

PARTICIPANTS

Medical student applicants in the 2023 residency match cycle who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey.

RESULTS

Among 6756 applicants for the 2023 match, 496 (7.3%) took USMLE Step 1 with pass/fail reporting. Pass/fail reporting was associated with lower USMLE Step 2-CK scores (245.9 vs 250.7), fewer honored clerkships (2.4 vs 3.1), and lower Alpha Omega Alpha membership (12.5% vs 25.2%) (all p < 0.001). Applicants with numeric USMLE Step 1 scores received more interview offers after adjusting for academic performance (beta coefficient 1.04 (95% CI 0.28-1.79); p = 0.007). Numeric USMLE Step 1 scoring was associated with more interview offers in nonsurgical specialties (beta coefficient 1.64 [95% CI 0.74-2.53]; p < 0.001), but not in general surgery (beta coefficient 3.01 [95% CI −0.82 to 6.84]; p = 0.123) or surgical subspecialties (beta coefficient 1.92 [95% CI −0.78 to 4.62]; p = 0.163). Numeric USMLE Step 1 scoring was not associated with match outcome.

CONCLUSIONS

Applicants with numeric USMLE Step 1 scoring had stronger academic profiles than those with pass/fail scoring; however, adjusted analyses found only weak associations with interview or match outcomes. Further research is warranted to assess longitudinal outcomes.