The USMLE Step 1 Transitions to Pass/Fail Scoring: Perceptions of Dermatology Residents

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Mara Trifoi
Lauren Claire Hollins


USMLE, Step 1, pass/fail, dermatology residency


Background: The USMLE Step 1 exam has been a critical objective tool for residency applications, and given the recent score change to a binary pass/fail system it is essential for programs and future residency applicants to understand the implications of this score change.

Methods: A survey containing 21 items was dispensed through REDCap utilizing an established email list of all dermatology program directors (PDs) who then distributed the survey to residents in their programs in December 2021. 132 residents completed the survey.  Perceptions regarding the USMLE Step 1 scoring change were probed.

Results: Out of the 132 residents surveyed, the highest proportion of respondents were PGY2 (36.4% [48/132]) and PGY3 (25.8% [34/132]). Of that group, most of them (74.2% [98/132]) achieved a self-reported score of 240 or higher on their USMLE Step 1 exam and most (69.7% [92/132]) disagreed with Step 1 changing to a pass/fail scoring system. Similarly, 65% (86/131) opposed Step 2 CK also going pass/fail. The majority of respondents agreed that there will be increased emphasis placed on research (90.0% [118/131]), extracurricular involvement (76.5% [101/132]) and the Step 2 CK score (96.21% [127/132]). Further, 82.3% (107/130) of respondents agreed that more students pursuing a dermatology residency will need to take a gap year.

Conclusion: According to current dermatology residents, the USMLE Step 1 exam score change to a binary scoring system will lead to more emphasis being placed on the Step 2CK exam, research, and extracurricular activities.


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