Department of General Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, Pennsylvania.
Department of General Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, Pennsylvania.
J Surg Res. 2021 Sep;265:317-322. doi: 10.1016/j.jss.2021.03.056. Epub 2021 May 7.
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.
简介 美国医师执照考试（USMLE）第 1 步既是一种执照考试，也是住院医师项目评估申请人的一种方式。随着 2020 年因该考试对未来医生表现的评估有效性不明确而决定采用通过/不通过制，该考试对匹配过程产生了重大影响。由于没有第 1 步的成绩，项目将在没有该成绩的情况下进行匹配。我们着手更好地了解考试成绩对我们选择过程的影响，假设没有第 1 步的成绩，我们申请人的排名将发生重大变化。
方法 我们对一家由医生领导的学术性三级护理医疗中心的普外科住院医师项目进行了回顾性分析，该项目每年有 4 名住院医师。申请人的重要因素包括 USMLE 第 1 步和第 2 步、AOA 身份、科学成绩、实习成绩、试听轮转、志愿者活动、研究活动、推荐信和个人陈述，通过我们的方程式对这些因素进行评分和评估，总分用于创建排名表并提供面试机会。计算了有和没有 USMLE 第 1 步的分数的标准差，并比较了分数的分布。检查了申请人分数变化的范围和平均值。
结果 共审查了 653 名学生的申请。在去除 USMLE 第 1 步的分数后，所有申请人中有 40%的排名下降，35%的排名不变，24%的排名上升。具体来说，三分之一的顶尖申请人中有 18.8%下降到中间三分之一，三分之一的垫底申请人中有 11.7%上升到中间三分之一，而中间三分之一的变化很小（0.2%下降，0.9%上升出中间三分之一）。USMLE 第 1 步的分数给分产生了一个分数分布范围较宽的分布，具有负偏态，这表明低于平均值的申请人比高于平均值的申请人多。去除这些分数后，申请人的分数分布更窄，偏度更接近 0，表明高分段的外显值较少，更多的申请人接近平均值。
结论 USMLE 第 1 步的分数显著影响了对申请人的评估，从招聘标准中删除该分数使申请人的排名更加严格。在评估申请人时，取消 USMLE 第 1 步的分数将允许用更好地反映住院医师项目核心价值的变量来替代它。
