Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
World Neurosurg. 2022 Oct;166:e511-e520. doi: 10.1016/j.wneu.2022.07.045. Epub 2022 Jul 16.
Neurosurgery (NS) is among the most selective specialties in the United States. As the United States Medical Licensing Examination (USMLE) Step 1 transitions to a binary pass/fail score, residency programs face unclear challenges in screening and evaluating applicants. The aim of this study is to provide insights into the perceived impact of changes to the USMLE Step 1 grading in the applicant selection process.
We created a survey using questions regarding NS program demographics, the perceived predictive abilities of Step 1 and Step 2 clinical knowledge (CK), and several factors that programs consider when assessing applicants. We queried program directors (PDs), program coordinators (PCs), and assistant PDs at 117 NS residency programs. Respondents were asked to rank these factors in order of importance for selection at their respective training program. We used descriptive statistics and a Wilcoxon matched-pairs signed-rank test to evaluate the effects of these changes using STATA 17.
A total of 35 (30%) residency programs responded with 26 (74%) completing the factor ranking questions. 86% (95% confidence interval, 71.5%-94.3%) disagreed that the changes will better prepare students clinically. USMLE Step 2 CK scores, class rank, and away rotations saw significant increases in priority in the absence of a graded Step 1, whereas letters of recommendation and surrogates for research productivity saw notable, but not significant, changes after adjusting for multiple testing.
Reporting binary Step 1 grades marks a significant shift in assessing applicants for NS residency by emphasizing Step 2 CK, class rank, and research productivity.
神经外科（NS）是美国最具选择性的专业之一。随着美国医师执照考试（USMLE）第 1 步从分级成绩过渡到二分制的通过/不通过成绩，住院医师项目在筛选和评估申请人方面面临着不明朗的挑战。本研究旨在深入了解第 1 步成绩变化对申请人选拔过程的影响。
我们使用有关 NS 项目人口统计学、第 1 步和第 2 步临床知识（CK）的预期预测能力以及项目在评估申请人时考虑的几个因素的问题创建了一项调查。我们向 117 个 NS 住院医师项目的项目主任（PDs）、项目协调员（PCs）和助理 PDs 询问了调查。受访者被要求按照其所在培训项目的重要性对这些因素进行排名。我们使用描述性统计和 Wilcoxon 配对符号秩检验使用 STATA 17 评估这些变化的影响。
共有 35 个（30%）住院医师项目回复，其中 26 个（74%）完成了因素排名问题。86%（95%置信区间，71.5%-94.3%）不同意这些变化将使学生在临床方面得到更好的准备。在没有分级第 1 步的情况下，USMLE 第 2 步 CK 成绩、班级排名和轮调实习的优先级显著增加，而推荐信和研究生产力的替代指标在进行多次检验调整后也有显著但不显著的变化。
报告二进制第 1 步成绩标志着通过强调第 2 步 CK、班级排名和研究生产力来评估 NS 住院医师申请人的重大转变。
