Ahmed Haris, Yu Peter, Rosamond Brendan, Lall Jonathan, Zimmerle Scott, Maldonado Said, Lyons Nicole, Mills Ashlynn N, Seo Yoolim Alex, Rodriquez Angelica C, Levesque Jacqueline E, Anwoju Oluwatunmininu A, Ali Zuhair, Raghavan Rajeev, Liang Mike
HCA Florida Orange Park Hospital, Orange Park, Florida.
HCA Houston Healthcare Kingwood, Kingwood, Texas.
HCA Healthc J Med. 2025 Aug 1;6(4):311-318. doi: 10.36518/2689-0216.1895. eCollection 2025.
In January 2022, the United States Medical Licensing Examination (USMLE) Step 1 exam became pass/fail and the transition to using USMLE Step 2 scores for residency interview screening appeared imminent. While this change was intended to result in holistic reviews of residency applicants, the impact remains unclear. In this study, we aimed to determine how USMLE scoring changes might affect female candidates and applicants from underrepresented groups (URM).
We performed a retrospective cross-sectional study of all applicants to a single institution. Data for applicants were extracted from their 2021-2022 residency applications and included age, race, sex, medical school, region, USMLE Step 1 score, and USMLE Step 2 scores. All applicants who graduated from a US medical school with both USMLE Step 1 and Step 2 scores were eligible for inclusion. Our primary outcome was the difference between USMLE Step 1 versus Step 2 scores. Two comparisons were made; female candidates were compared to male candidates and URM compared to non-URM.
On regression analysis, we noted that female candidates (coefficient = 4.007; 95% CI, 2.64-5.37, < .001) had greater improvements between USMLE Step I and Step II scores compared to male applicants, while URM (coefficient = -5.056; 95% CI, -7.6 to -2.5, < .005) demonstrated smaller differences between USMLE scores compared to the reference group (non-URM).
Making USMLE Step 1 pass/fail may benefit female candidates during the interview process, while adversely impacting URM. As the application process evolves, the impacts on female and URM need to be carefully evaluated to achieve equitable representation in residency programs.
2022年1月，美国医师执照考试（USMLE）第一步考试改为通过/不通过制，并且使用USMLE第二步考试成绩进行住院医师面试筛选的转变似乎迫在眉睫。虽然这一变化旨在对住院医师申请人进行全面评估，但其影响仍不明确。在本研究中，我们旨在确定USMLE评分变化如何影响女性考生和来自代表性不足群体（URM）的申请人。
我们对一所机构的所有申请人进行了回顾性横断面研究。申请人的数据从他们2021 - 2022年的住院医师申请中提取，包括年龄、种族、性别、医学院校、地区、USMLE第一步考试成绩和USMLE第二步考试成绩。所有毕业于美国医学院且有USMLE第一步和第二步考试成绩的申请人都符合纳入条件。我们的主要结果是USMLE第一步考试成绩与第二步考试成绩之间的差异。进行了两项比较；女性考生与男性考生进行比较，URM与非URM进行比较。
在回归分析中，我们注意到与男性申请人相比，女性考生（系数 = 4.007；95%置信区间，2.64 - 5.37，P <.001）在USMLE第一步和第二步考试成绩之间有更大的提高，而与参照组（非URM）相比，URM（系数 = -5.056；95%置信区间，-7.6至 -2.5，P <.005）在USMLE考试成绩之间的差异较小。
将USMLE第一步考试改为通过/不通过制可能在面试过程中使女性考生受益，同时对URM产生不利影响。随着申请过程的演变，需要仔细评估对女性和URM的影响，以在住院医师项目中实现公平的代表性。
