Impacts of United States Medical Licensing Examination Step 1 Scoring Change on Emergency Medicine Applicant Screening

Background: The U.S. Medical Licensing Ex-amination (USMLE) Step 1 has been used as a screening tool for residency selection. In February 2020 , Step 1 nu-merical scoring changed to pass/fail. Objective: Our aim was to survey emergency medicine (EM) residency pro-gram attitudes towards the new Step 1 scoring change and to identify important applicant screening factors.Methods: A 16-question survey was distributed through the Coun-cil of Residency Directors in Emergency Medicine listserv from November 11 through December 31, 2020. Given the Step 1 scoring change, the survey questioned the impor-tance of EM rotation grades, composite standardized letters of evaluation (cSLOEs), and individual standardized letters of evaluation, using a Likert scale. Descriptive statistics of demographic characteristics and selection factors were per -formed along with a regression analysis.Results: Of the 107 respondents, 48% were program directors, 28% were as-sistant or associate program directors, 14% were clerkship directors, and 10% were in other roles. Sixty (55.6%) dis-agreed with pass/fail Step 1 scoring change and, of those, 82% believed that numerical scoring was a good screen -ing tool. The cSLOEs, EM rotation grades, and interview were the most important selection factors. Residencies with 50 or more residents had 5.25 odds (95% CI 1.25-22.1; p = 0.0018) of agreeing with pass/fail scoring and those who ranked cSLOEs as the most important selection factor had 4.90 odds (95% CI 1.125-21.37; p = 0.0343) of agreeing with pass/fail scoring.Conclusions: Most EM programs disagree with pass/fail scoring of Step 1 and will most likely use Step 2 score as a screening tool. The cSLOEs, EM rotation grades, and interview are considered the most important selection factors.& COPY; 2023 Elsevier Inc. All rights reserved.