Use of the United States Medical Licensing Examination Step-1 Score as a Screening Tool for Orthopaedic Surgery Away Rotations

Background: Orthopaedic surgery has become an increasingly competitive specialty for medical students applying to residency. Aside from residency interviews, away rotations are one of the only opportunities for residency programs to qualitatively evaluate an applicant. The purpose of this study was to determine if residency program directors (PDs) use a minimum United States Medical Licensing Examination (USMLE) Step-1 score as a screening tool for students applying for away rotations at their institution. Methods: An anonymous 12-question survey about residency selection criteria and which criteria are used to select applicants for away rotations was distributed to PDs at U.S. allopathic orthopaedic surgery residency programs who are members of the Council of Orthopaedic Residency Directors (CORD). Questions included information on minimum USMLE Step-1 scores, the number of students who complete away rotations at the program each year, and how applicants are selected for rotations. Results: Survey responses were received from 87 (58%) of 149 PDs. Seventy-one (82%) of these PDs reported that their program uses a minimum Step-1 score for residency applications, with the most common cutoff score being between 231 and 240 (as answered by 33 [46%] of 72 PDs). Twenty-seven (31%) of 87 PDs reported that if a student does not meet their residency minimum Step-1 score, he or she is not offered the opportunity to rotate at the program. Eleven (25%) of 44 PDs reported that they do not inform students when their score is below the program's minimum. Conclusions: A substantial proportion of orthopaedic surgery residency PDs use the USMLE Step-1 score as a screening tool for students interested in doing away rotations at their programs. If a student's Step-1 score does not meet the program's minimum, the majority of programs still will allow the student to rotate at their institution. Students should take this information into account when selecting away rotations in order to maximize their chances of matching into an orthopaedic surgery program.