BACKGROUND: As of January 26, 2022, USMLE Step 1 score reporting has changed from a numeric to a pass/fail scoring system. Although the new scoring policy is expected to benefit medical students, there is concern that it will also amplify preexisting disadvantages and worsen disparities for students applying into the already-competitive plastic surgery match. Whether the reporting change will tangibly benefit applicants to plastic surgery has yet to be elucidated. This study aims to assess medical student opinions on the impact of this scoring change on their stress, expectations, and behaviors regarding plastic surgery residency applications.
METHOD: A cross-sectional survey was distributed to medical students and graduates via social media platforms from July 7th to October 22nd, 2020. The survey consisted of multiple-choice and free-response questions aimed at gauging student opinions and expectations regarding the Step 1 scoring change. Data were analyzed using Student t test and Chi-squared statistics, with an alpha level set at 0.05. For questions inquiring about likelihood of exhibiting a certain behavior, Net Likelihood Score (NLS) was used to grade aggregate sentiments.
RESULTS: Of 120 participants interested in plastic surgery, a majority were MD candidates (n = 83, 69.2%). Responses were split nearly equally between American Medical Trainees (AMTs) and International Medical Trainees (IMTs) (49.2% v. 50.8%). Of the 29 (24.2%) trainees who had already completed Step 1 (post-Step 1 students), 65.5% scored at least a 240. The average number of months spent studying for Step 1 in this cohort was 3.7±2.9 months. A plurality of respondents were against the new Step 1 score reporting (AMT: 40.7%; IMT: 44.3%). Most IMTs (60.7%) felt that the reporting change would make HCS more competitive, whereas only 47.8% of AMTs expressed this opinion (p = 0.016). Similarly, there was a statistically significant association between training group and impact of the scoring change on stress levels (p < 0.001), with a greater percentage of AMTs expressing that the change will decrease stress levels compared to IMTs (71.2% vs. 24.6%). Overall, respondents felt that the pass/fail scoring system would increase their likelihood to engage with more research (49.2%; NLS = 48), dual apply (51.7%; NLS = 53), prioritize studying for Step 2 CK (74.2%; NLS = 77), and consider a dedicated research year (66.7%; NLS = 67).
CONCLUSION: While a pass/fail reporting system for Step 1 may alleviate some stress for medical trainees, other issues arise that may perpetuate disparities in access to adequate resources for a successful plastic surgery match. Residency programs should offer anticipatory guidance regarding prioritization of aspects of application to ease this psychosocial and financial pressure, as well as help students reorganize their constrained time.