Abstract
Background Scoring for the United States Medical Licensing Examination (USMLE) Step 1 was recently
announced to be reported as binary as early as 2022. The general perception among
program directors (PDs) in all specialties has largely been negative, but the perspective
within ophthalmology remains uncharacterized.
Objective This article characterizes ophthalmology residency PDs' perspectives regarding the
impact of pass/fail USMLE Step 1 scoring on the residency application process.
Methods A validated 19-item anonymous survey was electronically distributed to 111 PDs of
Accreditation Council for Graduate Medical Education-accredited ophthalmology training
programs.
Results Fifty-six PDs (50.5%) completed the survey. The median age of respondents was 48
years and the majority were male (71.4%); the average tenure as PD was 7.1 years.
Only 6 (10.7%) PDs reported the change of the USMLE Step 1 to pass/fail was a good
idea. Most PDs (92.9%) indicated that this will make it more difficult to objectively
compare applicants, and many (69.6%) did not agree that the change would improve medical
student well-being. The majority (82.1%) indicated that there will be an increased
emphasis on Step 2 Clinical Knowledge (CK) scores, and many (70.4%) felt that medical
school reputation will be more important in application decisions.
Conclusion Most ophthalmology PDs who responded to the survey do not support binary Step 1 scoring.
Many raised concerns regarding shifted overemphasis on Step 2 CK, uncertain impact
on student well-being, and potential to disadvantage certain groups of medical students
including international medical graduates. These concerns highlight the need for reform
in the ophthalmology application process.
Keywords
medical education - residency selection - SF match - match process - USMLE - Step
1 - program directors
