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Considerations of a Resident Recruitment Committee on the USMLE Step 1 Examination

de Haan, Johanna Blair MD; Markham, Travis MD; Ghebremichael, Semhar MD

doi: 10.1097/ACM.0000000000002721
Letters to the Editor
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Assistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas; johanna.b.dehaan@uth.tmc.edu.

Assistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.

Assistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.

Disclosures: None reported.

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To the Editor:

As members of a residency recruitment committee (RRC), we disagree with Andolsek1 and Chen et al.2 Elimination of the United States Medical Licensing Examination (USMLE) Step 1 score would limit the ability of the RRC to evaluate candidates for postgraduate training, threaten board certification, and jeopardize the excellence of physicians.

Selection of medical school applicants for residency is rigorous. Ideal applicant characteristics include motivation to achieve excellence, a greater goal than competence, and predicted successful board certification. We previously described a successful well-rounded approach to candidate selection.3

Assessment of medical knowledge (MK) is constant during medical school, postgraduate training, and maintenance of certification. Successful certification is paramount for individuals as well as residency training programs. In anesthesiology, for example, Step 1 and in-training examination scores predict academic and clinical success.4,5 Additionally, anesthesiology residents must pass part one of their specialty board certification exams during their second year of residency. Inability to pass this exam prohibits further continuation in residency. Data from our institution demonstrate that success on this exam strongly correlates to Step 1 performance. Furthermore, the lay public expects that physicians possess excellent MK. We suspect they would embrace excellence over competence.

The paucity of useful information within the medical student performance evaluation (MSPE) increases the need to rely on Step 1 scores. The majority of MSPEs now use pass/fail grading, an arbitrary ranking system wherein “outstanding” has equal likelihood to mean either first or fourth quartile, and they lack National Board of Medical Examiners shelf exam scores during clerkships. Without useful information in the MSPE, numeric Step 1 scores are critical for evaluation of applicants for residency.

Johanna Blair de Haan, MD

Assistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas; johanna.b.dehaan@uth.tmc.edu.

Travis Markham, MD

Assistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.

Semhar Ghebremichael, MD

Assistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.

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References

1. Andolsek KM. One small step for Step 1. Acad Med. 2019;94:309–313.
2. Chen DR, Priest KC, Batten JN, Fragoso LE, Reinfeld BI, Laitman BM. Student perspectives on the “Step 1 climate” in preclinical medical education. Acad Med. 2019;94:302–304.
3. Gumbert SD, Normand KC, Artime CA, et al. Reliability of a faculty evaluated scoring system for anesthesiology resident applicants (original investigation). J Clin Anesth. 2016;31:131–136.
4. Chen F, Arora H, Martinelli SM, et al. The predictive value of pre-recruitment achievement on resident performance in anesthesiology. J Clin Anesth. 2017;39:139–144.
5. Zhou Y, Sun H, Lien CA, et al. Effect of the BASIC Examination on knowledge acquisition during anesthesiology residency. Anesthesiology. 2018;128:813–820.
© 2019 by the Association of American Medical Colleges