Every year, program directors spend large amounts of time and effort in the application process to select qualified radiology residents. Currently, we rely upon sparse information to ensure we get capable residents. And, one of those pieces of data includes one of a few items that discriminate all applicants equally regardless of institution, nationality, or sort of medical school degree: the USMLE Step 1 examination. But, that stream of information will become even more meager. As some of you may have heard, as of 2022, this USMLE Step 1 examination will become a pass/fail examination. As a result, we lose out on a discriminator that can assess a resident’s ability to pass exams and correlates to passing our radiology core examination. Unfortunately, these changes render the test useless for our purposes.
So, we will need to rely upon other methods to select residents that can pass a radiology board examination. In this case, let’s take this issue on step further. How is the new grading system going to affect applicants? And, who will be the winners and losers? Let me guide you through what I predict will happen once the new grading system for this exam begins.
Winners
Ivy League Medical Graduates/Medical Schools
Since we are losing out on one of the few means of equalizing all applicants, we will have to rely more upon the “name” of the school rather than the individual data points. Therefore, known medical schools will take on higher importance in the application process. Regardless of quality, the system is forcing us to use the institution’s reputation over the quality of the individual’s data.
Poor Test Takers
For those folks with problems passing an examination, this change will help somewhat. You will have one less exam to obsess about your score, now that you only have to pass the test. Of course, you will now need to do well on the Step II examination. And, this test will probably replace the Step I exam as a screening tool for the ERAS application to our specialty. But, it is one less hoop for the average poor exam taker to jump through.
Step II USMLE Examination Review Courses
Now that acing the Step I examination no longer becomes significant, program directors will need to rely on another indicator for test-taking abilities. And, the only one left during the residency will be the Step II examination. So, this will force applicants to take this examination m0re seriously. So, you will probably see more Step II courses sprouting up to help applicants score well on this test.
Losers
Foreign Applicants
As program directors, we like to compare apples to apples when assessing resident applications. And, many times, it is harder to determine the quality of a medical school when it does not adopt the standards of the ACGME. So, we need to rely on other means to assess the residents. Now, we lose out on another data point to do so. Therefore, foreign residents will be the first to lose out in the selection process at the expense of other standardized medical institutions.
Radiology Program Directors
For several reasons, this will hamper our radiology residency selection process. First of all, we are losing out on one of the only examinations that correlate with passing the core exam. Therefore, theoretically, we will be accepting more residents that will not be able to pass a standardized test, the core examination. Second, we will have a smaller pool of applicants from which to choose, now that many of us will require applicants to take the USMLE Step II as our “test-ability discriminator.” Third, we will be more delayed in waiting for Step II exams to come in for the ERAS application. And, finally, we will have one less data point to use in our assessment arsenal.
Step I Pass-Fail Grading: Changing The Playing Field!
Tweaking the testing process always changes the outcomes for those applicants that take them. And, the new grading system for the USMLE Step I is no exception. In the radiology application process, there will be clear winners and losers. Foreign applicants and radiology program directors will get the short end of the stick. Meanwhile, Ivy League applicants and poor test-takers will benefit a bit more. And, to assess applicants, we will become more reliant on Step II USMLE examination. So, these are the main changes that lurk over the horizon. Get ready to change accordingly!
