Medical student non-modifiable risk factors and USMLE Step 1 exam score

For diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 1...

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Main Authors: Jenna M. Davison, Margot B. Taylor, Tracy N. Bumsted
Format: Article
Language:English
Published: Taylor & Francis Group 2024-12-01
Series:Medical Education Online
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Online Access:https://www.tandfonline.com/doi/10.1080/10872981.2024.2327818
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author Jenna M. Davison
Margot B. Taylor
Tracy N. Bumsted
author_facet Jenna M. Davison
Margot B. Taylor
Tracy N. Bumsted
author_sort Jenna M. Davison
collection DOAJ
description For diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 14-question voluntary survey on their Step 1 score and the following non-modifiable risk factors: Adverse Childhood Experience score (ACEs), sex, gender, Underrepresented in Medicine status (URiM), family income during adolescence, highest degree held by a guardian, discrimination experience during medical school, federal/state assistance use, and rural versus urban primary home. Descriptive statistics and unadjusted risk ratios were applied to study the relation between Step 1 score and non-modifiable risk factors as well as certain non-modifiable risk factors and ACEs ≥ 3. The mean Step 1 score was 230 (213, 247). Of the students, 28.2% identified ACEs ≥ 3, 13.6% were considered URiM, and 65.4% were female. URiM were 2.34 (1.30, 4.23), females were 2.77 (1.06–7.29), and those who experienced discrimination in medical school were 4.25 (1.85, 9.77) times more likely to have ACEs ≥ 3. Students who had ACEs ≥ 3 were 3.58 (1.75, 7.29) times less likely to meet a minimal threshold for residency interviews of 220. These are the first results to demonstrate a relationship between Step 1 score and ACEs. Those who identified as URiM, females, and those who experienced discrimination in medical school were at a higher risk of ACEs of ≥ 3. Step 1 transitioned to pass/fail in January 2022. However, the first application cycle that residencies will see pass/fail scoring is 2023–2024, and fellowships will continue to see scored Step 1 until, at the earliest, the 2026–2027 application cycle. These data contribute to a foundation of research that could apply to Step 2CK testing scores, and help to inform decisions about the diversity and equity of the residency interview process.
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spelling doaj-art-49fd2e43c36f4a469994d7e6e647c3bd2025-08-20T02:49:06ZengTaylor & Francis GroupMedical Education Online1087-29812024-12-0129110.1080/10872981.2024.2327818Medical student non-modifiable risk factors and USMLE Step 1 exam scoreJenna M. Davison0Margot B. Taylor1Tracy N. Bumsted2Internal Medicine, The Mayo Clinic, Rochester, MN, USAPortland State University School of Public Health, Portland, OR, USASchool of Medicine, Oregon Health & Science University, Portland, OR, USAFor diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 14-question voluntary survey on their Step 1 score and the following non-modifiable risk factors: Adverse Childhood Experience score (ACEs), sex, gender, Underrepresented in Medicine status (URiM), family income during adolescence, highest degree held by a guardian, discrimination experience during medical school, federal/state assistance use, and rural versus urban primary home. Descriptive statistics and unadjusted risk ratios were applied to study the relation between Step 1 score and non-modifiable risk factors as well as certain non-modifiable risk factors and ACEs ≥ 3. The mean Step 1 score was 230 (213, 247). Of the students, 28.2% identified ACEs ≥ 3, 13.6% were considered URiM, and 65.4% were female. URiM were 2.34 (1.30, 4.23), females were 2.77 (1.06–7.29), and those who experienced discrimination in medical school were 4.25 (1.85, 9.77) times more likely to have ACEs ≥ 3. Students who had ACEs ≥ 3 were 3.58 (1.75, 7.29) times less likely to meet a minimal threshold for residency interviews of 220. These are the first results to demonstrate a relationship between Step 1 score and ACEs. Those who identified as URiM, females, and those who experienced discrimination in medical school were at a higher risk of ACEs of ≥ 3. Step 1 transitioned to pass/fail in January 2022. However, the first application cycle that residencies will see pass/fail scoring is 2023–2024, and fellowships will continue to see scored Step 1 until, at the earliest, the 2026–2027 application cycle. These data contribute to a foundation of research that could apply to Step 2CK testing scores, and help to inform decisions about the diversity and equity of the residency interview process.https://www.tandfonline.com/doi/10.1080/10872981.2024.2327818Medical educationnon-modifiable risk factorsstep 1adverse childhood experience scorediversityresidency
spellingShingle Jenna M. Davison
Margot B. Taylor
Tracy N. Bumsted
Medical student non-modifiable risk factors and USMLE Step 1 exam score
Medical Education Online
Medical education
non-modifiable risk factors
step 1
adverse childhood experience score
diversity
residency
title Medical student non-modifiable risk factors and USMLE Step 1 exam score
title_full Medical student non-modifiable risk factors and USMLE Step 1 exam score
title_fullStr Medical student non-modifiable risk factors and USMLE Step 1 exam score
title_full_unstemmed Medical student non-modifiable risk factors and USMLE Step 1 exam score
title_short Medical student non-modifiable risk factors and USMLE Step 1 exam score
title_sort medical student non modifiable risk factors and usmle step 1 exam score
topic Medical education
non-modifiable risk factors
step 1
adverse childhood experience score
diversity
residency
url https://www.tandfonline.com/doi/10.1080/10872981.2024.2327818
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