The Association of Program Directors in Radiology recently issued a statement endorsing
continued reporting of results of the United States Medical Licensing Examination
(USMLE) as a three-digit score. While this position was approved by the Association
of Program Directors in Radiology Board of Directors, it does not reflect the opinions
of all radiology program directors. Here, we present an argument in support of reporting
USMLE results as pass/fail.
As a psychometric instrument, the USMLE Step 1 is designed to assess basic science
knowledge and intended to inform a binary decision on licensure. Due to a steadily-increasing
burden of applications to review, program directors have increasingly relied upon
scores for candidate screening. Such use has multiple adverse consequences. Student
focus on Step 1 systematically devalues educational content not evaluated on the exam,
and the reliance on Step 1 scores almost certainly works against efforts to increase
workforce diversity. Moreover, the increasing pressure of “Step 1 Mania” has negative
consequences for trainee mental health and wellness.
Despite the widespread use of Step 1 scores to select applicants, there are little
data to correlate scores to meaningful outcomes related to patient care or clinical
practice. We find the current situation untenable, and believe a necessary first step
toward reform is making Step 1 a pass/fail only examination.
Key Words
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Article info
Publication history
Published online: July 08, 2019
Accepted:
June 13,
2019
Received in revised form:
June 13,
2019
Received:
May 27,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of The Association of University Radiologists.
