(230) Perceived Impact of USMLE Step 1 Pass/Fail on Medical Student Applications to Otolaryngology

Introduction: The transition of USMLE Step 1 to pass/fail reporting was intended to improve medical student well-being, promote a more holistic approach to residency application review, and reduce reliance on numeric screening metrics. This study aims to examine the impact of this change on medical student interest in otolaryngology and perceived priorities within the residency application process.

Methods: In 2024, an electronic survey was distributed via RedCap to enrolled medical students at Loyola University Chicago Stritch School of Medicine and the Larner College of Medicine at the University of Vermont. The survey included questions about the transition to pass/fail, interest in surgical subspecialty, and importance of other application components. Data collection is ongoing, with the recent addition of two academic institutions in the Northeastern region.

Results: Among the 189 medical students who completed the survey, 68.3% supported the transition of USMLE Step 1 to pass/fail, 15.9% of students were neutral, and 14.8% opposed the change. With respect to specialty choice, only 13.8% of respondents were more likely to apply to their preferred specialty, while 9.0% were less likely, and 77.2% were unaffected. Research (70.4%) and USMLE Step 2 CK (87.3%) were cited as the most important variables for a successful residency application.

Conclusions: Recent literature demonstrates the Step 1 pass/fail scoring system has resulted in fewer objective measures of medical student performance, no significant improvement in learner anxiety, and greater emphasis on research endeavors rather than clinical performance. Our findings similarly identified research as one of the most highly regarded factors in residency applications, with little improvement in broadening accessibility to preferred specialty. This has important implications for otolaryngology, as applicants face heightened pressure to undertake a research year, despite research productivity remaining a questionable predictor of clinical success.