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

ABSTRACT

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.

KEYWORDS:

• Medical education
• non-modifiable risk factors
• step 1
• adverse childhood experience score
• diversity
• residency

View correction statement:

Correction

Acknowledgments

We would like to thank the students who participated in this project and helped bring it to fruition.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author upon a reasonable request.

Consent for publication

All participants of the study provided informed consent to participate in the study and publish its findings.

Ethics approval and consent to participate

The Oregon Health & Science University Institutional Review Board approved the present study (Study ID: 00022312). All methods were performed in accordance with the Declaration of Helsinki. We only analyzed the data of the participants that provided informed consent. We did not collect sensitive information from participants and data was anonymized prior to data processing.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/10872981.2024.2334472).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.