Graduate Medical Education Rounds|Articles in Press

Impact of Considering USMLE Step 1 Pass/Fail on Diversity in Dermatology Residency Recruitment

      • USMLE Step 1 Pass/Fail, Residency Recruitment, Diversity Equity and Inclusion


      The University of Chicago dermatology residency program considered USMLE Step 1 pass/fail during the 2020-2021 application cycle with the goal of recruiting diverse dermatology residency candidates. Multi-year cross-sectional study among applicants to the dermatology residency program during the 2018-2019 and 2020-2021 application cycles, the latter excluding use of USMLE Step 1 cutoff scores as a screening tool. Of the applicants, 69.8% (n = 419) and 94.5% (n= 605) had their residency applications reviewed by our program during the 2018-2019 and 2020-2021 application cycles, respectively. There was a statistically significant upward trend in the number of underrepresented in medicine (URiM) applicants offered an interview from 10.4% (n = 5) to 37.7% (n = 20) across the application cycles. Multiple linear regression demonstrated there was a statistically significant decrease in the mean USMLE Step 1 score among applicants reviewed across application cycle and URiM status independently, and as a factor of their interaction (P=0.016 and P=0.001). By de-emphasizing the USMLE Step 1 score and using the test as originally intended, a marker for licensure, our program significantly increased the number of URiM applicants who were offered an interview and implemented a holistic review process focused on individual attributes and cultural competence.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McGaghie WC
        • Cohen ER
        • Wayne DB.
        Are United States Medical Licensing Exam Step 1 and 2 scores valid measures for postgraduate medical residency selection decisions?.
        Acad Med. 2011; 86: 48-52
        • Panda N
        • Bahdila D
        • Abdullah A
        • et al.
        Association Between USMLE Step 1 Scores and In-Training Examination Performance: A Meta-Analysis.
        Acad Med. 2021; 96: 1742-1754
        • Korman AM
        • Grant-Kels JM.
        Applying to dermatology residency: An ethical approach to an inherently unethical process.
        Int J Womens Dermatol. 2018; 4: 176-178
        • Akhiyat S
        • Cardwell L
        • Sokumbi O.
        Why dermatology is the second least diverse specialty in medicine: How did we get here?.
        Clin Dermatol. 2020; 38: 310-315
        • Ramirez RN
        • Franklin CC.
        Racial Diversity in Orthopedic Surgery.
        Orthop Clin North Am. 2019; 50: 337-344
        • McDade W
        • Vela MB
        • Sánchez JP.
        Anticipating the Impact of the USMLE Step 1 Pass/Fail Scoring Decision on Underrepresented-in-Medicine Students.
        Acad Med. 2020; 95: 1318-1321
        • Soliman YS
        • Rzepecki AK
        • Guzman AK
        • et al.
        Understanding Perceived Barriers of Minority Medical Students Pursuing a Career in Dermatology.
        JAMA Dermatol. 2019; 155: 252-254
        • Wijesekera TP
        • Kim M
        • Moore EZ
        • et al.
        All Other Things Being Equal: Exploring Racial and Gender Disparities in Medical School Honor Society Induction.
        Acad Med. 2019; 94: 562-569
        • Wang A
        • Karunungan KL
        • Shlobin NA
        • et al.
        Residency Program Director Perceptions of Resident Performance Between Graduates of Medical Schools With Pass/Fail Versus Tiered Grading System for Clinical Clerkships: A Meta-Analysis.
        Acad Med. 2021; 96: S216-S217
        • Solola J
        • McQueen A
        • Naylor R
        • et al.
        Why We Can't Wait.
        J Grad Med Educ. 2021; 13: 37-38
        • Pandya AG
        • Alexis AF
        • Berger TG
        • et al.
        Increasing racial and ethnic diversity in dermatology: A call to action.
        J Am Acad Dermatol. 2016; 74: 584-587
        • Conrad SS
        • Addams AN
        • Young GH.
        Holistic Review in Medical School Admissions and Selection: A Strategic, Mission-Driven Response to Shifting Societal Needs.
        Acad Med. 2016; 91: 1472-1474
        • Grabowski CJ.
        Impact of holistic review on student interview pool diversity.
        Adv Health Sci Educ Theory Pract. 2018; 23: 487-498
        • Aibana O
        • Swails JL
        • Flores RJ
        • et al.
        Bridging the Gap: Holistic Review to Increase Diversity in Graduate Medical Education.
        Acad Med. 2019; 94: 1137-1141