USMLE Step 1 Scoring Changes and the Urology Residency Application Process: Program Directors’ Perspectives

  • Leah P. Chisholm
    Department of Urology, Vanderbilt University Medical Center, Nashville, TN
    Search for articles by this author
  • Brian C. Drolet
    Address correspondence to: Brian C. Drolet, M.D., F.A.C.S., Department of Plastic Surgery, Vanderbilt University Medical Center, D-4207 Medical Center North, 1161 21st Avenue South, Nashville, TN 37212.
    Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN

    Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN

    Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
    Search for articles by this author


      To capture the perspectives of urology program directors (PDs) regarding the change in United States Medical Licensing Examination (USMLE) Step 1 scoring to pass/fail (binary) and the impact of this change on the urology residency application process.


      A validated survey was developed and distributed via email to urology PDs at all Accreditation Council for Graduate Medical Education-accredited programs.


      A total of 65 PDs completed the survey, for a response rate of 49.0%. Most PDs (58.7%) did not agree that binary USMLE Step 1 scoring is a good idea. The majority (84.6%) felt that this change would make it more difficult to compare applicants objectively and that the change would increase emphasis on Step 2 clinical knowledge (CK) scores. Likewise, 73.8% of PDs reported that they would start requiring applicants to submit Step 2 CK scores and 78.5% of PDs felt that Step 2 CK should remain numerically scored. Free text responses highlighted concerns for students at medical schools with pass/fail grading and the potential impact this change could have on the early match.


      Urology PDs have generally negative perspectives towards binary scoring of USMLE Step 1. They believe the change will make residency selection more arduous and less objective, without increasing medical student well-being. PDs anticipate a heavier emphasis on USMLE Step 2 CK scores and this may alter the urology early match process. Modifications to application requirements and interview schedules may be necessary to uphold an unbiased selection of applicants with respect to the early match timeline.
      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 Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American Urological Association. Urology Residency Match Statistics. Available at: Accessed May 27, 2019

        • Weissbart SJ
        • Stock JA
        • Wein AJ
        Program directors’ criteria for selection into urology residency.
        Urology. 2015; 85: 731-736
        • Makhoul AT
        • Pontell ME
        • Ganesh Kumar N
        • Drolet BC
        Objective measures needed — program directors’ perspectives on a pass/fail USMLE step 1.
        N Engl J Med. 2020; 382: 2389-2392
        • {United States Medical Licensing Examination}
        United Summary Report and Preliminary Recommendations from the Invitational Conference on USMLE Scoring (InCUS).
        2019 (Available at: Accessed May 3, 2020)
        • Filippou P
        • Mahajan S
        • Deal A
        • et al.
        The presence of gender bias in letters of recommendations written for urology residency applicants.
        Urology. 2019; 134: 56-61
        • Thompson RH
        • Lohse CM
        • Husmann DA
        • Leibovich BC
        • Gettman MT
        Predictors of a successful urology resident using medical student application materials.
        Urology. 2017; 108: 22-28