ABSTRACT
INTRODUCTION AND OBJECTIVE: Originally created for the purpose of demonstrating medical student proficiencydthe United States Medical Licensing Examination (USMLE) Step 1 examination has gained prominence as a tool to screen for urology residency applicants, significantly impacting residency prospects for medical students. Due to the COVID-19 pandemic and pause on in-person interviews, many urology programs have cited significant increases in residency applications overwhelming their institutions. In January 2022, the Step 1 score will transitioned to a pass-fail outcome. In this study, we aim to describe how urology program directors (PDs) use Step 1 and Step 2 scores in light of the upcoming change. METHODS: A survey was developed and distributed to the PDs of all 144 accredited urology programs via the Society of Academic Urology list-serve. Responses regarding Step 1 and Step 2 score minimum requirements for the 2020-2021 urology residency match were evaluated with descriptive statistics. RESULTS: Of those who responded to the survey, 112 identified as PDs, representing 78% of residency programs. For Step 1 and Step 2, there was no cut-off score for 29% and 41% of programs, respectively. Of institutions with Step 2 cut-off scores, 55% had cutoff scores above 236 as compared to 42% of institutions having the same cut-off for Step 1. CONCLUSIONS: In this study we demonstrated that although Urology programs are more likely to have a required minimum score for USMLE Step 1 than for Step 2, a higher proportion of programs have a higher Step 2 cut-off score than they do for Step 1. Given the upcoming transition to pass-fail for Step1, there may be increasing importance placed on Step 2 and higher threshold scores required to be screened in. Institutions should consider transparency regarding Step 2 score cut-offs to enable applicants to apply judiciously to programs and to decrease the overall application review burden on PDs. Attention should be paid to the downstream effects of these changes to the diversity of the available pool of urology applicants.