Does US Medical Licensing Examination Step l Score Really Matter in Surgical Residency Match Outcomes (and Should It)?

Background: The relationship between US Medical Licensing Examination Step 1 scores and core surgical-specialty match outcomes has not been well defined. Study Design: With IRB approval, we measured associations between aggregate Step 1 scores and other specialty-specific, match-process variables for 3 surgical-specialty matches. Chi-square tests measured differences between proportions of US students and independent applicants (ie, all non-US allopathic student applicants) who matched. Independent samples t-tests compared differences in Step 1 scores between matched- and unmatched-applicant groups. Pearson correlations measured the magnitude and direction of associations between matched-applicants' Step 1 scores and other variables of interest and between Step 1 scores for all match participants and percentage of positions filled by US students (two-tailed p values). Results: Step 1 scores were lower for unmatched- than matched-applicant groups for each specialty examined (each p < 0.0001). Matched-applicant groups' Step 1 scores positively correlated with each unmatched-applicant groups' Step 1 scores (r =.82, p < 0.0001), Step 1 gap between matched- and unmatched-applicant groups' scores (r = .40, p = 0.035), percentage of positions filled by US students (r = .62, p < 0.0001), and mean number of applications filed/applicant (r = .50, p < 0.0001). Step 1 scores for all match participants correlated with percentage of positions filled by US students (r = .61, p = 0.0006). Conclusions: Step 1 scores were closely related to match process outcomes and match participation itself, with increasing Step 1 scores among both matched- and unmatched-applicant groups as specialty selectivity increased.