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American Association of Plastic Surgeons

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Predicting Academic Performance During Plastic Surgery Residency: Can Step 2 Scores Reliably Replace Step 1?
Amanda R. Sergesketter, MD1, Ronnie L. Shammas, MD1, Hannah C. Langdell, MD1, Yisong Geng, MD, PhD, MBA2, Kyle R. Eberlin, MD3, Paige Fox, MD4, Jason H. Ko, MD, MBA5, Scott D. Lifchez, MD6, Adeyiza O. Momoh, MD7, Vu Nguyen, MD8, Marissa Tenenbaum, MD9, Vishal Thanik, MD10, Brett T. Phillips, MD, MBA1.
1Duke University, Durham, NC, USA, 2Calc LLC, Durham, NC, USA, 3Harvard University, Boston, MA, USA, 4Stanford University, Palo Alto, CA, USA, 5Northwestern University, Chicago, IL, USA, 6Johns Hopkins University, Baltimore, MD, USA, 7University of Michigan, Ann Arbor, MI, USA, 8University of Pittsburgh, Pittsburgh, PA, USA, 9Washington University, St. Louis, MO, USA, 10New York University, New York, NY, USA.

PURPOSE: Step 1 will transition to a pass/fail system in 2022. This study aimed to characterize the effects of this change on plastic surgery program directors' selection criteria and assess whether Step 2 Clinical Knowledge (CK) can replace Step 1 as an application selection metric.
METHODS: An online survey was administered to a collaborative group of ten plastic surgery program directors. USMLE Step 1, Step 2 CK, In-Service, and written board scores for three years of graduated integrated residents were collected. Relative correlation of Step 1 and Step 2 CK with In-Service scores was compared.
RESULTS: Across 80 included integrated residents, mean (SD) Step 1 score was 247 (13), Step 2 CK was 249 (13), In-Service percentiles varied from 45 to 53 percentile, and written board pass rate was 98.3%. Both Step 1 and Step 2 CK correlated highly with In-Service percentiles (both p<0.001), with Step 2 CK scores correlating similarly with In-Service performance compared to Step 1 (rho 0.359 vs. 0.355, respectively), Table. Across applicant characteristics, program directors reported the highest relative increase in Step 2 CK importance after Step 1 transitions to pass/fail.
CONCLUSIONS: Step 2 CK correlates similarly with In-Service performance compared to Step 1. For programs seeking objective metrics to differentiate applicants, Step 2 CK may also be used to predict test performance during residency.

USMLE Step 1USMLE Step 2
Examrho95% Confidence Intervalp-valuerho95% Confidence Intervalp-value
PGY-1 In-Service0.286(0.033, 0.496)0.0430.335(0.059, 0.592)0.028
PGY-2 In-Service0.376(0.147, 0.588)0.0020.410(0.164, 0.608)0.002
PGY-3 In-Service0.338(0.108, 0.558)0.0040.321(0.070, 0.552)0.014
PGY-4 In-Service0.401(0.183, 0.591)0.0000.431(0.190, 0.624)0.000
PGY-5 In-Service0.329(0.099, 0.534)0.0030.329(0.083, 0.550)0.007
PGY-6 In-Service0.400(0.159, 0.604)0.0000.325(0.090, 0.548)0.008

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