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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 1			USMLE Step 2
Exam	rho	95% Confidence Interval	p-value	rho	95% Confidence Interval	p-value
PGY-1 In-Service	0.286	(0.033, 0.496)	0.043	0.335	(0.059, 0.592)	0.028
PGY-2 In-Service	0.376	(0.147, 0.588)	0.002	0.410	(0.164, 0.608)	0.002
PGY-3 In-Service	0.338	(0.108, 0.558)	0.004	0.321	(0.070, 0.552)	0.014
PGY-4 In-Service	0.401	(0.183, 0.591)	0.000	0.431	(0.190, 0.624)	0.000
PGY-5 In-Service	0.329	(0.099, 0.534)	0.003	0.329	(0.083, 0.550)	0.007
PGY-6 In-Service	0.400	(0.159, 0.604)	0.000	0.325	(0.090, 0.548)	0.008

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