The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross‐sectional study

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Abstract
Background and Aims: United States Medical Licensing Exam (USMLE) scores are the single, most objective criteria for admission into residency programs in the country. Underrepresented minorities in medicine (URiM) are found to have lower USMLE scores compared to their White counterparts. The objective of this study is to examine how USMLE step 1 cutoff scores may exclude self‐reported URiM from the residency interview process across various specialties.Methods: This was a retrospective cross‐sectional study of 10 541 applicants to different residency programs at Zucker School of Medicine at Hofstra/Northwell Health between May 2014 and May 2015. We identified Blacks and Hispanics as URiM. The primary outcome is the percentage of applicants with USMLE step 1 score above different ranges of cutoff score, from 205 to 235 in five‐point increments, by race/ethnicity and by URiM status. Secondary outcome is percentages of URiM vs non‐URiM above and below mean USMLE step 1 scores by different specialties (internal medicine, obstetrics/gynecology, pediatrics, and psychiatry).Results: The study sample included 2707 White, 722 Black, 805 Hispanic, 5006 Asian, and 562 Other Race/Ethnicity applicants. Overall, 50.2% were male, 21.3% URiM, 7.4% had limited English proficiency, 67.6% attended international medical schools, and 2.4% are Alpha Omega Alpha Honor Medical Society (AOA) members. The mean (±SD) USMLE step 1 score was significantly greater among non‐URiM applicants as compared to URiM applicants (223.7 ± 19.4 vs 216.1 ± 18.4, P < .01, two‐sample t‐test). Non‐URiM applicants were younger, and the percentage of male and AOA applicants was greater among non‐URiM applicants as compared to URiM applicants (50.5% vs 47.7%, P = .02, Chi‐Square test; 2.9% vs 1.2%, P < .01, Chi‐Square test, respectively).Conclusion: Using a USMLE step 1 cutoff score as an initial filter for applicant recruitment and selection could jeopardize the benefits of a diverse residency program. Practical implications are discussed.

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