USMLE Step I Reporting and Changes in Integrated Plastic Surgery Residency Applications

Introduction: In 2022, the United States Licensing Medical Examination (USMLE) Step 1 transitioned to pass/fail reporting. In the absence of a scored Step 1, research activity has emerged as key metric for distinguishing applicants in highly competitive specialties. This study examines trends in pre-residency research productivity among matched integrated plastic surgery residents across 3 classes before and after the Step 1 transition. Methods: Five hundred and sixty-one matched residents from graduating residency classes of 2026 (pre-transition), 2028 (pre-transition), and 2030 (post-transition) across 81 integrated plastic surgery programs were identified. Pre-residency research output, including total publications, first-author publications, plastic surgery-related publications, and normalized citation counts, was collected from PubMed. Medical schools were stratified by NIH funding level. Group comparisons were performed using Jonckheere-Terpstra tests, Mann-Whitney U tests, and segmented regression analysis. Results: Median total publications increased from 1.0 to 2.0 to 3.0 across the 3 cohorts ( P < .001). Growth in first-author, specialty-related, and citation counts was observed between the first 2 cohorts but plateaued thereafter. The rate of growth in total publications slowed significantly following the Step 1 transition (1.5 vs 0.4 publications/year; P = .014). Citation rates post-Step 1 transition declined among residents who graduated from high NIH-funded medical schools (1.97-1.44; P = .036), but rose among those from lower-funded schools. Conclusion: Following the USMLE Step 1 transition to pass/fail, research output among matched plastic surgery residents continued to increase but at a slower rate than in prior years. This observed rise in research productivity appears to be the continuation of a pre-existing trend, rather than a consequence of the Step 1 transition.