Association of the Change in USMLE Step 1 Scoring With Research Output Among Applicants to Anesthesiology Residency Programs: A Retrospective Observational Study

Background: As anesthesiology residency becomes increasingly competitive, the transition of US Medical Licensing Examination (USMLE) Step 1 to pass/fail scoring has raised questions about the evolving role of research in applicant selection. Whereas national data suggests rising research engagement, there are limited insights into publication output among medical students applying into anesthesiology. The purpose of this study is to evaluate the relationship between the USMLE Step 1 transition and preresidency publication output of matched anesthesiology residents and to assess the role medical school National Institutes of Health (NIH) funding level has on publication metrics. Methods: This retrospective cohort study analyzed the research output of 461 anesthesiology residents across 30 programs from the classes of 2026 (numerical Step 1 scoring) and 2028 (pass/fail Step 1 scoring). Medical schools were stratified by NIH funding level to evaluate its association with research output. PubMed-indexed publications were examined using metrics including first author status, specialty relevance, citation counts, and publication types. Using Mann-Whitney U tests, group differences were compared with total publications serving as the primary outcome. Results: There were no significant differences in research output between pre- and post-Step 1 transition cohorts across all metrics. The 50th percentile in total publications was 0 for both cohorts. There was also no difference in publication output when groups were stratified by NIH funding level. Logistic regression analysis showed that high NIH funding (odds ratio 1.87, 95% confidence interval 1.21-2.89) was a significant predictor of having at least 1 publication. Conclusions: Despite increasing emphasis on research in residency applications, our findings show no significant change in publication output among anesthesiology applicants in the first class following the Step 1 transition. Whereas NIH funding level was associated with a greater likelihood of having at least 1 publication, it was not linked to higher overall publication output. This study provides a timely baseline for understanding scholarly activity in anesthesiology applicants as the residency evaluation landscape continues to evolve.