Impact of USMLE Step 1 Pass/Fail on Research Trends among Ophthalmology Residency Applicants

Background: Ophthalmology is a very competitive specialty with a growing number of applicants each academic year. In the past, ophthalmology residency programs used the United States Medical Licensing Exam (USMLE) Step 1 numerical score as a key screening tool to narrow the applicant pool; however, the transition to pass/fail has created uncertainty regarding alternative selection criteria. Purpose: To evaluate ophthalmology residency applications submitted before and after the elimination of the numerical USMLE Step 1 scoring system, with a focus on assessing the volume and quality of research experiences. Methods: This is a single institution retrospective study examining ophthalmology residency applications in the 2019, 2022, and 2024 cycles. Baseline characteristics were compared using t tests, one-way ANOVA tests, Kruskal-Wallis tests and χ2 tests with Bonferroni correction (adjusted significance threshold, p < 0.002). Furthermore, linear regression analyses were performed to identify variables associated with total publications, total presentations, presentation: publication ratio and research gap years. Significance was set at a p < 0.05. Results: A total of 284, 361, and 381 applications were analyzed in the 2019, 2022, and 2024 cycles, respectively. All applicants (100%) in the 2019 and 2022 cycles had a numerical USMLE Step 1 score, compared with none (0%) in the 2024 cycle. Between the three application cycles, there was a significant increase in the number of listed research presentations (3.34 vs. 6.22 vs. 8.49 [p < 0.0001]), the presentation: publication ratio (1.56 vs. 2.18 vs. 2.93 [p < 0.0001]) and the number of applicants with a reported USMLE Step 2 score (51.1% vs 72.0% vs 93.2% [p < 0.0001]). The mean number of peer-reviewed publications significantly increased from 1.95 in 2019 to 3.26 in 2022; however, there was no difference between the 2022 and 2024 cycles (3.26 vs. 3.29 [p = 0.9063]). Similarly, there was no difference in average impact factor of the journal of publication (4.71 vs. 4.14 [p = 0.2431]) or annualized citation rate (4.88 vs. 3.13 [p = 0.0267]) between the 2022 and 2024 cycles. On multivariate analysis, having a PhD (p = 0.048), a higher USMLE Step 1 score (p = 0.022), taking a research gap year (p = 0.026) and having more research presentations (p < 0.001) were independently associated with a higher number of overall publications. Conclusions: Ophthalmology residency applicants have shifted towards increasing the volume of research experiences, potentially in response to the elimination of the numerical USMLE Step 1 score.