The Impact of Step 1 Scores on Medical Students’ Residency Specialty Choice

Background: Various factors have been found to affect medical students’ choice of residency specialty, but there is little quantitative evidence describing students’ perception of the impact of the United States Medical Licensing Examination (USMLE) Step 1 score. We sought to assess whether students at our institution self-reported changes in their specialty choices based on Step 1 score, and to investigate the relationship between students’ scores and their ultimate match fields. Methods: Medical students taking the USMLE Step 1 exam in 2011, 2012, 2013, and 2015 were surveyed after they received their scores regarding whether their residency specialty choices had changed. National Residency Match Program (NRMP) data was paired to these students’ Step 1 scores to stratify the students by their eventual matched specialty. Results: A total of 472 students responded to the survey (60% response rate), of which 376 (80% of respondents) had matched NRMP data, between 2011 and 2015. 27.5% of respondents reported that their Step 1 scores influenced a change in residency specialty choice. Students in the upper and lower third of Step 1 scores were more likely to change their choice than those in the middle third (p = 0.03). Conclusions: The majority of students report that Step 1 scores do not affect their specialty choices at the time they receive their scores. However, students in the upper and lower third of Step 1 scores are more likely to change their residency choice.