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Next month, results from the United States Medical Licensing Examination (USMLE) Step 1 exam will change from a numeric score to pass or fail. As students, medical schools, and residency programs anticipate this upcoming change, many are left wondering if and how this update will affect applicant selection for radiology residencies. Our study used an anonymous and voluntary 14-question online survey to assess program directors’ views on the scoring change of Step 1 from numeric to pass or fail, while assessing if other metrics, such as Step 2 Clinical Knowledge (CK) scores, may become more important during application review. Eighty-eight of 308 (29%) members of the Association of Program Directors in Radiology (APDR) completed the survey.

Our study found that more than two-thirds of survey respondents indicated their programs currently use a Step 1 screen before sending interview invitations. Specific to radiology, previous studies have demonstrated a correlation between Step 1 performance and both the number of interpretive errors made as a radiology resident and future success on the American Board of Radiology Core Exam. Our study also found that more than 90% of survey respondents anticipate their programs may or definitively will require Step 2 CK scores before application review, once Step 1 becomes pass or fail; in contrast, many radiology programs presently do not require Step 2 CK scores before reviewing applications. In addition, our study found that regardless of the current use of a Step 1 screen, survey respondents did not significantly differ in their anticipation of requiring Step 2 CK scores (p=0.71) or extending later interviews to accommodate Step 2 CK scores (p=0.64). This finding may reflect hesitancy from programs to place significant weight on Step 2 CK before more research is done. There may be increased utility of using Step 2 CK scores over Step 1 scores as a marker of clinical knowledge, as the material covered in Step 2 CK has greater clinical relevance than that of Step 1. Through faculty, peer, and patient-level evaluations, previous studies from internal medicine have shown that Step 2 CK scores correlate better to clinical performance both during and after residency than Step 1 scores. It could be informative to examine whether this correlation exists with Step 2 CK scores and performance in radiology residency, as more residency applicants may include Step 2 CK scores with their initial application in upcoming years.

Although making Step 1 pass or fail may help mitigate the significant distress surrounding the examination, there are valid concerns that the stress surrounding Step 1 will simply be transferred to Step 2 CK, when Step 2 CK becomes the only remaining standardized metric among applications. In an ideal world, all applications would receive a thorough and holistic review with consideration of both qualitative and quantitative characteristics. However, many selection committees do not have enough resources to do so, given the growing number of applications each program receives for the same number of residency spots. Some specialties have implemented preference signaling and supplemental applications to highlight an applicant’s top programs of interest and specific program characteristics (location, patient population, research, etc.) a particular applicant is seeking. Some studies have suggested more drastic measures, such as application caps, to reduce the usage of standardized test scores as a filter during application review and allow for more holistic application reviews. While changing Step 1 to pass or fail does not resolve all the challenges associated with the residency selection process, it does pave the way for additional meaningful changes to the system in the future.

ARRS In-Training Members, join leading radiologists this May for the 2022 ARRS Annual Meeting and receive clinical education you can trust on your schedule. Participate live in New Orleans or virtually and interact with world-renowned faculty in real time, then extend your learning with on-demand sessions and E-Posters for one full year after the meeting.

In-Training Meeting Features:

• Radiology Review Track—This educational track offers a broad review of cases across 11 subspecialties and is included with your general registration fee.
• Resident Track—This track will highlight content of particular value to in-training radiologists, covering a wide variety of subspecialty domains, physics problems, and noninterpretive skills.

In-Training Members save nearly 60%—register by Thursday, March 17 to receive the lowest rates!

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Every month, AJR Editor in Chief Andrew Rosenkrantz handpicks an article from “the yellow journal” specifically for ARRS In-Training Members. For December, Dr. Rosenkrantz has chosen “Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It.”

Highlight:

• Four-dimensional flow MRI is a highly valuable technique for comprehensive clinical evaluation of structural heart defects, although it requires radiologist awareness of various pearls and pitfalls.

Please see the Editorial Comment further discussing this article, as well as InPractice for more information on using 4D flow to enhance cardiac MRI.

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Also each month, AJR Journal Club authors write questions for ARRS In-Training Members to encourage more thorough participation in evidence-based medicine. December’s article compares CT and MRI cystic renal mass characterization using the Bosniak 2019 and 2005 versions.

And in this AJR Podcast, Giuseppe V. Toia explains how Bosniak 2019 demonstrated decreased sensitivity, while increasing specificity for malignancy detection.

Be sure to follow the world’s longest continuously published general radiology journal on TikTok, too!

Presented for free to ARRS In-Training Members by radiologists across multiple subspecialties, alongside experts in epidemiology, public health, and oncology, COVID-19: Prevailing Clinical, Imaging, Healthcare, and Economic Issues of 2022 will deliver a frontline-focused update on the principal problems still plaguing physicians around the world.

Designed especially for in-training imagers, primary care providers, and critical medicine attending and fellows, this symposium on Friday, January 28 will focus on the physical symptoms and imaging findings associated with persistent, lingering, “long-haul” COVID-19.

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“HRCT 1: The Basics” is this month’s Web Lecture, also specially selected for ARRS In-Training Members by our own in-house experts. Packed with practical information, residents and fellows will:

• Discuss basic patterns of HRCT, focusing on generating concise differential diagnoses
• Review imaging features of micronodular disease
• Describe cystic lung disease and mosaic lung attenuation

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How Residents and Fellows Can Join ARRS for FREE:

1. Visit the ARRS Membership page, select In-Training Members, and complete the application online.
2. Fill out the ARRS In-Training Membership Application, and mail or fax it back to us.

The Resident Roentgen File Archives, 2021: November | October | September | August | July | June | May | April