Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment.

Journal Article (Journal Article)

OBJECTIVES: Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. METHODS: A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. RESULTS: There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. DISCUSSION: When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.

Full Text

Duke Authors

Cited Authors

  • Maxfield, CM; Montano-Campos, JF; Chapman, T; Desser, TS; Ho, CP; Hull, NC; Kelly, HR; Kennedy, TA; Koontz, NA; Knippa, EE; McLoud, TC; Milburn, J; Mills, MK; Morgan, DE; Morgan, R; Peterson, RB; Salastekar, N; Thorpe, MP; Zarzour, JG; Reed, SD; Grimm, LJ

Published Date

  • November 2021

Published In

Volume / Issue

  • 18 / 11

Start / End Page

  • 1572 - 1580

PubMed ID

  • 34332914

Electronic International Standard Serial Number (EISSN)

  • 1558-349X

Digital Object Identifier (DOI)

  • 10.1016/j.jacr.2021.07.005


  • eng

Conference Location

  • United States