New data shows that radiology program directors prefer this factor when selecting residents

New data show that radiology program directors prioritize a specific factor when selecting residents.

The National Resident Match Program released new details on August 20 about the characteristics of final-year U.S. medical students who will be admitted to their preferred specialty in 2024. In a field as competitive as radiology, program directors look for objective measures to evaluate applicants.

As early as 2022, organizers of the U.S. Medical Licensing Examination have downplayed the importance of numerical scores on the Step 1 exam. While officials previously used the scores to select candidates, the test will now switch to a pass-fail system to reduce the overemphasis on those three-digit scores.

This created a “data gap in the resident selection process,” said Dr. Francis Deng, a radiologist, researcher and former NRMP board member. Radiologists have expressed concern in recent years that this transition would lead program directors to place more emphasis on the Level 2 exams, and it appears that is now happening.

USLME Step 2 CK scores are currently a “central focus in the U.S. residency competition,” Deng noted in a social media post. The average score of U.S. MD students was 250 in Match 2024. In highly competitive specialties — such as radiology, dermatology or orthopedics — the average score was above 255 (the diagnostic radiology average was 256, up from 247 in 2016).

“The focus on Level 2 CK compared to the previous focus on Level 1 means that greater importance is attached to clinical knowledge,” said Deng Radiology business via email on Friday. “Step 2 CK largely covers content learned in clinical clerkships, whereas Step 1 focused on the basic sciences learned in the preclinical curriculum. The content of Step 2 CK is more relevant to the practice of clinical radiology, so the shift in emphasis as a factor in residency selection should be welcomed as having apparent validity. In addition, Step 2 CK is taken later in medical school and represents a summative assessment that is closer in time to residency and therefore should correlate reasonably well with exam performance during residency. Students whose academic performance is improving or who are late in choosing a competitive specialty will also benefit from this change.”

Deng predicted this future trend in 2020, before the pass/fail criteria were set in Step 1. This was also done by the authors of a 2021 study published in Journal of the American College of Radiologywho also expected that the reputation of medical schools could gain “excessive influence.”

The higher-than-average Step 2 scores of U.S. medical students accepted into radiology reflect two factors, Deng said. Program directors “carefully select” applicants with higher scores, and applicants make their own selections based on their competitiveness.

“The latter factor is likely to be smaller than for Step 1 because there is little time for transition between the time a student learns their CK score for Step 2 and the time they must apply for residency,” he noted.

Deng’s advice to those seeking a place in the radiology program is: “Take Step 2 seriously.”

“The old adage for recommended preparation was, 'Two months for Step 1, two weeks for Step 2 CK, a number 2 pencil for Step 3,'” he said Radiology business“With the new USMLE scoring system, that is no longer the case. Preparation for Step 2 CK should include the use of spaced longitudinal revision to ensure high levels of retention of knowledge acquired over the course of the practicum year, culminating in more than two weeks of focused study for the test.”

And for those directing residency programs, “A score of 250 on Step 2 CK means the same today as it did when you were a medical student in terms of absolute mastery of medical knowledge,” Deng added. “However, the relative importance has changed significantly because students are studying harder for it. Four years ago, a score of 250 would have been above average, but today it is below the average for U.S. MD radiology applicants. The overall score distribution has shifted by about half a standard deviation, or 7 points, in that time.”

NRMP also released survey data from program directors on Aug. 8. The data shows that USMLE Step 2 CK scores now come before the personal statement and are among the top five factors in determining whether an applicant is invited to an interview, Deng noted. More than two-thirds of programs now require a Step 2 CK score for interview selection, an increase and “a direct result of the change from Step 1 to pass/fail reporting,” he added.

Further data can be found here. Deng is also co-author of a radiology The study will be published in September 2023 and shows that this year's residency application was the most competitive for the field since 2001.