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

• DOI: 10.1016/j.jacr.2021.07.005
• Publication Date: 2021-07-29T05:27:49Z
• Authors: Charles M. Maxfield; J. Felipe Montano...; Teresa Chapman; Terry S. Desser; Christopher P. Ho; Nathan C. Hull; Hillary R. Kelly; Tabassum A. Kennedy; Nicholas A. Koontz; Emily E. Knippa; Theresa C. McLoud; James Milburn; Megan K. Mills; Desiree E. Morgan; Rustain Morgan; Ryan B. Peterson; Ninad Salastekar; Matthew P. Thorpe; Jessica G. Zarzour; Shelby D. Reed; Lars J. Grimm
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Humans; Internship and Residency; Educational Measurement; Radiology; Licensure; Schools, Medical; United States

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.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.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.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.