Despite the fact that USMLE Step 1 was designed as a licensing exam, it is common practice for program directors to use the score as a means of comparing candidates to one another. Concordant with the suggestion of holistic review is the recent announcement from the US Licensing Medical Exam (USMLE) that Step 1 scores will soon be reported as pass/fail. This increase is occurring when programs are being asked to review applicants in a more holistic manner, and this year, to interview candidates virtually. In recent years, the total number of applicants, as well as the average number of applications per medical school graduate have increased in all specialties, making the process increasingly onerous. Residency program leadership must sift through myriad resources about potential applicants in their decision-making process regarding whom to invite and rank for residency slots. The residency selection process has never been so complex. A better understanding of end-users’ perceptions of the MSPE offers the UME community an opportunity to transform the MSPE into a highly valued, trusted document of communication. Despite this, continued mistrust of the MSPE persists. MSPE end-users across a variety of specialties utilize this complex document in different ways and value it differentially in their decision-making processes. Overwhelmingly, respondents suggested that including comparative performance and/or class rank would make the MSPE more useful once USMLE Step 1 becomes pass/fail. Performance in the internal medicine clerkship was rated as the most influential while neurology and psychiatry performances were rated as less influential. Professionalism was rated as the most important component and noteworthy characteristics among the least important in the decision-making process. Slightly less than half agreed or strongly agreed that they trust the information to be an accurate representation of applicants, though slightly more than half agree that the MSPE will become more influential once USMLE Step 1 becomes pass/fail. Approximately 1/3 of end-users stated that the MSPE is very or extremely influential in their initial screening process. Usage of the MSPE varied among specialties. Eight percent of all programs (364/4675) responded to the survey, with most respondents being program directors. Of the 28 specialties surveyed, at least one response was received from 26 (93%). The final survey was distributed to residency programs across 28 specialties in 2020 via the main contact on the ACGME listserv. A survey instrument including quantitative and qualitative measures was developed and piloted. To understand the perspective and usage of the MSPE across multiple medical specialties now and in anticipation of the planned changes in USMLE Step 1 score-reporting. The Medical Student Performance Evaluation (MSPE) is an important tool of communication used by program directors to make decisions in the residency application process.
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