Why are Step 1 Scores So Important to Dermatology Residency Programs?

An original article in the January 2011 issue of the Journal of the American Academy of Dermatology (Fening K, Vander Horst AV, Zirwas M. Correlation of USMLE Step 1 scores with performance on dermatology in-training examinations. J Am Acad Dermatol 2011;64:102-106) indirectly addresses this issue. The authors concluded that USMLE Step 1 scores were “…moderately, significantly correlated…” with the annual in-service dermatology test administered by the American Board of Dermatology. Statistically, the USMLE Step 1 score accounted about 26% of the in-service examination score variability. Of course, the other 74% of exam variability was due to other factors (“…quality of instruction, type of curriculum and motivational factors…resident work hours, family responsibilities, or personal problems…”), but 26% is still huge. The authors pointed out that the limitation of their study was a small sample size, with only 5 dermatology residency programs surveyed (86 residents with Step 1 scores ranging from 177 to 266).

Some dermatology programs may worry about accepting applicants who may not ultimately pass their board certification examination following completion of residency, because board certification examination failure reflects poorly on the training institution and may raise accreditation issues by the ACGME. These authors noted that a previous Step 1 failure will make it difficult to get dermatology interviews (2008 NRMP data cited). They also noted that only about 7% of applicants with a Step 1 Score of 220 or lower matched into a dermatology residency (2009 NRMP data).