Objective:

This study aims to identify predictors of successful matches into U.S.-based neurology residency programs following the shift to pass-fail grading for USMLE Step 1.

Background:

Historically, USMLE Step 1 scores were crucial in residency selection. Recent trends, however, emphasize a holistic review, considering factors like resident well-being and program location over exam scores. Gaps remain in understanding the impact of virtual interviews, extracurriculars, and the experiences of international medical graduates (IMGs), particularly after the Step 1 grading change.

Design/Methods:

This retrospective study analyzed neurology residency applicant data from the Texas STAR database (2019–2024). Following IRB exemption, metrics such as research output, leadership roles, Step 2 scores, and program signaling were evaluated. ANOVA and T-tests were used to determine statistically significant predictors of match success.

Results:

Among 1,017 matched neurology applicants, the mean number of abstracts presented increased from 2018 (mean = 4.65, SD = 3.79, CI [3.89, 5.39]) to 2024 (mean = 5.63, SD = 3.89, CI [5.05, 6.22], p < 0.05). Leadership roles, publications, and research experiences increased until 2023 but declined in 2024. Volunteer experiences have decreased from 6.17 to 4.11 (p <0.01). Step 2 scores rose from 2018 (mean = 220.42) to 2023 (mean = 225), then decreased in 2024 (mean = 218.25). Clerkship honors fluctuated but peaked in 2024 (mean = 3.51, SD = 2.32, CI [3.15, 3.87]). Comparing unmatched applicants to matched applicants over time, clerkship honors has been the only continuous statistically significant factor for match success (p = 0.02). Program signaling became increasingly predictive, with 47.1% of 2024 applicants matching to a signaled program. No significant changes were found in gender, underrepresented minorities, or first-generation applicants.

Conclusions:

Following the transition to pass-fail Step 1, research output has become increasingly important whereas extracurriculars, clerkship honors and step 2 scores have remained important.