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We believe these limited forms of assessment, while valuable, are not enough to fully capture a physician's competence. Many of these studies compare application materials to only 1 or 2 other assessment metrics, usually standardized test scores and work-based observational faculty assessments.

19 – 21 Despite the heavy reliance on USMLE Step 1 scores, recent studies suggested USMLE Step 2 Clinical Knowledge (CK) actually may be a better predictor of ITE scores and resident performance overall. 12 – 18 Studies that have shown a connection between USMLE Step 1 and global performance generally have weak associations, 19, 20 limited scope of comparisons (ie, just faculty assessment), 21 or were in fields other than IM. 11 Most studies show USMLE Step 1 largely predicts future test scores, such as in-training examinations (ITEs) and specialty board examinations, but not competency domains such as communication, teamwork, and professionalism. 1, 9, 10īecause of these issues, use of USMLE Step 1 scores as a prominent applicant selection tool has intensified in recent years.

One small study showed successful residents had more LOR comments about excellence in the Accreditation Council for Graduate Medical Education core competency areas of patient care, medical knowledge, and interpersonal and communication skills, 8 but other studies found little value of LOR altogether for residency selection or resident performance. 6, 7 Evidence is mixed about LOR predictive value. 1 – 5 The MSPE, despite recent efforts at improvement, often lacks transparency and standardization, making it difficult to interpret during the selection process. However, studies across many specialties demonstrate wide variability in satisfaction and usefulness of this information in selecting residents during the application process. Internal medicine (IM) residency programs receive large amounts of information about applicants, including academic transcripts, the Medical Student Performance Evaluation (MSPE), letters of recommendation (LORs), and United States Medical Licensing Examination (USMLE) scores.