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

Charles M. Maxfield, J. Felipe Montano-Campos, 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. ReedLars J. Grimm

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives: 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. Methods: 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. Results: 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. Discussion: 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.

Original languageEnglish (US)
Pages (from-to)1572-1580
Number of pages9
JournalJournal of the American College of Radiology
Issue number11
StatePublished - Nov 2021


  • Radiology
  • Step 1
  • residency
  • selection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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