Overemphasis of USMLE and Its Potential Impact on Diversity in Otolaryngology

Pompeyo R. Quesada, Roberto N. Solis, Macaulay Ojeaga, Nuen T. Yang, Sandra L. Taylor, Rodney C. Diaz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Applicant demographics during the 2019-2020 residency cycle were evaluated to determine if strict utilization of United States Medical Licensing Examination (USMLE) scores in applicant selection could lead to a restriction in diversity. Study Design: Cross-sectional study. Setting: Otolaryngology residency applicants to a single institution. Methods: A total of 381 applicants were analyzed by age, gender, applicant type, race/ethnicity, USMLE scores, permanent zip code, and graduating medical school. Results: Among applicants, 37% were women; 9% were ≥30 years of age; 12% were underrepresented minorities (URMs); 71% to 81% had above-average socioeconomic surrogate markers; 22% were from a top 25 US News & World Report–ranked institution; and 81% were from an institution with an otolaryngology residency program. There was no increase in applicants who identified as URM from the 2015-2020 cycles. Multivariable regression analysis showed that applicants who were international medical graduates, URMs, and ≥30 years of age had lower Step 1 and Step 2 scores (P <.05). Applicants who identified as women had a lower Step 1 score, and those from top 25 National Institutes of Health–funded institutions had a higher Step 1 score; however, there was no difference when Step 2 scores were compared (P >.05). Conclusion: Our data suggest that in the pre–USMLE Step 1 pass/fail setting, strict adherence to USMLE scores may lead to disproportionally low recruitment of applicants who are women, ≥30 years of age, URMs, and from institutions without an otolaryngology residency program. We must implement measures against overemphasizing the absolute values of USMLE scores for a true holistic review of applicants, specifically to prevent an overemphasis on the USMLE Step 2 score.

Original languageEnglish (US)
JournalOTO Open
Issue number3
StatePublished - 2021
Externally publishedYes


  • diversity
  • inclusion
  • medical education
  • resident education
  • step 1
  • step 2

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery


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