Escalating Research Output After the USMLE Step 1 Pass/Fail Transition: Implications for Equity, Ethics, and the Orthopaedic Residency Match.
Document Type
Article
Publication Date
6-11-2026
Publication Title
Journal of medical education and curricular development
Abstract
BACKGROUND: Orthopaedic surgery remains one of the most competitive residency specialties in the United States. Following the 2022 transition of USMLE Step 1 to pass/fail, research output (RO) has emerged as a prominent screening metric for residency selection. However, longitudinal trends in RO and the impact of this policy change on applicant behavior have not been fully characterized.
METHODS: Aggregate data from the National Resident Matching Program (NRMP) Charting Outcomes in the Match reports from 2014 to 2024 were analyzed for U.S. allopathic applicants to orthopaedic surgery. RO was defined as the self-reported number of peer-reviewed publications, abstracts, and poster presentations. Descriptive analyses were performed, and linear trend modeling compared RO growth before the Step 1 policy change (2014-2020) and after implementation (2022-2024).
RESULTS: Average RO among matched applicants increased by 255% over the study period, rising from 6.7 in 2014 to 23.8 in 2024. Unmatched applicants demonstrated similar upward trends but consistently reported lower RO. From 2014 to 2020, RO increased modestly at approximately 1.3 research products per year. Following the Step 1 pass/fail transition, RO growth accelerated sharply to approximately 5.2 products per year between 2022 and 2024. During this period, matched applicants experienced a 44.24% increase in RO and reported 32% higher RO than unmatched applicants by 2024.
CONCLUSIONS: Research output among orthopaedic residency applicants has risen dramatically over the past decade, with a pronounced acceleration following the Step 1 transition to pass/fail. These findings suggest a shift toward research quantity as a dominant selection metric, raising concerns regarding sustainability, equity, burnout, and ethical authorship practices. Ongoing ERAS reforms and adoption of holistic review frameworks may be necessary to ensure fair, meaningful, and transparent residency selection in orthopaedic surgery.
Volume
13
First Page
23821205261450081
Recommended Citation
Al-Marrawi Y, Burmeister JR, Al-Marrawi M, Al-Marrawi A, Zazay I, Hammad A. Escalating research output after the usmle step 1 pass/fail transition: implications for equity, ethics, and the orthopaedic residency match. J Med Educ Curric Dev. 2026 Jun 11;13:23821205261450081. doi: 10.1177/23821205261450081. PMID: 42291106
DOI
10.1177/23821205261450081
ISSN
2382-1205
PubMed ID
42291106