With the recent announcement that Step 1 score reporting will soon change to pass/fail, residency programs will need to reconsider their recruitment processes.


We (1) evaluated the feasibility of blinding residency programs to applicants' Step 1 scores and their number of attempts throughout the recruitment process; (2) described the selection process that resulted from the blinding; and (3) reviewed if a program's initial rank list, created before scores were known, would be changed before submission for the Match.


During the 2018–2019 and 2019–2020 recruitment seasons, all programs at a single sponsoring institution were invited to develop selection criteria in the absence of Step 1 data, and to remain blinded to this data throughout recruitment. Participating programs were surveyed to determine factors affecting feasibility and metrics used for residency selection. Once unblinded to Step 1 scores, programs had the option to change their initial rank lists.


Of 24 residency programs, 4 participated (17%) in the first year: emergency medicine, neurology, pediatrics, and psychiatry. The second year had the same participants, with the addition of family and community medicine and radiation oncology (n = 6, 25%). Each program was able to determine mission-specific qualities in the absence of Step 1 data. In both years, one program made changes to the final rank list.


It was feasible for programs to establish metrics for residency recruitment in the absence of Step 1 data, and most programs made no changes to final rank lists after Step 1 scores were known.

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Author notes

All authors are with the University of Arizona College of Medicine–Tucson. Kathy W. Smith, MD, is Associate Professor, Department of Psychiatry, and Assistant Dean of Student Affairs; Richard Amini, MD, is Professor, Department of Emergency Medicine, and Assistant Dean of Student Affairs; Madhulika Banerjee, BS, is a Fourth-Year Medical Student; and Conrad J. Clemens, MD, MPH, is Professor, Department of Pediatrics and Public Health, and Senior Associate Dean of Graduate Medical Education.