Program Directors’ Selection Criteria for Urology Residency Match in a United States Medical Licensing Examination Step 1 Pass/Fail Era

Introduction: Program directors of urology residencies have historically weighted the United States Medical Licensing Examination Step 1 heavily to select interview candidates. In January 2022, the 3-digit Step 1 score changed to pass/fail, aiming to reduce the burden of examination preparation and promote more holistic review, yet, in doing so, abolished a key objective metric. This study examines the criteria now prioritized in the selection of urology candidates to interview. Methods: A survey was distributed to program directors of 150 nationally accredited urology residency programs, consisting of 26 factors across 4 domains: (1) academics, (2) extracurriculars, (3) virtual etiquette, and (4) applicant diversity. Respondents rated each factor on a 1 to 10 scale (from no importance to most important), with free-text options for additional input. Results: Forty-six program directors completed the survey. The top 5 factors were (1) urology letters of recommendation (mean ± SD, 8.58 ± 1.57), (2) signaling (8.56 ± 1.69), (3) virtual professionalism (7.33 ± 2.71), (4) completion of a subinternship at the director’s program (7.22 ± 2.20), and (5) camera on during virtual meetings (7.04 ± 2.75). Notably, a Step 2 score ≥ 250 (5.84 ± 2.45) ranked sixth among 9 academic factors. Conclusions: The shift to a pass/fail Step 1 has reshaped urology applicant selection, where Step 2 scores do not seem to replace Step 1 as a primary metric. The implications of these changes, including their impact on holistic application review and candidate selection, remain to be determined.