Design, Implementation, and Evaluation of City as Text™ as a Place-Based Framework for Service-Learning in Pre-clinical Medical Education.

The United States Medical Licensing Examination (USMLE) is a three-step licensure examination in the U.S., assessing competencies across , , and . Historically, Step 1 had a three-digit scoring system and was often used by Residency Program Directors (RPDs) to shortlist candidates. However, Step 1 transitioned to a pass/fail format in January 2022. Due to this change, the medical education community anticipated focus shifting towards USMLE-CK (which continues to provide a three-digit score) to objectively evaluate students’ caliber and suitability for residency. This expectation was supported by the National Resident Matching Program (NRMP)’s annual , which highlighted an increasing reliance on USMLE-CK scores as a critical component in the residency application assessment process. In 2022, 96% of RPDs considered USMLE-CK scores informative when extending interview invitations to candidates from both U.S. medical graduates (USGs) and International Medical Graduates (IMGs) applicant groups. In comparison to the previous years (2022 vs 2021), dependence on this rose by 2% among USGs and more pronounced 6% for IMGs. These data points not only underscore the integral role of the USMLE-CK in the residency selection landscape but also reflects the near-consensus among RPDs regarding its value as a reliable and objective measure to shortlist the number of applications submitted to their program. The significance of this trend was further amplified in the context of the 2024 NRMP Match, with 44,853 certified applicants (highest number on record) vying for one of 41,503 PGY-1 or PGY-2 training positions amongst the 6,395 certified programs on offer. In such a competitive environment, the RPDs reliance on a quantifiable and objective metric like the USMLE-CK score has become naturally preferred, serving as a filter to manage the voluminous number of applications submitted to residency programs. From the student’s perspective, a survey of 4,649 prospective residency applicants, including US-MD, Doctor of Osteopathic Medicine (DO), and IMG students, found that knowing the minimum USMLE-CK or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 scores required by programs is highly desired. This was especially important for IMG applicants, with 65.48% highlighting it as key, compared to 18.57% of US-MD and 15.90% of DO applicants (P<.001).