Trends in the National Resident Matching Program: shifting applicant priorities in the setting of application limits and pass/fail Step 1 grading

Purpose: This study evaluated differences in expected and observed proportions of activities, average Step 2 scores, and abstracts, publications, and presentations since the adoption of a 10-experience maximum for residency applications and pass/fail Step 1 grading. Method: The authors queried National Resident Matching Program data for MD senior applicants from 2016 to 2024 across 22 specialties. Data included average Step 2 scores; research, work, and volunteer experiences; and number of research products for matched and unmatched students by specialty. Repeated-measures multilevel models were used to estimate the difference in observed outcome in 2024 and expected outcome based on trends from 2016 to 2022. The difference in the 2024 predicted and observed values was the estimated effects of pass/fail Step 1 grading and 10-experience maximum. Results: A total of 91,992 applicants were included in this analysis. In 2024, residency applicants reported higher average Step 2 scores (average observed, 249.62; average predicted, 248.48; b = 1.21; 95% confidence interval [CI], 0.39-2.03; P = .003) and higher average number of research outputs (average observed, 10.30; average predicted, 9.21; b = 1.10; 95% CI, 0.61-1.59; P < .001) than predicted. The proportion of reported research experiences was significantly higher than expected (observed, 0.360; model predicted, 0.254; odds ratio [OR], 1.67; 95% CI, 1.58-1.75), whereas reported work (observed, 0.445; model predicted, 0.506; OR, 0.85; 95% CI, 0.80-0.89) and volunteer (observed, 0.194; model predicted, 0.221; OR, 0.73; 95% CI, 0.69-0.76) experiences were significantly lower than expected (P < .001 for all). Conclusions: These results suggest potential downstream effects of the Step 1 shift to pass/fail and the imposition of a 10-experience limit on residency applications with an increase in scholarly output but a decrease in volunteer and work experiences. These findings challenge medical education leadership to evaluate whether these potential changes align with desired applicant qualities.