Predicting successful general surgery matching in a Step 1 pass/fail era: Analysis of the Texas STAR database

Am J Surg. 2025 Nov 12:116718. doi: 10.1016/j.amjsurg.2025.116718. Online ahead of print.

ABSTRACT

BACKGROUND: General surgery residency is a competitive match. USMLE Step1 became pass/fail in 2022. We sought to compare matched general surgery applicants between scored and pass/fail Step1 eras to elucidate possible shifts in residency applications.

METHODS: The Texas Seeking Transparency in Application to Residency database was queried from 2017 to 2024. Academic, extracurricular, geographic, and away rotation data were analyzed.

RESULTS: 1861 scored and 302 pass/fail Step1 applicants matched in general surgery. More pass/fail applicants scored ≥250 on Step2 (p ​= ​0.03). Pass/fail applicants had more honored clerkships (p ​= ​0.01). More pass/fail applicants completed away rotations; more away rotations were associated with more interviews (p ​= ​0.003), but not with matching at that program. Pass/fail applicants applied to more programs (p ​< ​0.001); they did not attend more interviews.

CONCLUSIONS: Pass/fail applicants demonstrated higher Step2 performance. They applied to more programs, did more away rotations, with similar interview success. This early analysis helps inform applicants into general surgery in the Step1 pass/fail era.

PMID:41260949 | DOI:10.1016/j.amjsurg.2025.116718