Pass/Fail Step 1 Reshapes the Research Race for Top Dermatology Residency Spots

When the United States Medical Licensing Examination Step 1 switched from a three-digit numerical score to pass/fail, educators predicted that the change would ripple far beyond the testing hall. A new study published in the Archives of Dermatological Research suggests those predictions were correct. Researchers led by Hadar K. Shimshon of SUNY Downstate Health Sciences University examined the research productivity of applicants who matched into the nation’s top Doximity-ranked dermatology residency programs, comparing cohorts before and immediately after the scoring transition. Their findings paint a picture of a specialty in which publications have become an ever more central currency of competitiveness, even as the exam that once dominated application files lost its numerical power.

Dermatology has long been among the most competitive specialties in the National Resident Matching Program. With a limited number of positions, high board scores historically expected, and a lifestyle that attracts large applicant pools, the field has developed one of the most demanding unofficial credential portfolios in graduate medical education. Previous analyses, including work published in JAMA Dermatology, documented a steady rise in the research output of medical students matching into dermatology between 2007 and 2018, a trend some commentators have described as research fever. The new study asks whether that fever intensified once Step 1 scores could no longer differentiate applicants numerically.

The rationale for the investigation rests on a simple structural fact. Before the transition, a high Step 1 score served as a widely used screening filter, allowing program directors to rank candidates quickly and giving applicants a clear, if stressful, way to demonstrate academic strength. When scoring became binary, that signal disappeared. Students who might once have relied on a strong score to compensate for thinner research records suddenly faced a signaling vacuum, and many appear to have responded by accelerating their publication efforts. The SUNY Downstate team set out to quantify whether the applicants entering elite dermatology programs indeed became more research-productive in the immediate aftermath of the change.

Methodologically, the researchers constructed an applicant-level dataset by tracing publication records through PubMed, the publicly accessible bibliographic database maintained by the National Library of Medicine. By linking successful applicants to the top Doximity-ranked dermatology programs with their indexed scholarly records, the team could count manuscripts, characterize authorship positions, and compare productivity across the pre-transition and post-transition eras. The compiled dataset was analyzed to detect shifts in the volume and pattern of research output, with the authors reporting their comparisons in graphical form across two figures in the short report. The use of PubMed as the source of publication records means the analysis captures indexed journal articles, the most verifiable form of student research output.

The study’s central observation is that research productivity among applicants to top-ranked dermatology programs did not decline after Step 1 became pass/fail; rather, the pressure to publish appears to have persisted or grown in the immediate post-transition period. This aligns with what residency directors anecdotally report: when one differentiator is removed from the application, others expand to fill the space. Publications, particularly peer-reviewed manuscripts with meaningful authorship roles, offer a quantifiable, durable signal of initiative, intellectual curiosity, and the capacity to complete a long-term project, qualities that a pass/fail exam can no longer convey with any granularity.

The findings carry particular weight because dermatology sits at the extreme end of the competitiveness spectrum. Prior work by Behbahani and colleagues in the International Journal of Women’s Dermatology analyzed the number of manuscripts in successful dermatology applications and found that publications were a common feature of matched candidates. A related 2025 analysis by Abizadeh and colleagues, which included several of the same SUNY Downstate investigators, documented similar dynamics in ophthalmology, another highly competitive specialty that also experienced the Step 1 transition. Together, these studies suggest a broader pattern across competitive fields: the removal of numerical Step 1 scores has shifted, not lightened, the burden of differentiation onto other parts of the application.

That shift has consequences for equity. Research productivity is not distributed evenly across medical students. Access to mentorship, dedicated research time, institutional funding, and proximity to academic medical centers all shape a student’s ability to publish before applying. Students at resource-rich institutions with established dermatology departments can more easily find projects, co-authors, and submission support, while students at schools without such infrastructure face structural barriers. If publications become the dominant differentiator in the post-pass/fail era, the authors’ findings imply that the transition may have amplified existing inequities rather than reduced them, a concern echoed in a 2023 JAMA Dermatology commentary describing research fever in dermatology as a symptom of a larger problem within the specialty’s selection culture.

The study also speaks to the ongoing debate about holistic review in residency selection. Proponents of the Step 1 pass/fail change argued that it would reduce student stress, discourage rote test preparation, and encourage programs to evaluate candidates on a broader set of attributes, including clinical performance, letters of recommendation, and personal qualities. The SUNY Downstate results suggest that at least one intended consequence, a de-emphasis on credential accumulation, has not materialized in elite dermatology recruitment. Instead, the credential economy appears to have migrated from the exam score to the curriculum vitae, with students responding rationally to the incentives programs continue to reward.

For medical educators and advisors, the practical implications are immediate. Students targeting competitive specialties now need earlier and more deliberate research planning, ideally beginning in the preclinical years, to build a publication record that can withstand comparison in a post-transition applicant pool. Programs, meanwhile, face a choice: continue to reward publication counts, thereby sustaining the arms race, or develop more structured ways to assess the quality and authenticity of research experiences, such as standardized descriptions of the applicant’s actual role and contribution. The authors of the current study, funded by the SUNY Downstate Health Sciences University Dermatology Department, frame their work as a snapshot of a system in transition, and they note that longer-term follow-up across additional match cycles will be needed to determine whether the patterns observed immediately after the change persist, stabilize, or prompt reform in how dermatology programs select the next generation of specialists.

Subject of Research: Research productivity of applicants to top Doximity-ranked dermatology residency programs in the USA before and after the Step 1 pass/fail transition

Article Title: Research productivity among applicants into top Doximity-ranked dermatology programs in the USA before and immediately after step 1 transition to pass/fail scoring

Article References: Research productivity among applicants into top Doximity-ranked dermatology programs in the USA before and immediately after step 1 transition to pass/fail scoring. (n.d.). https://doi.org/10.1007/s00403-026-04893-0

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04893-0

Keywords: dermatology, residency match, Step 1 pass/fail, research productivity, medical education, NRMP, publications, Doximity rankings, USMLE, competitive specialties, PubMed, SUNY Downstate