Longitudinal Trend: How the Value of Research Has Changed Post‑Step 1 P/F

The narrative that Step 1 going pass/fail would “de-emphasize” metrics is wrong. The data show it mainly shifted the arms race toward research output and Step 2 scores.

The Baseline: Research Value Before Step 1 Went P/F

Before Step 1 flipped to pass/fail (officially for tests taken January 26, 2022 and after), program directors consistently rated board scores as the top screening variable. Research mattered, but it was a supporting actor, not the lead.

Let’s anchor with concrete numbers from NRMP Program Director Surveys and Charting Outcomes (pre-P/F, mostly 2018–2020):

• In 2018 NRMP PD Survey (for many competitive specialties):

  • 75–90%+ of programs cited USMLE Step 1 as a factor in offering interview.
  • Research was “very important” for competitive fields but less so than Step 1.

• For matched U.S. MD seniors in 2020 (pre-P/F), average number of research products (abstracts, presentations, publications) looked roughly like this (rounded from Charting Outcomes 2020):

Specialty	Abstracts/Presentations/Publications
Internal Medicine	~6
General Surgery	~7
Orthopedic Surgery	~12–13
Dermatology	~18–19
Neurosurgery	~23–24

Those numbers already looked high, but they were inflated by a long tail of hyper-productive applicants. Still, the signal was clear: research volume correlated with specialty competitiveness.

Pre-P/F, the implicit weighting for many competitive programs was:

• Step 1: primary numeric filter.
• Research: tie-breaker and evidence of academic potential, especially for academic programs.
• Step 2 CK, AOA, class rank, letters: important but secondary to Step 1 at the early screen.

Then Step 1 went pass/fail. Programs lost their easiest numerical sledgehammer.

What Actually Changed After Step 1 P/F

The belief that programs would suddenly shift to “holistic review” overlooks how overloaded PDs already were. When you get 800–1000 applications per position in some specialties, you will not read them all deeply. You will find new numeric proxies.

The data from NRMP’s 2021 and 2023 Program Director Surveys, combined with emerging match stats, show three consistent shifts:

1. Step 2 CK rose to become the primary numeric screen.
2. Research output increased, especially in competitive fields.
3. The relative importance of research increased for certain applicant groups (IMGs, low-tier schools, non-AOA) and certain specialties.

Let’s quantify a few of these.

Step 2 CK Replaces Step 1 at the Top, Research Moves Up a Tier

In the 2021 Program Director Survey (just before full P/F implementation but after the policy announcement), many PDs were already asked how they would adapt. The 2023 cycle gives a more accurate post-P/F picture.

Condensed pattern across competitive specialties (derm, ortho, neurosurgery, plastics, ENT):

• Step 2 CK:

  • 85–90% of programs now report using Step 2 CK to decide whom to interview.

  • Frequently rated in the top 2–3 most important factors.

• Research:

  • Still not #1, but its ranking relative to preclinical grades and AOA has moved up.
  • More programs now report having “minimum” or “expected” research thresholds for interview.

A simplified ranking trend looks like this:

Shift in Relative Weighting of Application Components (Competitive Specialties)

Category	Value
Pre-P/F: Step 1	10
Pre-P/F: Research	6
Post-P/F: Step 2 CK	10
Post-P/F: Research	8

Here the scale is conceptual (10 = highest relative weight). The key point: Step 2 fills Step 1’s vacuum, but research moves closer to the top tier of decision variables rather than staying in the background.

Trend in Research Output: Volume Creep

The most obvious metric to track is average research output per matched applicant over time. The full 2024 and 2026 Charting Outcomes data will make this clearer, but even comparing 2016, 2018, 2020, and early internal reports shows a consistent upward curve.

For highly academic specialties, rough trendline (US MD seniors, matched):

Approximate Trend in Average Research Outputs for Competitive Specialties

Category	Dermatology	Neurosurgery
2016	12	17
2018	15	20
2020	19	24
2022 (est.)	22	28

These are rounded approximations based on NRMP and specialty group reports, but the direction is robust: more research per matched applicant over time, with no evidence of a post-P/F drop.

Programs did not say, “We lost Step 1, let’s relax on research.” They said, “We lost Step 1, we need additional signals of seriousness and academic potential.” Research is one of the few scalable, documentable signals.

How the Value of Research Has Shifted by Specialty

The real story is not “research now matters” — it already mattered. The real story is the shape of that importance curve across specialties and applicant types.

High-Research Fields: From “Expected” to “Mandatory Signal”

Dermatology, neurosurgery, plastics, ENT, radiation oncology, and some academic internal medicine programs were already research-heavy. Post-P/F, the threshold for “competitive” quietly crept up.

Patterns I see when looking at recent matched cohorts (MD seniors):

• Dermatology:

  • Pre-P/F matched applicants: ~15–19 research products.
  • Post-P/F early cycles: reports from programs show many successful applicants with 20–30+ total works, including multi-year projects, at least 1–2 PubMed-indexed papers.

• Neurosurgery:

  • Pre-P/F: ~20–24 works, often including basic science.
  • Post-P/F: not unusual for serious applicants to list 30–40+ works, backed by 2+ years of longitudinal engagement at a neurosurgery department.

This is not just volume. The structure of research matters more now:

• Longitudinal involvement with a department (2+ years vs. a 4-week summer).
• Project ownership (first or second author vs. “Author #14” on a large registry paper).
• Specialty-specific work that demonstrates commitment.

Programs are more explicit that they see research as:

• A proxy for persistence.
• A test of whether you can contribute to their academic productivity.
• A substitute data point to justify ranking without Step 1.

Middle-of-the-Road Specialties: Subtle But Real Shift

For general surgery, internal medicine, EM, OB/GYN, and even pediatrics, research used to be a “nice-to-have unless you want academics.” That is fading.

Look at general surgery and IM matched US MD seniors pre vs. post:

• General Surgery (pre-P/F, 2020):

  • Matched US MD seniors: ~7 research outputs on average.

• General Surgery (early post-P/F pattern from program reports/interviews):

  • Top programs now see many applicants with 10–15+ items.
  • Dedicated research years are more common among those matching at high-prestige academic centers.

• Internal Medicine:

  • Pre-P/F average ~6.
  • Now: high-tier IM programs (Hopkins, MGH, UCSF, etc.) quietly expect at least several publications or serious scholarly products if you want a shot as an out-of-region applicant.

Not every community IM or surgery program cares deeply about research. But the competitive subset, which disproportionately influences applicant behavior, clearly does.

Lower-Research Specialties: Less Change, But Not Zero

Fields like family medicine, psychiatry (outside top academic centers), and many community-based programs still do not treat research as a central pillar. But even here, Step 1 P/F altered the dynamics.

Two concrete changes:

1. For IMGs and DOs targeting these specialties, research has become a differentiator when Step scores alone are not enough to stand out.
2. For academic subsets in these specialties, research provides justification to filter more aggressively when Step 2 CK distributions compress.

You see more FM and psych applicants listing QI projects, local poster presentations, or case reports simply because any scholarly activity now looks relatively more valuable without a numeric Step 1.

Who Benefited and Who Got Hurt by This Shift

The Step 1 P/F change did not treat everyone equally. It reweighted the portfolio in ways that help some applicant profiles and punish others.

Advantage: Students at Research-Heavy Institutions

The winners are obvious:

• Students at large academic medical centers with:
  • Established derm/neurosurg/ortho labs.
  • Full-time resident research coordinators.
  • Funding for summer or dedicated research years.

These students can rack up 10–20+ products relatively “systematically”:

• Multi-author retrospective chart reviews.
• Multi-site quality improvement initiatives.
• Pipeline into faculty projects that reliably yield publications.

When Step 1 was numeric, an applicant from a less-researchy state school with a 255 could still look strong against a 240 from a top-10 research powerhouse. Now, with P/F Step 1 and Step 2 CK often similarly high across both, the student with better research infrastructure wins more often.

Disadvantage: Late-Deciders and Non-Research Schools

Groups that are now at a measurable disadvantage:

• Late specialty deciders:

  • Somebody who discovers dermatology in late MS3 is severely behind peers who started derm research MS1–MS2. They have no way to quickly backfill 2–3 years of longitudinal work.

• Students from community or less research-focused medical schools:

  • Fewer home departments in ultra-competitive specialties.
  • Less access to funded, mentored projects.
  • Less institutional pressure to publish early.

• IMGs without access to U.S.-based research:

  • Previously, a high Step 1 could open doors without extensive U.S. research.
  • Now, the same IMG might need both high Step 2 CK and some form of U.S. scholarly output (often via unpaid observerships plus remote research).

The structural inequality in research access has become more expensive. Step 1 used to provide a clean, centralized metric that could partially offset weak research ecosystems. That lever is gone.

How Programs Actually Use Research Now

Programs rarely come out and say, “We require X publications.” But behind closed doors and, frankly, in applicant spreadsheets, patterns are obvious.

From interviews with residents and PDs and data patterns:

1. Screening Heuristic:

   • For competitive specialties, some programs use simple internal cutoffs such as:
     • At least 1–2 first-author specialty-specific papers or
     • ≥10 total research works for “serious” interview consideration, unless the applicant has very strong home institution ties.

2. Tie-Breaker Within the Interview Pool:

   • Step 2 CK, school reputation, and letters get you the interview.
   • Research productivity and fit (topic alignment with departmental strengths) decide where you end up on the rank list.

3. Signal of Fit for Academic vs Community Tracks:

   • For programs with explicit academic vs community tracks, research is the clearest signal that you want the academic lane.
   • Residents with more serious research backgrounds are more likely to be steered toward subspecialty fellowships and funded projects.

In other words: research used to be a “nice bonus” in many situations. Post-P/F, it acts as both a floor (you need enough to not look unserious) and a ceiling-raiser (it is one of the strongest levers to break out of the median pool).

The Longitudinal Trend: Where This Is Heading

You wanted longitudinal trend. Let us project forward, based on the last decade of data.

We have three overlapping curves from 2014–2024:

• Average Step 1 scores of matched applicants in competitive specialties climbed every cycle until P/F.
• Average research outputs per matched applicant also climbed every cycle.
• Once Step 1 went P/F (2022+), Step 2 CK scores took over the “climbing” role, but research output did not drop; it either stabilized at a high level or continued slow growth.

Conceptual Trend Lines: Scores vs Research Over Time

Category	Value
2014	3
2016	4
2018	5
2020	6
2022	7
2024 (proj)	8

Treat the vertical axis as “competitiveness pressure units.” Step 1 used to absorb much of this. Once that went P/F, pressure redistributed primarily to Step 2 CK and research.

Looking at this as an analyst, I do not see a credible scenario where research importance decreases in the next 5–10 years unless:

• NRMP and ACGME impose strict caps on application volume and interviews, AND
• There is a coordinated move to standardized, non-academic assessments (e.g., situational judgment tests) that PDs actually trust.

Neither is happening at scale yet. So:

• Expect research expectations to keep creeping up in competitive specialties.
• Expect a growing divide between applicants with early, structured research access and those without.
• Expect more formalized “research tracks,” “sub-internship research months,” and funded research years that essentially become prerequisites for top-tier spots.

Practical Implications for Current Applicants

Let me translate the trend into decisions you can control.

1. If you are M1–M2 and remotely considering a competitive specialty:

   • You should be starting research now, not MS3.
   • Prioritize longitudinal, mentored work in the specialty rather than disconnected one-off projects.

2. If you are at a less research-heavy school:

   • Leverage virtual collaborations, multi-institution registries, and national student research groups.
   • Aim for at least one substantial, completed project rather than chasing 10 half-finished case reports.

3. If you are already late in the game (MS3–MS4, no research, aiming high):

   • The data are blunt: your odds without research are worse post-P/F than they were when a stellar Step 1 might have compensated.
   • You may need to consider:
     • A dedicated research year, or
     • Adjusting specialty or program tier expectations.

4. For IMGs and DOs:

   • High Step 2 CK is necessary but less sufficient than it used to be when paired with a high Step 1.
   • U.S.-based, specialty-specific research is increasingly a quasi-requirement for competitive fields.

You cannot ignore the longitudinal trend and hope “holistic review” saves you. PDs are drowning in applications. They default to measurable, documented achievements. Research output is one of the most visible.

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FAQ

1. Did Step 1 going pass/fail reduce overall research pressure on applicants?
No. If anything, the aggregate data and specialty reports suggest the opposite. Research output has remained high or increased in competitive specialties, and its relative importance has grown as programs look for more non-test-score signals of academic potential and commitment.

2. Is a dedicated research year now mandatory for competitive specialties?
Not universally, but the proportion of matched applicants in fields like dermatology, neurosurgery, plastic surgery, and some surgical subspecialties who have taken a research year has grown. At top academic programs, a research year is approaching “expected” for many applicants, especially those without strong home-department connections.

3. For less competitive specialties, does research now matter a lot more post-P/F?
The shift is more modest. Community-focused programs in family medicine, psychiatry, and pediatrics still do not prioritize research to the same extent. However, for academic tracks or for applicants with weaker Step 2 CK scores or coming from less-known schools, research has become a more valuable differentiator than it was when Step 1 provided a strong numeric signal.