Recent studies have brought forth potential downstream implications of a binary reporting of the United States Medical Licensing Examination (USMLE) Step 1 score. 1 Rajesh A Asaad M Sridhar M. Binary reporting of USMLE step 1 scores: Resident perspectives. ,2 Lin LO Makhoul AT Hackenberger PN et al. Implications of pass/fail step 1 scoring: Plastic surgery program director and applicant perspective. Potential issues such as applicant selection for interviews, shifted focus to Step 2 CK, additional paradoxical stresses, and added barriers to international medical graduates compound the inherent stresses in applying to competitive surgical residencies.