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Medical associations have intensified their efforts to identify effective methods for evaluating medical students for residency program selections due to various changes. Thus, a scoping review was performed to explore the terrain of assessments and validity/reliability evidence. Various databases were searched from 2004 to 2021 following PRISMA, and 218 empirical studies were identified. Despite the existence of contemporary validity theories for over two decades, there remains a need for greater education regarding the pivotal role of validity in conducting assessment research. While unilateral changes to USMLE alone will not “fix” the system and residency programs will continue to encounter challenges in differentiating applicants, these changes present opportunities for medical schools to validate assessments that are contextualized to their educational environments.