Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination

Abstract

USMLE Step 2 CK scores provide useful information about the odds a physician will receive an official sanction for problematic practice behavior. These results provide validity evidence supporting current interpretation and use of Step 2 CK scores.

The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: a Population Cohort Study

“…While it is true that residency ratings of core competencies are inter-correlated, 27 our data add to growing evidence suggesting the amount of medical knowledge a physician has acquired, and maintains, is itself associated with better performance and care independent of other acts of professionalism. [28][29][30] This is particularly evident in the Bdose response^of examination scores now demonstrated in the United States Medical Licensing Examination, 31 certification 15 and MOC (Fig. 2); i.e., it is not just passing vs failing that is associated with fewer disciplinary actions; rather, those with demonstrably more medical knowledge (i.e., higher scores) have significantly fewer disciplinary actions than those with lower scores distributed in a score-dependent gradient.…”

Medical School Resourcing of USMLE Step 1 Preparation: Questioning the Validity of Step 1

“…However, further studies have identified USMLE Step 2 Clinical Knowledge (CK) as a better predictor of board pass rates [25]. Furthermore, USMLE Step 2 CK has been shown to negatively correlate with other meaningful indicators, such as future malpractice suits as a physician [26].…”

Malpractice Reform and the Sorting of New Physicians by Medical Human Capital

“…They find that patients assigned to the highly ranked teams experienced substantially lower costs (by as much as 25 percent)-the physicians in the lower-ranked program ordered more tests and took longer to order them-but no differences in health outcomes. Cuddy et al (2017), using a large sample of MDs graduating from medical school between 1994 and 2006, report that a one standard deviation increase in the Step 2 Clinical Knowledge score on the United States Medical Licensing Exam (USMLE) 8 is associated with about a 25 percent decrease in the likelihood of having a disciplinary action from a U.S. state medical board, after controlling for gender and the number of years since medical school graduation. While the evidence on medical education quality and postgraduate performance is scant, as Gardner and Vishwasrao (2010, p. 63) note, "[t]here is certainly a presumption that the quality of physicians is important to patients even if the effects on the outcome are not measured.…”