Predicting performance on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge using results from previous examinations

Abstract

BackgroundFinding early specific indicators of failure in the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) could be used to develop early interventions that could solve deficiencies and help at-risk students to ultimately attain a passing score. This study was aimed at determining if the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) could predict a passing score during the USMLE Step 1. We also assessed if the NBME Medicine Clinical Science Subject Examination (CSSE) or the USMLE Step 1 could predict passing scores during the USMLE Step 2 CK.MethodsGender and scores from 724 students who took the USMLE Step 1 were linked and analyzed with the scores of the NBME CBSE, the NBME Medicine CSSE, and the USMLE Step 2 CK using IBM-SPSS.ResultsThere were significant correlations between the scores from NBME CBSE and USMLE Step 1 (r=0.73, P≤0.001), between the scores from the NBME Medicine CSSE and the USMLE Step 2 CK (r=0.572, P≤0.001), and between the scores from the USMLE Step 1 and Step 2 CK (r=0.698, P≤0.001). Students with scores <66 in the NBME CBSE were less likely to approve the USMLE Step 1 on their first attempt (P≤0.00001). There was a significant correlation (r=0.684, P≤0.0001) between a score of ≥208 in the USMLE Step 1 and passing the Step 2 CK on the first attempt.ConclusionA score <66 in the NBME CBSE might indicate failure during the USMLE Step 1 first take. Similarly, a score <208 in the USMLE Step 1 might predict failure in the USMLE Step 2 CK.

Rate of USMLE Step 2 CK Scores Included on Orthopedic Surgery Applications and Associations With Step 1 Score

“…The exam scores are not a 1:1 conversion with a given percentile score represented by a higher three-digit Step 2 CK versus Step 1 score [ 9 ]. We suspected that our findings would be consistent with the literature showing Step 2 CK scores correlate significantly with Step 1 scores [ 10 - 12 ]. We were also interested in how scores varied grossly and by percentile rank from Step 1 to Step 2 CK.…”

“…Multiple possible explanations exist for this phenomenon including a ceiling effect for those test takers who scored sufficiently high on Step 1, the statistical variability associated with the USMLE examinations [9], or students with lower Step 1 scores were more motivated than those with higher scores to study for Step 2 CK, ultimately improving their performance compared to Step 1. As multiple studies have shown that scoring well on standardized tests predicts future standardized test success [10,12,16], the discrepancy between scoring differences reported in the present study suggests an element of effect modification or confounding or both. Importantly, the scoring change of Step 1 may affect both factors.…”

Predictors of Performance on USMLE Step 1

“…15 In addition, CBSE results with scores less than 66 were significantly associated with failure of USMLE Step 1. 22 deMogrAPhiCS Gender, student debt, underrepresented minority status, age, and clinical experience were predictors of USMLE Step 1 performance. 23 After controlling for MCAT scores and undergraduate GPAs, men scored 1.5 points higher on Step 1 than women.…”

Educational and Practical Implications of Step 1 Timing in the Context of COVID-19

“…Nonetheless, it is helpful to utilize shelf exam scores to monitor student progress and potential need for extra help during Step 1 studying time. Similarly, schools can gather information from the NBME Comprehensive Basic Science Exams, preclinical exams, and other assessments to help predict scores, and over time, develop predictive models to identify students who may need extra time or support during the Step 1 studying process [ 28 ].…”