USMLE Step 2 CK: Best Predictor of Multimodal Performance in an Internal Medicine Residency

Abstract

Background Internal medicine (IM) residency programs receive information about applicants via academic transcripts, but studies demonstrate wide variability in satisfaction with and usefulness of this information. In addition, many studies compare application materials to only 1 or 2 assessment metrics, usually standardized test scores and work-based observational faculty assessments.Objective We sought to determine which application materials best predict performance across a broad array of residency assessment outcomes generated by standardized testing and a yearlong IM residency ambulatory long block.Methods In 2019, we analyzed available Electronic Residency Application Service data for 167 categorical IM residents, including advanced degree status, research experience, failures during medical school, undergraduate medical education award status, and United States Medical Licensing Examination (USMLE) scores. We compared these with post-match residency multimodal performance, including standardized test scores and faculty member, peer, allied health professional, and patientlevel assessment measures. ResultsIn multivariate analyses, USMLE Step 2 Clinical Knowledge (CK) scores were most predictive of performance across all residency performance domains measured. Having an advanced degree was associated with higher patient-level assessments (eg, physician listens, physician explains, etc). USMLE Step 1 scores were associated with in-training examination scores only. None of the other measured application materials predicted performance. Conclusions USMLEStep 2 CK scores were the highest predictors of residency performance across a broad array of performance measurements generated by standardized testing and an IM residency ambulatory long block.

Relationship Between Standardized Test Scores and Board Certification Exams in a Combined Internal Medicine/Pediatrics Residency Program

“…Step 2 Clinical Knowledge (CK) scores significantly correlated with patient ratings, ABIM-CE passage, and ITE, while Step 1 scores predicted ITE scores [10].…”

Perspectives on Transitioning Step 1 of the United States Medical Licensing Examination to a Pass/Fail Scoring Model: Defining New Frameworks for Medical Students Applying for Residency

“…Step 2 CK has more clinical relevance, but, unlike Step 1, its validity has not been established for residency programs. A study published by Sharma et al, 14 noted that the USMLE Step 2 CK was the best predictor of residency performance on standardized testing during and after residency, as well as clinical performance from multiple perspectives during a yearlong block continuity experience. This study has many limitations, and it would be challenging to apply it to a holistic selection process.…”

Stepping Up: How U.S. Neurosurgery Training Programs Can Innovatively Assess Resident Applicants in a Post-Step 1 World

“…To this end, related studies from the internal medicine literature have identified the Step 2 CK examination as the strongest predictor of multimodal resident performance assessments. 8 Unsurprisingly, increasing emphasis on Step 2 CK after Step 1 converts to Pass/Fail has already been affirmed widely in a survey of neurosurgery program directors. Although the potential for excessively weighting a single assessment remains in play with Step 2 CK, alternative approaches, such as weighted or composite scores incorporating related metrics such as the numerical NBME shelf scores from key rotations (e.g., surgery, neurology, medicine), may have a role in offsetting this bias.…”