Dropping the shelf examination: does it affect student performance on the United States Medical Licensure Examination Step 2?

OBJECTIVE: Does use of the pediatric shelf examination affect students' performance on the United States Medical Licensure Examination (USMLE) Step 2 pediatric subtest?
METHODS: The National Board of Medical Examiners Pediatrics Subject Examination (NBMEPSE) was used as the pediatric clerkship final examination at Brown Medical School through the 1996-97 academic year. The NBMEPSE was dropped in July 1997. Students' mean scores for the pediatric subtest of the USMLE Step 2 were compared for the years before and after the NBMEPSE was dropped. Performance on the internal medicine subtest of the USMLE Step 2 examination was used as a control because the National Board of Medical Examiners Internal Medicine Subject Examination (NBMEIMSE) remained the final examination in the internal-medicine clerkship.
RESULTS: USMLE Step 2 scores trended upward from 1993 to 2003. From 1993 to 1997, Brown medical students performed above the US/Canadian mean on both the USMLE Step 2 pediatrics and internal medicine subtests as well as on the overall examination. Students performed at or just below the mean on both the USMLE Step 2 pediatrics and internal medicine subtests from 1998 to 2001.
CONCLUSIONS: Dropping the shelf examination coincided with a decrease in performance on the USMLE Step 2 pediatric subtest in comparison with the US/Canadian mean. Similar decreases in performance in overall and USMLE Step 2 internal medicine subtest scores also occurred. Numerous confounding variables make it difficult to determine the effect of the shelf exam on Step 2 performance.