Matthew Fitz1, William Adams2, Marc Heincelman3, Steve Haist4, Karina Whelan5, LeeAnn Cox6, Uyen-Thi Cao7, Susan Hingle8, Amanda Raff9, Bruce Houghton10, Janet Fitzpatrick11, Ryan Nall12, Jennifer Foster13, Jonathan Appelbaum14, Cyril Grum15, Anna Donovan16, Stuart Kiken17, Reeni Abraham18, Marti Hlafka8, Chad Miller19, Saurabh Bansal20, Douglas Paauw21, Cindy J Lai22, Amber Pincavage23, Gauri Agarwal24, Cynthia Burns25, Horatio Holzer26, Katie Lappé27, Viju John28, Blake Barker18, Nina Mingioni29, Deepti Rao30, Laura Zakowski31, Chayan Chakraborti32, Winter Williams33, William Kelly34. 1. Dept of Medicine, Loyola University Stritch School of Medicine, Building 102, Room 7614, Maywood, IL, 60153, USA. mfitz1@lumc.edu. 2. Loyola University Stritch School of Medicine, Maywood, IL, USA. 3. Medical University of South Carolina, Charleston, SC, USA. 4. University of Kentucky College of Medicine-Northern Kentucky Campus, Highland Heights, KY, USA. 5. University of North Carolina School of Medicine, Chapel Hill, NC, USA. 6. Indiana University School of Medicine, Indianapolis, IN, USA. 7. Texas A&M Health Science Center College of Medicine, Bryan, TX, USA. 8. Southern Illinois School of Medicine, Springfield, IL, USA. 9. Albert Einstein College of Medicine, Bronx, NY, USA. 10. Creighton University School of Medicine, Omaha, NE, USA. 11. Drexel University College of Medicine, Philadelphia, PA, USA. 12. University of Florida College of Medicine, Gainesville, FL, USA. 13. Florida Atlantic University Charles E Schmidt College of Medicine, Boca Raton, FL, USA. 14. Florida State University College of Medicine, Tallahassee, FL, USA. 15. University of Michigan Medical School, Ann Arbor, MI, USA. 16. University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA. 17. Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA. 18. University of Texas Southwestern Medical School, Dallas, TX, USA. 19. Tulane University Medical School, New Orleans, LA, USA. 20. University of Illinois College of Medicine, Peoria, IL, USA. 21. University of Washington School of Medicine, Seattle, WA, USA. 22. School of Medicine, University of California, San Francisco, San Francisco, CA, USA. 23. University of Chicago Pritzker School of Medicine, Chicago, IL, USA. 24. University of Miami Miller School of Medicine, Miami, FL, USA. 25. Wake Forest School of Medicine, Winston-Salem, NC, USA. 26. Icahn School of Medicine at Mt. Sinai, New York City, NY, USA. 27. University of Utah School of Medicine, UT, Salt Lake City, USA. 28. Rush Medical College, Chicago, IL, USA. 29. Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA. 30. University of New Mexico School of Medicine, Albuquerque, NM, USA. 31. University of Wisconsin School of Public Health, Madison, WI, USA. 32. Tulane University School of Medicine, New Orleans, LA, USA. 33. UAB Heersink School of Medicine, Birmingham, AL, USA. 34. Uniformed Services University, Bethesda, MD, USA.
Abstract
BACKGROUND: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. DESIGN: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis. RESULTS: On multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78). CONCLUSION: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.
BACKGROUND: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. DESIGN: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis. RESULTS: On multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78). CONCLUSION: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.
Authors: Amber T Pincavage; Mark J Fagan; Nora Y Osman; Debra S Leizman; Deborah DeWaay; Camilla Curren; Nadia Ismail; Karen Szauter; Michael Kisielewski; Amy W Shaheen Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Christopher M Zahn; Aaron Saguil; Anthony R Artino; Ting Dong; Gerald Ming; Jessica T Servey; Erin Balog; Matthew Goldenberg; Steven J Durning Journal: Acad Med Date: 2012-10 Impact factor: 6.893
Authors: David Hirsh; Elizabeth Gaufberg; Barbara Ogur; Pieter Cohen; Edward Krupat; Malcolm Cox; Stephen Pelletier; David Bor Journal: Acad Med Date: 2012-05 Impact factor: 6.893