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The Impact of Internal Medicine Clerkship Characteristics and NBME Subject Exams on USMLE Step 2 Clinical Knowledge Exam Performance
Journal article   Open access   Peer reviewed

The Impact of Internal Medicine Clerkship Characteristics and NBME Subject Exams on USMLE Step 2 Clinical Knowledge Exam Performance

Matthew Fitz, William Adams, Marc Heincelman, Steve Haist, Karina Whelan, LeeAnn Cox, Uyen-Thi Cao, Susan Hingle, Amanda Raff, Bruce Houghton, …
Journal of general internal medicine : JGIM, v 37(9), pp 2208-2216
2022
url
https://doi.org/10.1007/s11606-022-07520-6View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open

Abstract

Internal Medicine Medicine Medicine & Public Health Original Research
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 ( M diff = −3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK ( M diff = 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.

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Collaboration types
Domestic collaboration
Web of Science research areas
Health Care Sciences & Services
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