Investigating the Relationship Between a Clinical Science Composite Score and USMLE Step 2 Clinical Knowledge and Step 3
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ORIGINAL RESEARCH
Investigating the Relationship Between a Clinical Science Composite Score and USMLE Step 2 Clinical Knowledge and Step 3 Performance Carol Morrison 1
&
Michael Barone 1 & Gregory Baker 1 & Linette Ross 1 & Seohong Pak 1
# International Association of Medical Science Educators 2020
Abstract Previous research has found a moderate relationship between performance on individual clinical science subject examinations and USMLE performance. Given the widespread use of the clinical science subject examinations and the need for measures of clinical knowledge that help predict performance on Steps 2 CK and 3 and performance in residency training, this study explores the use of composite scores based on clinical science subject examinations to predict clinical knowledge outcome measures. The data set included students who took all of the five most widely used clinical science subject examinations (medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery) between January 1, 2013, and December 31, 2017 (N = 65,516). Composite scores were calculated based on average equated percent correct scores across various combinations of clinical science subject examinations. Stepwise linear regression analyses were performed with composite score and Step 1 score as predictor variables and Step 2 CK score or Step 3 score as the dependent variable. In all cases, the proportion of variance explained (R2) by the composite score (0.62–0.65 for Step 2 CK score and 0.45–0.48 for Step 3 score) was greater than R2 for Step 1 by itself (0.52 for Step 2 CK score and 0.37 for Step 3 score). Logistic regression analyses found that higher composite scores were associated with a greater probability of passing Steps 2 CK and 3. Composite scores can be used alone or in conjunction with Step 1 to identify students at risk of failing Step 2 CK and/or Step 3 to facilitate remediation. Keywords Predictive validity . Clinical science assessment . Composite score
Introduction The National Board of Medical Examiners® (NBME®) clinical science subject examinations are primarily designed to assess performance at the end of traditional block clerkship rotations [1]. Most medical schools in the USA use several of the NBME clinical science subject examinations and incorporate scores as one component of final clerkship grades, with a weight generally ranging from 11% to 40% [2]. Previous research has shown that there is a moderate positive relationship between performance on individual clinical science subject examinations and performance on United States Medical Licensing Examination® (USMLE®) Step 1, Step 2 Clinical Knowledge (CK), and Step 3 [3–5]. This finding is expected
* Carol Morrison [email protected] 1
National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA 19104, USA
given that the subject examinations are developed using the same rigorous process as USMLE and item formats are similar to those used in USMLE [1]. In one study, Zahn et al. found moderate positive correlations of individual clinical
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