Exploring the Predictors of Post-Clerkship USMLE Step 1 Scores

Area of Science:

• Medical Education
• Medical Assessment

Background:

• The timing of the United States Medical Licensing Examination (USMLE) Step 1 exam in relation to clinical clerkships is a critical factor in medical student assessment.
• Understanding the predictors of USMLE Step 1 performance is essential for curriculum development and student support.

Purpose of the Study:

• To evaluate the impact of rescheduling the USMLE Step 1 exam to after the core clerkship year on student performance.
• To identify key pre-clerkship and clerkship variables that predict USMLE Step 1 scores.

Main Methods:

• A curriculum revision moved the USMLE Step 1 exam timing to post-clerkship.
• Descriptive statistics, ANCOVA, and stepwise linear regression were used to analyze data from 993 students across graduating classes before and after the change.
• Performance on National Board of Medical Examiners (NBME) exams and other academic metrics were assessed as predictors.

Main Results:

• USMLE Step 1 scores significantly increased after the curriculum change (mean 218 to 228, p < 0.01), even after controlling for MCAT and GPA.
• Pre-clerkship NBME exams collectively explained 57.0% of the variance in Step 1 scores.
• Overall, 66.4% of the variance in Step 1 scores was explained by a combination of pre-clerkship (NBME exams, Integrated Clinical Skills, MCAT) and clerkship (NBME subject exams) performance variables.

Conclusions:

• Rescheduling the USMLE Step 1 exam to after the clerkship year at this institution led to improved student performance.
• Pre-clerkship academic variables, particularly NBME customized basic science exams, are strong predictors of USMLE Step 1 success.
• Further research is needed to determine which specific clerkship experiences enhance performance on high-stakes licensing exams.