Related Experiment Video
Updated: Nov 2, 2025
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Exploring the Association Between USMLE Scores and ACGME Milestone Ratings: A Validity Study Using National Data From
Stanley J Hamstra1, Monica M Cuddy2, Daniel Jurich3
1S.J. Hamstra was vice president, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, at the time of writing, and is now professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada, and adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0680-366X .
Purpose:
The United States Medical Licensing Examination (USMLE) sequence and the Accreditation Council for Graduate Medical Education (ACGME) milestones represent 2 major components along the continuum of assessment from undergraduate through graduate medical education. This study examines associations between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and ACGME emergency medicine (EM) milestone ratings.
Method:
In February 2019, subject matter experts (SMEs) provided judgments of expected associations for each combination of Step examination and EM subcompetency. The resulting sets of subcompetencies with expected strong and weak associations were selected for convergent and discriminant validity analysis, respectively. National-level data for 2013-2018 were provided; the final sample included 6,618 EM residents from 158 training programs. Empirical bivariate correlations between milestone ratings and Step scores were calculated, then those correlations were compared with the SMEs' judgments. Multilevel regression analyses were conducted on the selected subcompetencies, in which milestone ratings were the dependent variable, and Step 1 score, Step 2 CK score, and cohort year were independent variables.
Results:
Regression results showed small but statistically significant positive relationships between Step 2 CK score and the subcompetencies (regression coefficients ranged from 0.02 [95% confidence interval (CI), 0.01-0.03] to 0.12 [95% CI, 0.11-0.13]; all P < .05), with the degree of association matching the SMEs' judgments for 7 of the 9 selected subcompetencies. For example, a 1 standard deviation increase in Step 2 CK score predicted a 0.12 increase in MK-01 milestone rating, when controlling for Step 1. Step 1 score showed a small statistically significant effect with only the MK-01 subcompetency (regression coefficient = 0.06 [95% CI, 0.05-0.07], P < .05).
Conclusions:
These results provide incremental validity evidence in support of Step 1 and Step 2 CK score and EM milestone rating uses.
Related Concept Videos
01:20Comparing the Survival Analysis of Two or More Groups
00:54Ratio Level of Measurement
A set of data measured using the ratio scale takes care of the ratio problem and provides complete information. Ratio scale data are like interval scale data, except they have a zero point and ratios can be calculated....