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Related Experiment Video

Updated: Jan 17, 2026

Constructing and Visualizing Models using Mime-based Machine-learning Framework
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Are Physicians' USMLE Scores Associated With Patient Mortality? A Multilevel Modeling Approach to USMLE Predictive

Mohammed A A Abulela1,2,3, Daniel P Jurich4, Alex J Mechaber4

  • 1Office of Assessment and Evaluation University of Minnesota Medical School Minneapolis Minnesota USA.

Health Science Reports
|September 19, 2025
PubMed
Summary
This summary is machine-generated.

Physician and hospital factors explain patient mortality variability. Higher United States Medical Licensing Examination (USMLE) scores correlate with reduced patient mortality, supporting exam validity for medical licensure.

Keywords:
USMLEmortalitymultilevel modelingpatient outcomespredictive validity

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Area of Science:

  • Medical Education
  • Health Services Research
  • Biostatistics

Background:

  • Assessing high-stakes licensing exams requires evidence linking scores to clinical outcomes.
  • Understanding physician vs. hospital contributions to patient mortality is crucial.
  • Previous research lacked insight into USMLE scores' association with patient mortality via multilevel modeling.

Purpose of the Study:

  • To quantify variability in patient in-hospital mortality attributed to physicians and hospitals.
  • To investigate the association between physicians' United States Medical Licensing Examination (USMLE) composite scores and patient mortality.
  • To provide validity evidence for the USMLE exam in medical licensure decisions.

Main Methods:

  • Utilized deidentified hospitalization data from 150,907 patients across 170 hospitals and 1744 physicians.
  • Employed multilevel logistic regression with random intercepts and hierarchical models to analyze nested data.
  • Controlled for patient, physician, and hospital covariates in seven fitted models.

Main Results:

  • Physicians accounted for approximately 5% and hospitals for 12% of patient mortality variability.
  • A one standard deviation increase in USMLE composite score predicted a 6% reduction in patient mortality (OR 0.94; 95% CI 0.89–0.99).
  • Results were adjusted for patient, physician, and hospital characteristics.

Conclusions:

  • Physician and hospital factors significantly contribute to patient mortality variations.
  • Higher USMLE composite scores are associated with lower in-hospital patient mortality.
  • Findings provide additional validity evidence for the USMLE exam, supporting its use for licensure.