Understanding Score Trends in Clinical Science Subject Exams: A Longitudinal Study

The purpose of this study was to analyze performance on Clinical Science Subject Exams from academic years 2018-2019 through 2020-2021, across a large national sample of medical schools, to identify score trends and assess the impact of the COVID-19 pandemic on exam performance.

Using descriptive statistics, data visualization, and a series of multilevel models, we investigated patterns for neurology, family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. The analysis sample ranged from 36,791 to 54,770 examinees across specialties.

In 2018-2019, Subject Exam scores for almost all specialties followed a pattern of gradual increase as the academic year progressed. The average score was 2 to 3 points higher in May than in August of the previous calendar year for pediatrics, family medicine, internal medicine, and surgery. The averages for psychiatry and neurology also partially followed this trend. Patterns were somewhat more varied in Spring 2020 and Spring 2021. Despite some disruptions, the largest differences in average scores were around two points on the 0-100 scale. There were no major and sustained decreases.

Scores remained relatively stable over the three academic years studied, with small and intermittent score pattern disruptions appearing after March 2020. These disruptions included both higher-than-expected increases and decreases. Possible explanations include the intermittent nature of COVID-19 surges as well as changes in clerkship structure and resources. Scores did not decrease across the board, indicating a level of stability in exam performance despite the challenges posed by the pandemic.

The online version contains supplementary material available at 10.1007/s40670-025-02458-w.