Predictors of USMLE Step 2 performance.

Area of Science:

• Medical Education
• Standardized Testing
• Medical Licensing Examinations

Background:

• United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) scores predict in-training exam performance.
• USMLE Step 1 transitioned to pass/fail grading in 2022.
• Identifying predictors for Step 2 CK is crucial for medical student assessment.

Purpose of the Study:

• To identify factors predicting USMLE Step 2 CK scores.
• To compare the predictive power of prior standardized test scores.
• To inform interventions for students potentially underperforming.

Main Methods:

• Cross-sectional study of 600 medical students (UCSF, matriculated 2016-2019).
• Collected scores for Medical College Admission Test (MCAT), Comprehensive Basic Sciences Examination (CBSE), in-house block exams (OEQ), and National Board of Medical Examiners (NBME) subject exams.
• Utilized multivariable regression models to assess score predictability.

Main Results:

• A model including MCAT percentile, CBSE scores, NBME subject exams (neurology, psychiatry, surgery), and in-house block exams explained 45% of Step 2 CK score variability.
• NBME subject exams in surgery demonstrated the strongest predictive value (β = 0.212, P < .001).
• Neurology, psychiatry, and surgery NBME exam scores emerged as the most significant predictors of Step 2 performance.

Conclusions:

• Prior standardized test performance, particularly NBME subject exams, predicts USMLE Step 2 CK scores.
• Findings support early interventions for underperforming students.
• Optimizing test scores enhances residency match success alongside a strong curriculum vitae.