Predictors of USMLE Step 2 performance

United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) scores have been predictive of performance on in-training examinations in various fields, including internal medicine and surgery. As of 2022, USMLE Step 1, a basic science examination that has been studied as a strong predictor of Step 2 CK scores, has transitioned to pass/fail grading. This study aims to identify factors that predict performance on the Step 2 exam, focusing on comparisons with prior standardized test scores.

In this single-institution cross-sectional study, data from 600 medical students at the University of California San Francisco who matriculated between 2016 and 2019 were analyzed. Scores on the Medical College Admission Test (MCAT), Comprehensive Basic Sciences Examination (CBSE), Open-Ended Question (OEQ) in-house block exams, and National Board of Medical Examiners (NBME) subject examinations were collected. There were 12 OEQ exams taken during the preclinical foundational science blocks. Multivariable regression models were used to examine MCAT, CBSE, OEQ, and NBME subject exam score predictability of Step 2 CK score. Data were analyzed in February 2023.

A model containing the MCAT combined percentile, CBSE 1, CBSE 2, NBME subject exams for neurology, psychiatry, and surgery, and in-house block examinations for five different blocks accounted for 45% of variability in Step 2 score. The surgery NBME subject exams had the largest β coefficient (β = 0.212, P < .001). This study found that neurology, psychiatry, and surgery NBME exam scores are the strongest predictors of Step 2 performance.

In students who may be underperforming, these findings promote earlier interventions to optimize standardized test scores, which, with a well-rounded curriculum vitae, maximize chances of successful residency match.