USMLE Step 2 Clinical Knowledge performance by disability, race, and ethnicity in U.S. medical students: A multi-site...

Area of Science:

• Medical Education
• Health Equity
• Standardized Testing

Background:

• USMLE Step 1 transitioned to pass/fail, increasing USMLE Step 2 CK's importance in residency selection.
• Concerns exist that reliance on Step 2 CK may worsen existing inequities for students with disabilities and marginalized identities.

Purpose of the Study:

• To investigate USMLE Step 2 CK performance differences based on disability status, race, ethnicity, and their intersections among U.S. medical students.

Main Methods:

• Cross-sectional analysis of the Pathways II dataset (2020-2023 cohorts) from nine U.S. MD-granting medical schools.
• Students with disabilities (registered with disability resource offices) were matched 1:2 with non-disabled peers.
• Multivariable linear regression models analyzed Step 2 CK score differences, adjusting for MCAT scores and clustering by school.

Main Results:

• Students with disabilities scored lower on Step 2 CK (mean 239.6) compared to non-disabled peers (mean 246.7).
• Students with ADHD, learning, or psychological disabilities scored 9-11 points lower (P < .001).
• Underrepresented in Medicine (URiM) students scored lower than White students; disparities were largest for URiM and Asian students with disabilities.

Conclusions:

• Significant disparities in Step 2 CK performance exist for medical students with disabilities, particularly those with cognitive disabilities and intersecting marginalized identities.
• Addressing structural barriers in assessment and accommodation is critical to promote equity in residency selection.