A Low-Resource Intervention to Improve Emergency Medicine NBME Scores: Risk Notification and Study Plan Submission

It is unclear what strategies are helpful to support medical students who are at risk of failing required clerkship final examinations, such as the commonly used National Board of Medical Examiners shelf exam (NBME). This study examined whether asking students who performed poorly on their practice Emergency Medicine NBME to create their own study plan, regardless of their chosen study method or resource, would result in better performance on the end of clerkship NBME.

700 students enrolled in a required Emergency Medicine (EM) clerkship were evaluated during the Academic Year (AY) before and after implementation of the study plan requirement (AY-2023 vs. AY-2024). In both AYs, a practice NBME examination was required in addition to the mandatory end-of-clerkship exam, but in AY-2024 students scoring 65 or below on the practice test were required to create a study plan without any specific resource or time-commitment requirements. We compared the relationship between practice and final NBME scores pre/post intervention, using mixed modeling regression for multivariable adjustment of confounders.

After implementation of the study plan requirement for students failing the practice test in AY-2024, both the overall NBME shelf exam scores and the rates of High Pass or Honors level final NBME scores rose. The difference in final exam scores between those failing the practice vs. passing it was dramatically smaller and no longer statistically significant between AY-2023 and AY-2024.

For medical students that failed the Emergency Medicine NBME practice exam, a simple intervention of notification of potential failure and instruction to develop a study plan was associated with improved outcomes on the final examination, even without any requirement for the format or intensity of the study plan.