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In a multistep reaction mechanism, one of the elementary steps progresses significantly slower than the others. This slowest step is called the rate-limiting step (or rate-determining step). A reaction cannot proceed faster than its slowest step, and hence, the rate-determining step limits the overall reaction rate.
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Steps in the Modeling Process01:14

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Albert Bandura's theory of observational learning identifies four critical processes: attention, retention, motor reproduction, and reinforcement or motivation.
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meta-Directing Deactivators: –NO2, –CN, –CHO, –⁠CO2R, –COR, –CO2H01:13

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All meta-directing substituents are deactivating groups. These substituents withdraw electrons from the aromatic ring, making the ring less reactive toward electrophilic substitution. For example, the nitration of nitrobenzene is 100,000 times slower than that of benzene because of the deactivating effect of the nitro group. The first step in an electrophilic aromatic substitution is the addition of an electrophile to form a resonance-stabilized carbocation. The energy diagrams for...
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Updated: Feb 15, 2026

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Predictores del rendimiento en el examen Step 2 de la USMLE

Mandeep Kaur1, Matthew Y C Lin2, Adnan Alseidi2,3

  • 1University of California San Francisco School of Medicine, San Francisco, CA, United States.

Academic medicine : journal of the Association of American Medical Colleges
|February 14, 2026
PubMed
Resumen

Con el USMLE Step 1 ahora aprobado/reprobado, las puntuaciones de exámenes estandarizados previos como el MCAT y los exámenes de materia NBME predicen el rendimiento del USMLE Step 2 CK. Los exámenes NBME de cirugía, neurología y psiquiatría son predictores clave.

Palabras clave:
NBMEExamen Step 2 de la Licencia Médica de los Estados Unidosproblemas de licencia o certificaciónevaluación estandarizadaeducación médica de pregrado

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Área de la Ciencia:

  • Educación Médica
  • Evaluación Estandarizada
  • Exámenes de Licencia Médica

Sus antecedentes:

  • Las puntuaciones del Step 2 Clinical Knowledge (CK) del Examen de Licencia Médica de los Estados Unidos (USMLE) predicen el rendimiento en los exámenes de capacitación en servicio.
  • El USMLE Step 1 pasó a una calificación de aprobado/reprobado en 2022.
  • Identificar predictores para el Step 2 CK es crucial para la evaluación de estudiantes de medicina.

Objetivo del estudio:

  • Identificar factores que predicen las puntuaciones del USMLE Step 2 CK.
  • Comparar el poder predictivo de las puntuaciones de exámenes estandarizados previos.
  • Informar intervenciones para estudiantes que potencialmente tienen un rendimiento inferior.

Principales métodos:

  • Estudio transversal de 600 estudiantes de medicina (UCSF, matriculados entre 2016-2019).
  • Se recopilaron puntuaciones del Examen de Admisión a la Facultad de Medicina (MCAT), Examen Integral de Ciencias Básicas (CBSE), exámenes de bloque internos (OEQ) y exámenes de materia de la National Board of Medical Examiners (NBME).
  • Se utilizaron modelos de regresión multivariable para evaluar la predecibilidad de las puntuaciones.

Principales resultados:

  • Un modelo que incluye el percentil MCAT, las puntuaciones CBSE, los exámenes de materia NBME (neurología, psiquiatría, cirugía) y los exámenes de bloque internos explicó el 45% de la variabilidad de la puntuación del Step 2 CK.
  • Los exámenes de materia NBME en cirugía demostraron el valor predictivo más fuerte (β = 0.212, P < .001).
  • Las puntuaciones de los exámenes de materia NBME de neurología, psiquiatría y cirugía emergieron como los predictores más significativos del rendimiento del Step 2.

Conclusiones:

  • El rendimiento previo en exámenes estandarizados, particularmente los exámenes de materia NBME, predice las puntuaciones del USMLE Step 2 CK.
  • Los hallazgos respaldan intervenciones tempranas para estudiantes con bajo rendimiento.
  • La optimización de las puntuaciones de los exámenes mejora el éxito en la correspondencia de residencia junto con un sólido currículum vitae.