The association between United States Medical Licensing Examination scores and clinical performance in medical students

Abstract

Purpose: United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores are frequently used to evaluate applicants to residency programs. Recent literature questions the value of USMLE scores for evaluation of residency applicants, in part due to a lack of evidence supporting a relationship with clinical performance. This study explored the relationship between USMLE scores and medical students’ clinical performance, as measured by the count of honors grades received in core clinical clerkships.

Methods: USMLE Step 1 and Step 2 CK scores and number of honors grades per student in seven core clinical clerkships were obtained from 1,511 medical students who graduated in 2013–2017 from two medical schools. The relationships between variables were analyzed using correlation coefficients, independent-samples t-tests, and hierarchical multiple regression.

Results: Count of honors grades correlated with both Step 1 (R=0.480, P<0.001) and Step 2 CK (R=0.542, P<0.001). After correcting for gender, institution, and test-taking ability (using MCAT scores as a proxy for test-taking ability) in a hierarchical multiple regression model, Step 1 and Step 2 CK scores together explained 22.2% of the variance in count of honors grades.

Conclusion: USMLE Step 1 and Step 2 CK scores moderately correlate with the number of honors grades per student in core clinical clerkships. This relationship is maintained even after correcting for gender, institution, and test-taking ability. These results indicate that USMLE scores have a positive linear association with clinical performance as a medical student.

Keywords:

• United States Medical Licensing Exam
• clinical performance
• residency application
• correlation
• hierarchical multiple regression

Acknowledgments

The authors wish to thank the Medical Education Outcomes Center at the University of Minnesota Medical School and Matthew Edwards, registrar at the University of Iowa Carver College of Medicine, for their support in the data collection portion of this study. The University of Minnesota and the University of Iowa provided funding for the salaries of the researchers.

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Supplementary Materials

Table S1 Summary of hierarchical regression analysis for variables predicting count of honors grades received in core clinical clerkships for medical students graduating in 2013–2017 from institution A (N=790)

Table S2 Summary of hierarchical regression analysis for variables predicting count of honors grades received in core clinical clerkships for medical students graduating in 2013–2017 from institution B (N=721)