Use of Curricular and Extracurricular Assessments to Predict Performance on the United States Medical Licensing Examination (USMLE) Step 1: A Multi-Year Study.

This paper studies student performance predictions based on the United States Medical Licensure Exam (USMLE) Step 1. Subjects were second-year medical students from academic years of 2002 through 2006 (n=711). Three measures of basic science knowledge (two curricular and one extracurricular) were evaluated as predictors of USMLE Step 1 scores. The USMLE Step 1 scores correlated with performance on Organ Systems (r=0.76), Human Structure (r=0.65), and CBSE (r=0.69). Accounting for 59% of variance in the USMLE Step 1 scores, Organ Systems course was a better predictor compared to Human Structure (R=42%), or CBSE (R=51%). Combined, the curricular and extracurricular courses accounted for nearly 70% of total variance in the Step 1 scores. The study concluded that curricular courses are good predictors of student performance on the USMLE Step 1, and their value as identifiers of students at risk for failure is promising. In 1994, the United States Medical Licensure Examinations (USMLE) became the only way in which allopathic physicians could obtain medical licensure in the United States (Swanson, Ripkey & Case, 1996). The USMLE consists of four separate examinations, Step 1, Step 2 Clinical Knowledge (CK), Step 2 Clinical Skills (CS), and Step 3 (Federation of State Medical Boards and National Board of Medical Examiners, 2008). Since a passing scores on the USMLE Steps 1 and 2 are required for a candidate to provide medical care under supervision, i.e., to enter residency training, many medical schools have adopted policies that require passage of Steps 1 and 2 for promotion and graduation. The National Board of Medical Examiners (NBME) has not set a limit to the number of times a student attempts to pass the USMLE Steps. However, a majority of medical schools and state medical For further information contact: Robyn A. Gandy | Lourdes College | 6832 Convent Blvd | Sylvania, OH 43560 | rgandy@lourdes.edu | TLAR, Volume 13, Number boards in the United States have established a limit to the number of times the exams can be taken. At many medical institutions, passing the USMLE Step 1 examination is required for a student’s promotion to the third year clinical clerkships and is particularly essential for graduation (Barzansky, Jonas, & Etzel, 1997). Our institution has required a passing performance on the USMLE Step 1 for graduation since 1992, and during the academic year 2001-2002, the policy was changed to make that a requirement for promotion to the third year clinical clerkships. The attention on student performance on the USMLE Step 1 has increased the need to identify accurate predictors of success. Several recent studies have revealed a number of variables (learning styles, performance on Medical College Admission Test (MCAT), student entry grade point average, age, gender, and race) that correlate with USMLE Step 1 performance (Case, Becker & Swanson, 1993; Elam & Johnson, 1994; Koenig, Sireci, & Wiley, 1998; Lynch, Woelfl, Steele & Hanssen, 1998; Swanson, Ripkey & Case, 1996; Wiley & Koenig, 1996). With the growing significance of students’ performance on the USMLE Step 1, research to identify significant predictors of success on this standardized test has also substantially increased. Several studies have previously identified variables such as age, gender, race, learning style, entry level grade point average, the performance on Medical College Admissions Test (MCAT), and undergraduate and graduate grades that correlate with USMLE Step 1 performance (Case et al., 1993; Elam & Johnson, 1994; Koenig et al., 1998; Lynch et al., 1998; Swanson et al., 1996; Wiley & Koenig, 1996). Use of students’ performance in the pre-clinical/basic science curricular courses as predictors of USMLE Step 1 scores has been under-explored although researchers have highlighted its importance (Holtman, Swanson, Ripkey, & Case, 2001). Previous research has indicated a correlation between students’ performance in the medical gross anatomy course and the USMLE Step 1 score (Peterson & Tucker, 2005). In this study we evaluate the ability of two curricular measures and one extracurricular measure in predicting performance in the USMLE Step 1 examination. The curricular measures evaluated in this study include the final percent scores achieved in two pre-clinical courses, Human Structure in the first year curriculum and Organ Systems in the second year curriculum. These two curricular measures were selected because they have the highest failure rate at our institution in the first two years of the curriculum. The Human Structure course is part of the first year curriculum; it integrates topics from gross anatomy, microanatomy, and embryology and contains gross dissections and microanatomy labs (The University of Toledo College of Medicine, 2008a). The Organ Systems course is the principal course in the second year of the curriculum. Topics are organized and based on nine major organ systems. These include the relevant physiology, pharmacology, and pathology for the following systems: Cardiovascular, respiratory, renal, electrolytes, hematopoietic, gastrointestinal, hepatic endocrinology, reproductive, skin, and skeletal (The University of Toledo College of Medicine, 2008b). The extracurricular measure evaluated as a predictor of USMLE Step 1 performance was scores on the Comprehensive Basic Science Examination (CBSE).