Medical Education Online ISSN: (Print) 1087-2981 (Online) Journal homepage: http://www.tandfonline.com/loi/zmeo20 The association of USMLE Step 1 and Step 2 CK scores with residency match specialty and location Jacqueline L. Gauer & J. Brooks Jackson To cite this article: Jacqueline L. Gauer & J. Brooks Jackson (2017) The association of USMLE Step 1 and Step 2 CK scores with residency match specialty and location, Medical Education Online, 22:1, 1358579, DOI: 10.1080/10872981.2017.1358579 To link to this article: http://dx.doi.org/10.1080/10872981.2017.1358579 © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Published online: 01 Aug 2017. Submit your article to this journal Article views: 627 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=zmeo20 Download by: [University of Minnesota Libraries, Twin Cities] Date: 09 October 2017, At: 05:58 MEDICAL EDUCATION ONLINE, 2017 VOL. 22, 1358579 https://doi.org/10.1080/10872981.2017.1358579 RESEARCH ARTICLE The association of USMLE Step 1 and Step 2 CK scores with residency match specialty and location Jacqueline L. Gauera and J. Brooks Jacksonb aUniversity of Minnesota Medical School, Minneapolis, MN, USA; bUniversity of Minnesota, Minneapolis, MN, USA ABSTRACT ARTICLE HISTORY Background: For future physicians, residency programs offer necessary extended training in Received 3 April 2017 specific medical specialties. Medical schools benefit from an understanding of factors that Accepted 17 July 2017 lead their students to match into certain residency specialties. One such factor, often used KEYWORDS during the residency application process, is scores on the USA Medical Licensing Exam Licensing exams; USMLE; (USMLE). residency; specialty; career Objectives: To determine the relationship between USMLE Step 1 and Step 2 Clinical planning Knowledge (CK) scores and students’ residency specialty match, and the association between both USMLE scores and state of legal residency (Minnesota) at the time of admission with students staying in-state or leaving the state for residency program. Design: USMLE scores and residency match data were analyzed from five graduating classes of students at the University of Minnesota Medical School (N = 1054). Results: A MANOVA found significant differences (p < 0.001) between residency specialties and both USMLE Step 1 and Step 2 CK scores, as well as the combination of the two. Students who matched in Dermatology had the highest mean USMLE scores overall, while students who matched in Family Medicine had the lowest mean scores. Students who went out of state for residency had significantly higher Step 1 scores (p = 0.027) than students who stayed in-state for residency, while there was no significant difference between the groups for Step 2 scores. A significant positive association was found between a student who applied as a legal resident of Minnesota and whether the student stayed in Minnesota for their residency program. Conclusions: Residency specialty match was significantly associated with USMLE Step 1 and USMLE Step 2 CK scores, as was staying in-state or leaving the state for residency. Students who were legal residents of the state at the time of application were more likely to stay in- state for residency, regardless of USMLE score. Abbreviations: CK: Clinical knowledge; COMLEX: Comprehensive Osteopathic Medical Licensing Examination; GME: Graduate medical education; NRMP: National Resident Matching Program; UME: Undergraduate medical education; USMLE: United States Medical Licensing Examination Introduction National Resident Matching Program (NRMP). One of the major goals of an undergraduate medical edu- In the USA, medical education is completed through cation institution is to prepare medical students for a two steps. The first step, undergraduate medical edu- successful residency match. cation (UME), is completed after a bachelor’s degree, Every residency program has different criteria for typically lasts four years, and is historically comprised determining whether to accept a candidate into their of a foundational sciences coursework phase and a Downloaded by [University of Minnesota Libraries, Twin Cities] at 05:58 09 October 2017 program. One frequently-used criterion is the applicant’s clinical phase (although the current trend is towards score on the United States Medical Licensing integration of the coursework and clinical experi- Examination (USMLE). The USMLE is a three-step ences). After UME, a student generally proceeds on examination sponsored by the Federation of State to graduate medical education (GME), often referred Medical Boards and the National Board of Medical to as ‘residency,’ for further training as a physician. Examiners (NBME) required for physician licensure for Since medical practice often requires in-depth and all physicians, regardless of training location, to practice specific knowledge and experience, residency pro- in the USA. Typically, for medical students receiving grams are focused on training physicians in specific training at Liaison Committee on Medical Education specialties, such as pathology, surgery, or psychiatry. (LCME) accredited institutions in the U.S. and Canada, Students are matched with a residency program in students take Step 1 of the USMLE at the end of the their preferred specialty through a competitive pro- second year of medical school, and Step 2 Clinical cess, referred to as ‘The Match,’ facilitated by the CONTACT J. Brooks Jackson [email protected] University of Minnesota, MC 293 C607, 420 Delaware St SE, Minneapolis, MN, USA. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 2 J. L. GAUER AND J. B. JACKSON Knowledge (CK) and Clinical Skills (CS) in the fourth important factor in the initial screening of appli- year of medical school. Together, Step 1 and Step 2 CK cants [6]. assess a physician’s ability to apply knowledge and con- The use of USMLE scores in the residency pro- cepts to provide safe and effective patient care. Step 1 gram selection process is generally well-supported in assesses whether medical students understand and are the literature, as multiple studies have found USMLE able to apply important concepts of basic science to scores to be related to several measures of success in medical practice, with special emphasis on principles residency programs. Particularly strong associations underlying modes of therapy, health, and disease. Step 2 have been found between USMLE scores and other CK further assesses health promotion and disease pre- exam-related measures of success, such as scores on vention and strives to devote attention to incorporating in-training examinations in specialties such as der- principles of clinical sciences and basic patient-centered matology [7], emergency medicine [8], general sur- skills for safe practices of medicine [1]. Since Step 3 is gery [9], and neurology and neurosurgery [10], as typically taken well after students have been matched to a well as across specialties in meta-analyses [11,12]. residency program, it does not play a role in residency Other positive associations were found between match decisions, and is therefore not analyzed in the USMLE scores and a resident’s likelihood of success- current study. The USMLE was not originally intended fully passing board examinations [12,13], especially to be used in selection decisions, but, as it is a rigorous on the first attempt [14,15]. On the other hand, standardized exam that is taken by almost every applicant USMLE scores tend to not be as strongly correlated who participates in the Match, many residency program with more subjective outcome measures, such as directors have found it to be a useful measure for com- supervisor and faculty evaluations [10,11,15]. paring candidates from various UME institutions. Although some researchers have argued that the The NRMP releases an annual report which validity argument for using USMLE scores in resi- includes the medians and interquartile ranges of dency program selection is ‘neither structured, coher- Step 1 and Step 2 CK scores for the applicants who ent, nor evidence-based’ due to the lack of association successfully or unsuccessfully matched in each resi- between USMLE scores and measures of clinical skill dency specialty. Since certain residency specialties are acquisition [16], and others warn of the possible more competitive than others, patterns can be found existence of racial bias when USMLE scores are in the USMLE scores of students accepted into each used in residency program selection decisions [17], different specialty [2]. These patterns indicate that the fact remains that USMLE scores are generally students may need higher USMLE scores to be suc- considered, by both applicants and program directors cessfully matched into certain specialties. Indeed, stu- alike, to be an important factor in the residency dents are often advised to consider their own USMLE program selection process. scores when deciding which specialties and programs Medical school leaders can benefit from an enhanced to rank. In one survey, students applying to residency understanding