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Is Poor Performance on NBME Clinical Subject Examinations Associated With a Failing Score on the USMLE Step 3 Examination?

Dong, Ting PhD; Swygert, Kimberly A. PhD; Durning, Steven J. MD, PhD; Saguil, Aaron MD, MPH; Zahn, Christopher M. MD; DeZee, Kent J. MD; Gilliland, William R. MD; Cruess, David F. PhD; Balog, Erin K. MD; Servey, Jessica T. MD; Welling, David R. MD; Ritter, Matthew MD; Goldenberg, Matthew N. MD; Ramsay, Laura B. MD; Artino, Anthony R. Jr. PhD

doi: 10.1097/ACM.0000000000000222
Research Reports

Purpose: To investigate the association between poor performance on National Board of Medical Examiners clinical subject examinations across six core clerkships and performance on the United States Medical Licensing Examination Step 3 examination.

Method: In 2012, the authors studied matriculants from the Uniformed Services University of the Health Sciences with available Step 3 scores and subject exam scores on all six clerkships (Classes of 2007–2011, N = 654). Poor performance on subject exams was defined as scoring one standard deviation (SD) or more below the mean using the national norms of the corresponding test year. The association between poor performance on the subject exams and the probability of passing or failing Step 3 was tested using contingency table analyses and logistic regression modeling.

Results: Students performing poorly on one subject exam were significantly more likely to fail Step 3 (OR 14.23 [95% CI 1.7–119.3]) compared with students with no subject exam scores that were 1 SD below the mean. Poor performance on more than one subject exam further increased the chances of failing (OR 33.41 [95% CI 4.4–254.2]). This latter group represented 27% of the entire cohort, yet contained 70% of the students who failed Step 3.

Conclusions: These findings suggest that individual schools could benefit from a review of subject exam performance to develop and validate their own criteria for identifying students at risk for failing Step 3.

Dr. Dong is assistant professor, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Swygert is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania.

Dr. Durning is professor, Department of Medicine and Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Saguil is assistant dean for recruitment and admissions, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Zahn is professor and chair, Department of Obstetrics and Gynecology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. DeZee is associate professor, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Gilliland is professor, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Cruess is professor, Department of Preventive Medicine and Biometrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Balog is assistant professor, Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Servey is assistant professor, Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Welling is associate professor, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Ritter is associate professor, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Goldenberg is assistant professor, Department of Psychiatry, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Ramsay is assistant professor, Department of Obstetrics and Gynecology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Artino is associate professor, Department of Preventive Medicine and Biometrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Please see the end of this article for information about the authors.

Funding/Support: This study was part of the USU Long-Term Career Outcome Study. It was supported by an intramural grant from the dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Other disclosures: None reported.

Ethical approval: This study was approved by the institutional review board of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Disclaimer: The authors, with the exception of Dr. Swygert, are U.S. government employees. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the F. Edward Hébert School of Medicine, the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. government.

Correspondence should be addressed to Dr. Dong, Uniformed Services University of the Health Sciences, Department of Medicine, 4301 Jones Bridge Rd., Bethesda, MD 20814; telephone: (571) 303-8109; e-mail: ting.dong@usuhs.edu.

© 2014 by the Association of American Medical Colleges