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Medical Education Online

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The association of USMLE Step 1 and Step 2 CKscores 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 USMLEStep 1 and Step 2 CK scores with residency match specialty and location, Medical EducationOnline, 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 InformaUK Limited, trading as Taylor & FrancisGroup.

Published online: 01 Aug 2017.

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RESEARCH ARTICLE

The association of USMLE Step 1 and Step 2 CK scores with residency matchspecialty and locationJacqueline L. Gauera and J. Brooks Jacksonb

aUniversity of Minnesota Medical School, Minneapolis, MN, USA; bUniversity of Minnesota, Minneapolis, MN, USA

ABSTRACTBackground: For future physicians, residency programs offer necessary extended training inspecific medical specialties. Medical schools benefit from an understanding of factors thatlead their students to match into certain residency specialties. One such factor, often usedduring the residency application process, is scores on the USA Medical Licensing Exam(USMLE).Objectives: To determine the relationship between USMLE Step 1 and Step 2 ClinicalKnowledge (CK) scores and students residency specialty match, and the association betweenboth USMLE scores and state of legal residency (Minnesota) at the time of admission withstudents staying in-state or leaving the state for residency program.Design: USMLE scores and residency match data were analyzed from five graduating classesof students at the University of Minnesota Medical School (N = 1054).Results: A MANOVA found significant differences (p < 0.001) between residency specialtiesand both USMLE Step 1 and Step 2 CK scores, as well as the combination of the two. Studentswho matched in Dermatology had the highest mean USMLE scores overall, while studentswho matched in Family Medicine had the lowest mean scores. Students who went out ofstate for residency had significantly higher Step 1 scores (p = 0.027) than students who stayedin-state for residency, while there was no significant difference between the groups for Step 2scores. A significant positive association was found between a student who applied as a legalresident of Minnesota and whether the student stayed in Minnesota for their residencyprogram.Conclusions: Residency specialty match was significantly associated with USMLE Step 1 andUSMLE Step 2 CK scores, as was staying in-state or leaving the state for residency. Studentswho 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 MedicalLicensing Examination; GME: Graduate medical education; NRMP: National ResidentMatching Program; UME: Undergraduate medical education; USMLE: United States MedicalLicensing Examination

ARTICLE HISTORYReceived 3 April 2017Accepted 17 July 2017

KEYWORDSLicensing exams; USMLE;residency; specialty; careerplanning

Introduction

In the USA, medical education is completed throughtwo steps. The first step, undergraduate medical edu-cation (UME), is completed after a bachelors degree,typically lasts four years, and is historically comprisedof a foundational sciences coursework phase and aclinical phase (although the current trend is towardsintegration of the coursework and clinical experi-ences). After UME, a student generally proceeds onto graduate medical education (GME), often referredto as residency, for further training as a physician.Since medical practice often requires in-depth andspecific knowledge and experience, residency pro-grams are focused on training physicians in specificspecialties, such as pathology, surgery, or psychiatry.Students are matched with a residency program intheir preferred specialty through a competitive pro-cess, referred to as The Match, facilitated by the

National Resident Matching Program (NRMP). Oneof the major goals of an undergraduate medical edu-cation institution is to prepare medical students for asuccessful residency match.

Every residency program has different criteria fordetermining whether to accept a candidate into theirprogram. One frequently-used criterion is the applicantsscore on the United States Medical LicensingExamination (USMLE). The USMLE is a three-stepexamination sponsored by the Federation of StateMedical Boards and the National Board of MedicalExaminers (NBME) required for physician licensure forall physicians, regardless of training location, to practicein the USA. Typically, for medical students receivingtraining at Liaison Committee on Medical Education(LCME) accredited institutions in the U.S. and Canada,students take Step 1 of the USMLE at the end of thesecond year of medical school, and Step 2 Clinical

CONTACT J. Brooks Jackson JacksonB@umn.edu University of Minnesota, MC 293 C607, 420 Delaware St SE, Minneapolis, MN, USA.

MEDICAL EDUCATION ONLINE, 2017VOL. 22, 1358579https://doi.org/10.1080/10872981.2017.1358579

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 permitsunrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Knowledge (CK) and Clinical Skills (CS) in the fourthyear of medical school. Together, Step 1 and Step 2 CKassess a physicians ability to apply knowledge and con-cepts to provide safe and effective patient care. Step 1assesses whether medical students understand and areable to apply important concepts of basic science tomedical practice, with special emphasis on principlesunderlying modes of therapy, health, and disease. Step 2CK further assesses health promotion and disease pre-vention and strives to devote attention to incorporatingprinciples of clinical sciences and basic patient-centeredskills for safe practices of medicine [1]. Since Step 3 istypically taken well after students have beenmatched to aresidency program, it does not play a role in residencymatch decisions, and is therefore not analyzed in thecurrent study. The USMLE was not originally intendedto be used in selection decisions, but, as it is a rigorousstandardized exam that is taken by almost every applicantwho participates in the Match, many residency programdirectors have found it to be a useful measure for com-paring candidates from various UME institutions.

The NRMP releases an annual report whichincludes the medians and interquartile ranges ofStep 1 and Step 2 CK scores for the applicants whosuccessfully or unsuccessfully matched in each resi-dency specialty. Since certain residency specialties aremore competitive than others, patterns can be foundin the USMLE scores of students accepted into eachdifferent specialty [2]. These patterns indicate thatstudents may need higher USMLE scores to be suc-cessfully matched into certain specialties. Indeed, stu-dents are often advised to consider their own USMLEscores when deciding which specialties and programsto rank. In one survey, students applying to residencyprograms universally regarded Step 1 scores as one ofthe top academic factors considered by residencyprogram directors when evaluating applicants forresidency [3]. Their perceptions are well-founded: inthe 2014 national survey of residency program direc-tors across all specialties conducted by the NRMP(N = 1793), the USMLE Step 1 / COMLEX(Comprehensive Osteopathic Medical LicensingExamination) Level 1 score was the most commonlycited factor in selecting applicants to interview, with94% of respondents indicating that they consideredStep 1/ COMLEX Level 1 scores when selecting appli-cants, while 80% indicated that they considered Step2 CK / COMLEX Level 2 Cognitive Evaluation (CE)scores. When ranking applicants, 80% of respondentsindicated that they considered Step 1 / COMLEXLevel 1 scores and 71% Step 2 CK / COMLEX Level2 CE [4]. In specific specialties, a national survey ofneurologi