• Matthew Fitz, William Adams, Marc Heincelman, Steve Haist, Karina Whelan, LeeAnn Cox, Uyen-Thi Cao, Susan Hingle, Amanda Raff, Bruce Houghton, Janet Fitzpatrick, Ryan Nall, Jennifer Foster, Jonathan Appelbaum, Cyril Grum, Anna Donovan, Stuart Kiken, Reeni Abraham, Marti Hlafka, Chad Miller, Saurabh Bansal, Douglas Paauw, Cindy J Lai, Amber Pincavage, Gauri Agarwal, Cynthia Burns, Horatio Holzer, Katie Lappé, Viju John, Blake Barker, Nina Mingioni, Deepti Rao, Laura Zakowski, Chayan Chakraborti, Winter Williams, and William Kelly.
• Dept of Medicine, Loyola University Stritch School of Medicine, Building 102, Room 7614, Maywood, IL, 60153, USA. mfitz1@lumc.edu.
• J Gen Intern Med. 2022 Jul 1; 37 (9): 220822162208-2216.

BackgroundResidency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance.DesignThe authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis.ResultsOn multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78).ConclusionDespite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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