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Fam Med. 2019 Jun;51(6):483-499. doi: 10.22454/FamMed.2019.429968.

Identifying Students at Risk of Failing the USMLE Step 2 Clinical Skills Examination.

Author information

1
Office of Student Affairs and Career Counseling, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
2
Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
3
Center for Teaching and Learning, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
4
Mount Auburn Hospital, Cambridge, MA.
5
Center for Research in Medical Education and Healthcare, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

Abstract

BACKGROUND AND OBJECTIVES:

New standards announced in 2017 could increase the failure rate for Step 2 Clinical Skills (CS). The purpose of this study was to identify student performance metrics associated with risk of failing.

METHODS:

Data for 1,041 graduates of one medical school from 2014 through 2017 were analyzed, including 30 (2.9%) failures. Metrics included Medical College Admission Test, United States Medical Licensing Examination Step 1, and clerkship National Board of Medical Examiners (NBME) Subject Examination scores; faculty ratings in six clerkships; and scores on an objective structured clinical examination (OSCE). Bivariate statistics and regression were used to estimate risk of failing.

RESULTS:

Those failing had lower Step 1 scores, NBME scores, faculty ratings, and OSCE scores (P<.02). Students with four or more low ratings were more likely to fail compared to those with fewer low ratings (relative risk [RR], 12.76, P<.0001). Logistic regression revealed other risks: low surgery NBME scores (RR 3.75, P=.02), low pediatrics NBME scores (RR 3.67, P=.02), low ratings in internal medicine (RR 3.42, P=.004), and low OSCE Communication/Interpersonal Skills (RR 2.55, P=.02).

CONCLUSIONS:

Certain medical student performance metrics are associated with risk of failing Step 2 CS. It is important to clarify these and advise students accordingly.

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