Factors Predictive of Performance on USMLE Step 1: Do Commercial Study Aids Improve Scores?

Abstract

The United States Medical Licensing Examination (USMLE) Step 1 was the most cited factor in granting medical student applicants' residency interviews in a 2016 NRMP survey. Medical students utilize numerous commercial resources to achieve the highest score possible. This study sought to examine preparatory resources and their association with USMLE Step 1 performance. In 2016 and 2017, 170 medical students from a public, Midwestern medical school completed a voluntary survey after completing USMLE Step 1. The survey asked about study aids, anticipated performance, test preparation time, and practice exam performance. Actual scores and academic performance (overall percent for years 1 and 2 of medical school) were matched to survey responses. Data was analyzed using descriptive and inferential statistical analyses. USMLE Step 1 performance was associated with academic performance (r = 0.719, p < 0.01). Post hoc tests indicated a positive difference with the UWorld Qbank and exam performance (F 4,134 = 10.29, p < 0.05). Amount of days dedicated to test preparation was negatively correlated with performance in the 2017 student cohort (r = - 0.304, p < 0.01). The use of other commercially available products and the number of practice tests completed were not correlated with performance. Cumulative pre-clinical grades had the strongest association with performance on the USMLE Step 1. Completing UWorld Qbank at least once was positively related with Step 1 scores. However, the use of other study aids, completing multiple practice exams, and delaying exam dates were not statistically significant. This study indicates performance in the pre-clinical curriculum and increased usage of UWorld are strongly associated with USMLE Step 1 performance.