USMLE Step 2 CK: Best Predictor of Multimodal Performance in an Internal Medicine Residency

Abstract

Internal medicine (IM) residency programs receive information about applicants via academic transcripts, but studies demonstrate wide variability in satisfaction with and usefulness of this information. In addition, many studies compare application materials to only 1 or 2 assessment metrics, usually standardized test scores and work-based observational faculty assessments. We sought to determine which application materials best predict performance across a broad array of residency assessment outcomes generated by standardized testing and a yearlong IM residency ambulatory long block. In 2019, we analyzed available Electronic Residency Application Service data for 167 categorical IM residents, including advanced degree status, research experience, failures during medical school, undergraduate medical education award status, and United States Medical Licensing Examination (USMLE) scores. We compared these with post-match residency multimodal performance, including standardized test scores and faculty member, peer, allied health professional, and patient-level assessment measures. In multivariate analyses, USMLE Step 2 Clinical Knowledge (CK) scores were most predictive of performance across all residency performance domains measured. Having an advanced degree was associated with higher patient-level assessments (eg, physician listens, physician explains, etc). USMLE Step 1 scores were associated with in-training examination scores only. None of the other measured application materials predicted performance. USMLE Step 2 CK scores were the highest predictors of residency performance across a broad array of performance measurements generated by standardized testing and an IM residency ambulatory long block.