Medical Board Examinations Research Articles

The National Board of Medical Examiners on Potential Conflicts of Interest.

To the Editor: As officers of the National Board of Medical Examiners (NBME), and as physicians, educators, and citizens, we are deeply concerned about the well-being of students and physicians, the quality of our medical education and training system, and the health of our patients and our society. We remain committed to excellence in assessment, maintaining the highest ethical principles and using the tools at the NBME’s disposal for the betterment of all. Carmody and Rajasekaran1 as well as Gesundheit2 raise serious allegations regarding financial incentives intermixed with speculation and anecdote. We correct information presented and expand on issues raised. The mission of the NBME is to “protect the health of the public through state of the art assessment.”3 Its 12-member governing board includes diverse individuals with experience in medical education, training, and health care, with one-third representing perspectives of patients. With the exception of the chair and treasurer, no board members receive honoraria, and the former donate these. The NBME strives to meet educators’ and students’ stated needs. Without exception, subject exams and self-assessments were developed in response to medical education needs. We feel they are well aligned with the NBME’s mission. Medical schools use these high-quality exams for evaluation and as common metrics for purposes, such as curriculum evaluation and accreditation self-study. The NBME also pursues its mission by advancing assessment through empiric research and through development of formative tools aimed at improving the clinical performance of health professionals. The United States Medical Licensing Examination (USMLE) program is jointly governed by the NBME and the Federation of State Medical Boards (FSMB). The NBME’s governing board does not and cannot unilaterally set USMLE fees, which are determined by individuals drawn from the NBME’s volunteer academic and professional health care community membership, balanced equally with representatives of the FSMB. USMLE fee increases have approximated the Consumer Price Index. USMLEs are the work of over 350 voluntary medical school faculty, state medical board members, and the public drawn from across North America. Examination content thus represents the judgments of dedicated experts not employed by the NBME or the FSMB. Pass/fail standard, or “cut-point,” decisions are based on surveys of thousands of stakeholders, including examinees, and on committee work undertaken by faculty and state board members. Thus, determination of the pass/fail standard relies on individuals without financial ties to the USMLE program. In 2019, the NBME began a review of its governance. Although we believe that any potential conflicts of interest are already well managed, we will carefully consider all concerns raised, and if needed, modify structures, policies, or procedures to ensure that any potential conflicts of interest are managed appropriately. The NBME remains committed to the highest standards of excellence in assessment, ethics, and service to the public and the health professions. Alfred F. Tallia, MD, MPHProfessor and chair of family medicine and community health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, and chair, National Board of Medical Examiners, Philadelphia, Pennsylvania; [email protected]Paul M. Wallach, MDProfessor of medicine, Dolores and John Read Senior Professorship in Medical Education, executive associate dean for educational affairs and institutional improvement, Indiana University School of Medicine, Indianapolis, Indiana, and vice chair, National Board of Medical Examiners, Philadelphia, Pennsylvania.Latha Chandran, MD, MPHExecutive dean and founding chair, Department of Medical Education, Miller School of Medicine, University of Miami, Miami, Florida, and treasurer of the National Board of Medical Examiners, Philadelphia, Pennsylvania.

A Crisis of Trust Between U.S. Medical Education and the National Board of Medical Examiners.

This Invited Commentary is an independent opinion piece and companion to the Perspective by Carmody and Rajasekaran that appears in this issue of Academic Medicine. The National Board of Medical Examiners (NBME), a 501(c)(3) nonprofit, is a powerful gatekeeper to the medical profession in the United States. According to publicly available tax data, the NBME, which has increased its number of income-enhancing products, had revenues of $153.9 million (M) and net assets of $177.6M in 2017, earnings (revenue less expenses) of $39.7M in 2013-2017, and a highly compensated management team. Medical students are ultimately the source of nearly all the NBME's revenue, and the NBME has contributed to the growth of medical student debt. The NBME has operated as a monopoly since its agreement in the early 1990s with the Federation of State Medical Boards to cosponsor the United States Medical Licensing Examination (USMLE). Although the NBME has developed valuable products and is ostensibly governed by a capable board, the NBME has inherent financial conflicts of interest and may be benefiting from the current "Step 1 mania" undermining undergraduate medical education. Here, the author makes 4 recommendations to reestablish the trust of the U.S. medical education community in the NBME: (1) the NBME should recuse itself from current discussions and policy-making decisions related to changes in the score reporting of the USMLE Step 1 exam; (2) the NBME should disclose and be transparent about all aspects of its finances; (3) new NBME products, changes in pricing, and changes to pass thresholds should be approved by an oversight committee, independent of the NBME; and (4) the NBME (and USMLE) should not charge students or residents for retaking any of its licensing examinations.

On Step 1 Mania, USMLE Score Reporting, and Financial Conflict of Interest at the National Board of Medical Examiners.

Though intended to inform a binary decision on initial medical licensure, the United States Medical Licensing Examination (USMLE) is frequently used for screening candidates for residency positions. Some have argued that reporting results as pass/fail would honor the test's purpose while preventing inappropriate use. To date, the USMLE's sponsor organizations have declined to make such a change. In this Perspective, the authors examine the history and mission of the National Board of Medical Examiners (NBME), trace the rise of "Step 1 mania," and consider the current financial incentives for the NBME in implementing a pass/fail score-reporting policy.The NBME was founded in 1915 to address the lack of interstate reciprocity in medical licensure examination. With the creation of the USMLE in 1992, a single pathway for licensure was established, and the organization's original mission was achieved. Yet even after fulfilling its primary purpose, the NBME-classified as a nonprofit organization-has seen its revenues rise dramatically over the past 2 decades. Much of the increased revenue is derived from test products and services not required for medical licensure, with sales driven by the increasing importance of Step 1 scores in residency selection. Revenue from these products and services would likely decline if the NBME reported Step 1 results as pass/fail.A financial conflict of interest occurs when a judgment concerning a primary interest may be influenced by a secondary interest, such as financial gain. The data presented here demonstrate that the NBME has a conflict of interest in its current score-reporting policy. Possible remedies, such as disclosure, recusal, divestiture, and restructuring, are considered.

Pass/Fail Scoring of USMLE Step 1 and the Need for Residency Selection Reform.

The Federation of State Medical Boards and the National Board of Medical Examiners recently announced a change in the United States Medical Licensing Examination Step 1 scoring convention to take effect, at the earliest, on January 1, 2022. There are many reasons for this change, including decreasing medical student stress and incentivizing students to learn freely without solely focusing on Step 1 performance. The question remains how this will affect the future of the otolaryngology-head and neck surgery match. By eradicating Step 1 grades, other factors, such as research, may garner increased importance in the application process. Such a shift may discriminate against students from less well-known medical schools, international medical graduates, and students from low socioeconomic backgrounds, who have fewer academic resources and access to research. Residency programs should try to anticipate such unintended consequences of the change and work on solutions heading into 2022.

Medical Student Assessment in the Time of COVID-19

BackgroundMedical student education in the era of the COVID-19 outbreak is vastly different than the standard education we have become accustomed to. Medical student assessment is an important aspect of adjusting curriculums in the era of increased virtual learning.MethodsStudents took our previously validated free response clinical skills exam (CSE) at the end of the scheduled clerkship as an open-book exam to eliminate any concern for breaches in the honor code and then grades were adjusted based on historic norms. The National Board of Medical Examiners (NBME) shelf exam was taken with a virtual proctor. Students whose clerkship was affected by the COVID-19 pandemic were compared to the students from a similarly timed surgery block the previous 3 years. Primary outcomes included CSE and NBME exam scores. Secondary outcomes included clinical evaluations and the percentage of students who received grades of Honors, High Pass, and Pass. After the surgery clerkship was completed, we surveyed all students who participated in the surgery clerkship during the COVID-19 crisis.ResultsThere were 19 students during the COVID-interrupted clerkship and 61 students in similarly timed clerkships between 2017 and 2019. Prior to adjustment and compared to historic scores, the COVID-interrupted clerkship group scored higher on the CSE, NBME exam, and performance evaluations (median, CSE:75.2 vs 68.7, shelf:68.0 vs 64.0, performance evaluation mean: 2.96 vs 2.78). The percentage of students with an honors was marginally higher in the group affected by COVID (42% vs 32%). Out of 19 students surveyed, 9 students responded. Seven students stated they would have preferred a closed-book CSE, citing a few drawbacks of the open-book format such as modifying their exam preparation, being discouraged from thinking prior to searching online during the test, and second guessing their answers.ConclusionsDuring the initial outbreak of COVID-19, we found that an open book exam and a virtually proctored shelf exam was a reasonable option. However, to avoid adjustments and student dissatisfaction, we would recommend virtual proctoring if available.

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season

United States Medical Licensing Examination Step 1 Pass-or-Fail Reporting: Student Perspectives on Implications for Medical Student Education in Diagnostic Radiology.

In February 2020, the Federation of State Medical Boards and National Board of Medical Examiners announced that score reporting for United States Medical Licensing Examination (USMLE) Step 1 will change from numeric to pass or fail as soon as January 2022 [1]. This change has implications for stakeholders in radiology education, including residency programs, faculty, and medical students. The purpose of this commentary is to hypothesize this change’s potential effects on medical student education in diagnostic radiology.

Anticipating the Impact of the USMLE Step 1 Pass/Fail Scoring Decision on Underrepresented-in-Medicine Students.

Three-digit United States Medical Licensing Examination (USMLE) Step 1 scores have assumed an outsized role in residency selection decisions, creating intense pressure for medical students to obtain a high score on this exam. In February 2020, the Federation of State Medical Boards and the National Board of Medical Examiners announced that Step 1 would transition to pass/fail scoring beginning in 2022.The authors discuss the potential advantages and disadvantages of the pass/fail scoring change for underrepresented-in-medicine (UiM) trainees. UiM students may benefit from this change because it reduces the effect of an inequitable exam; helps correct for students who attend medical schools with a curriculum heavier on nontested formative elements; and decreases stress, improves quality of life, and undermines imposter syndrome. However, this change may also precipitate unforeseen challenges, such as increased discrimination toward UiM trainees, an increase in high-stakes test failures due to a reduced focus on preparing for standardized exams, or the development of new (e.g., subject exams) or overreliance on existing (e.g., school ranking) metrics that would make UiM residency candidates less competitive.To enhance UiM representation in the future health care workforce, it is imperative that national organizations (e.g., accrediting, licensing, regulatory, professional, honor, student, and faculty), hospitals, residency programs, and patient advocacy groups undertake a shared, rigorous approach in assessing the impact of the pass/fail scoring change on UiM applicants' selection to specialty and subspecialty residencies.

Stand Together and Deliver: Challenges and Opportunities for Rheumatology Education During the COVID-19 Pandemic.

Stand Together and Deliver: Challenges and Opportunities for Rheumatology Education During the COVID-19 Pandemic.

Trying To Do It All: Being a Physician-Mother during the COVID-19 Pandemic.

Trying To Do It All: Being a Physician-Mother during the COVID-19 Pandemic.

Medicolegal Sidebar: Peer Review of Professional Competence.

Medicolegal Sidebar: Peer Review of Professional Competence.

Correlation of Medical College Admission Test Scores and Self-assessment Materials with the United States Medical Licensing Examination Step 1 Performance.

PurposeCandidates' performance on the United States Medical Licensing Examination (USMLE) Step 1 examination had been correlated with the Medical College Admission Test (MCAT). However, in 2015, a new MCAT format was released and its correlation with Step 1 remains to be fully analyzed. Preparation for Step 1 typically involves purchasing and perusing practice tests from the National Board of Medical Examiners (NBME) and UWorld; however, their predictive value to performance on Step 1 remains to be ascertained, especially with the release of five new NBME practice tests. Additionally, there is a need for accurately predicting Step 1 scores to self-evaluate study progress and reduce student anxiety.RationaleProgram directors rank USMLE Step 1 scores as the number one criterion in selecting interviewees for residency. Step 1 scores are more important than Step 2 scores, Dean’s letter, or other letters of recommendation in determining the overall ranking of a candidate after interviews.HypothesesThe authors hypothesized that the new MCAT scores correlated positively with Step 1 scores and that the new NBME practice tests were more predictive of performance on Step 1 as compared to old NBME tests. MethodsLinear regression analysis followed by either analysis of variance (ANOVA) or Student's t-tests were used to analyze 399 responses. Data obtained was used to update an existing Step 1 score predictor, which was then validated.ResultsA positive correlation between the MCAT (average score: 510.1 ± 6.3) and Step 1 scores (average score: 246.1 ± 14.2) was observed. While new NBME practice tests were more predictive of Step 1 scores than old NBME tests, UWorld test scores were the most predictive. Students who practiced with the new NBME practice tests scored significantly higher than students who did not use them. However, students using any of the UWorld practice tests did significantly better than students who practiced using only NBME practice tests but not UWorld practice tests. Ironically, NBME16,the second-most correlativetest to Step 1 performance, is no longer available for purchase. Overall, taking six or more practice tests significantly enhanced Step 1 scores; the optimal number of tests was found to be between six and nine. The predicted score by an updated Step 1 score predictor was within 3.8 points or 1.6% of the actual Step 1 score.ConclusionsWe believe this study will aid in the selection and purchase of appropriate self-assessment tests as preparatory material for the USMLE Step 1 examination. It will also introduce them to an existing Step 1 score predictor that will help determine their readiness for Step 1.

Correlation of Stroop Effect in Medical Students to Their Performance in Pharmacology National Board of Medical Examiners (NBME) Examination

ObjectiveThe Stroop test is used to assess selective attention in cognitive psychology. Interference between word meaning and ink color in Incongruent Stroop test prolongs reaction time, which involves the brain searching for some collection of the stored information for prompt use. This is called the Stroop effect. Previous studies have reported the strong correlations between the Stroop effect and academic performance. Therefore, we aimed to study the correlation of the Stroop effect in medical students to their performance in pharmacology NBME examination.MethodsFor this study, 40 medical students who completed their pharmacology NBME examination were selected. The Stroop, congruent and incongruent, tests were performed using the EncephalApp Stroop Test (Android/iOS). In Congruent test (Stroop Off), the subjects were asked to select ink color of the hashtag (#) symbols printed in different ink colors (red, blue, and green). In Incongruent test (Stroop On), the subjects were asked to select the ink color of the words RED, BLUE, and GREEN printed in different ink colors, e.g., the word “RED” printed in blue ink had to be selected as blue. Each subject practiced each test for two attempts and 5 attempts of each test were then recorded.The EncephalApp Stroop Test automatically recorded the results of the tests as duration in seconds, which include Congruent Stroop (OffTime duration), Incongruent Stroop (OnTime duration), OffTime plus OnTime duration, OnTime minus OffTime duration. The results of OnTime minus OffTime duration of the Stroop test and pharmacology NBME examination scores were tabulated in Microsoft Excel and descriptive analysis was done. The correlation of the “OnTime minus OffTime duration” to pharmacology NBME examination scores was determined by a Pearson correlation coefficient and regression analysis.ResultsThe correlation coefficient (adjusted r2) of our study was −0.0255 and significance F was 0.862. The “OnTime minus OffTime duration” in medical students was not correlated with the pharmacology NBME examination score (r (38) = 0.0283, p = 0.862). The regression model predicted only 0.08% (R2 = 0.0008) of the pharmacology NBME examination score of medical students.ConclusionThe Stroop effect in medical students is insignificantly correlated with their performance in pharmacology NBME examination. However, correlations of the Stroop effect in medical students with their performance in other subjects and examinations need to be assessed in further studies.Support or Funding InformationThe study was supported by the Trinity Medical Sciences University School of Medicine, St. Vincent and the Grenadines.

Correlation of MCAT scores and preparative study material to USMLE Step I performance

The Medical College Admission Test (MCAT) is a well‐utilized metric for stratifying students for medical school admissions. The United States Medical Licensing Examination (USMLE) is a three‐step examination that assesses student knowledge of gross anatomy, biochemistry, biostatistics, genetics, and other basic science disciplines required for practicing medicine in the United States. The MCAT has been shown to correlate positively with student success on Step 1. However, in 2015, a new MCAT format was released and its correlation with Step 1 remains to be analyzed. Additionally, preparation for Step 1 typically involves purchasing and perusing practice tests from the National Board of Medical Examiners (NBME®) and UWorld®; however, their predictive value to performance on Step 1 remains to be ascertained, especially with the release of five new NBME® practice tests. We hypothesized that the new MCAT scores correlated positively with Step 1 scores and that the new NBME® practice tests were more predictive of performance on Step 1 as compared to old NBME® tests. An anonymous survey was posted on www.reddit.com requesting users to submit their scores on Step 1, practice tests and MCAT along with examination dates. Regression analysis indicated positive correlation of MCAT with Step 1 scores (P= 1.236E‐15; R2=0.2047; n=282). While new NBME® practice tests were more predictive of Step 1 scores than old NBME® tests, UWorld® SA2 scores were most predictive (P=3.752E‐93; R2=0.6803; n=370). Taking more than six practice tests significantly enhanced Step 1 scores (P=0.040). Data from this study can be used to create a mathematical framework using MCAT and practice test scores for accurate prediction of Step 1 scores.

Admissions Is Not Enough: The Racial Achievement Gap in Medical Education.

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.

Exploring the Predictors of Post-Clerkship USMLE Step 1 Scores

Theory: We used two theoretical frameworks for this study: a) experiential learning, whereby learners construct new knowledge based on prior experience, and learning grows out of a continuous process of reconstructing experience, and b) deliberate practice, whereby the use of testing (test-enhanced learning) promotes learning and produces better long-term retention. Hypothesis: We hypothesized that moving the USMLE Step 1 exam to follow the clerkship year would provide students with a context for basic science learning that may enhance exam performance. We also hypothesized that examination performance variables, specifically National Board of Medical Examiners (NBME) Customized Basic Science Examinations and NBME subject examinations in clinical disciplines would account for a moderate to large amount of the variance in Step 1 scores. Thus we examined predictors of USMLE Step 1 scores when taken after the core clerkship year. Method: In 2011, we revised our medical school curriculum and moved the timing of Step 1 to follow the clerkship year. We performed descriptive statistics, an ANCOVA to compare Step 1 mean scores for three graduating classes of medical students before and after the curriculum changes, and stepwise linear regression to investigate the association between independent variables and the primary outcome measure after curriculum changes. Results: 993 students took the Step 1 exam, which included graduating classes before (2012-2014, N = 491) and after (2015-2017, N = 502) the curriculum change. Step 1 scores increased significantly following curricular revision (mean 218, SD 18.2, vs. 228, SD 16.7, p < 0.01) after controlling for MCAT and undergraduate GPA. Overall, 66.4% of the variance in Step 1 scores after the clerkship year was explained by: the mean score on fourteen pre-clerkship customized NBME exams (p < 0.01, 57.0% R2); performance on the surgery NBME subject exam (p < 0.01, 3.0% R2); the pediatrics NBME subject exam (p < 0.01, 2.0% R2); the Comprehensive Basic Science Self-Assessment (p < .01, 2.0% R2) ; the internal medicine NBME subject exam (p < 0.01, 0.03% R2), pre-clerkship Integrated Clinical Skills score (p < 0.01, 0.05% R2), and the pre-matriculation MCAT (p < 0.01, 0.01% R2). Conclusion: In our institution, nearly two-thirds of the variance in performance on Step 1 taken after the clerkship year was explained mainly by pre-clerkship variables, with a smaller contribution emanating from clerkship measures. Further study is needed to uncover the specific aspects of the clerkship experience that might contribute to success on high stakes licensing exam performance.

An Interactive Process for Delivering Pharmacologic Interventions for Migraine Headache to First-Year Medical Students.

This interactive didactic session is designed for first-year medical students to explore the common clinical symptom of headache and its various management strategies. The session provides an opportunity to cover a variety of drugs, mechanisms of action, drug-drug interactions, and routes of administration in a single 50-minute time frame. Using a modified case-based approach, we designed an interactive session for 41 first-year medical students. Students prepared for the session using basic learning objectives and a table of drugs that treat headache pain. In class, we distributed a patient scenario and a series of discussion questions to explore headache management. We assessed student performance using questions purchased from the National Board of Medical Examiners and student perceptions using both qualitative and quantitative data collected from faculty and end-of-block evaluations. Student performance on purchased questions related to content was significantly increased when compared to the national average (n = 5; 90.6% ± 6.0% vs. 82.6% ± 8.5%; p = .0052). Student perceptions of the overall quality of the faculty, content presentation, and material were positive (4.4 out of 5.0). Two themes emerged in the end-of-block evaluations: Students commented positively on the prereading materials, and students commented on the need to address underlying physiology associated with the discussed pharmacology. This flexible activity can be delivered in a short time (50 minutes) by a single faculty member in a variety of curricular structures. Our data demonstrate strong student performance and suggest that incorporating additional content would enhance delivery.

Reporting a Pass/Fail Outcome for USMLE Step 1: Consequences and Challenges for International Medical Graduates.

After extensive stakeholder discussion, the Federation of State Medical Boards and the National Board of Medical Examiners announced in February 2020 that United States Medical Licensing Examination Step 1 will transition to a pass/fail exam. Program directors have historically used Step 1 scores in deciding which residency applicants to interview. The lack of numerical scores will force changes to the residency selection process, which could have both positive and negative consequences for international medical graduates (IMGs). In this Invited Commentary, the authors discuss how some of the issues associated with the transition to Step 1 pass/fail are likely to impact IMGs. The authors also provide insights into how this and other policy changes could help spur the medical education community to improve the process by which medical school graduates transition to graduate medical education.

Does Participation in Obstetrics and Gynecology Subspecialties Improve Clerkship Outcomes?

The primary objective is to determine if participation in subspecialty rotations during Ob/Gyn core clerkships improves student performance as measured by National Board of Medical Examiners (NBME) Ob/Gyn clinical science subject exam scores, clinical evaluations, and final clerkship summative grades when compared to students without focused subspecialty time. This is a retrospective study of third-year Alpert Medical School of Brown University (AMS) Ob/Gyn core clerkship students at a single institution (Women and Infants Hospital in Providence, RI) from 2012 to 2017. Participation in Maternal Fetal Medicine (MFM) and/or Gynecologic oncology (Gyn Onc) subspecialty track (a one-week focused experience), NBME Ob/Gyn clinical science subject exam raw score, clinical evaluation score, final clerkship summative grade, and decision to pursue Ob/Gyn as a career were analyzed. There was no significant difference in NBME scores or final clerkship summative grade when comparing general track students to the subspecialty track. There was a significant difference in the clinical evaluation scores between general track and sub-specialty track students (p < 0.002). Of the students who pursued an Ob/Gyn residency, 75% participated in a subspecialty track. Exposure to subspecialty fields is not uniform during core clerkships. Our study indicates that using core clerkship time for early subspecialty exposure does not negatively impact student outcomes, and potentially improves clinical evaluations.

National Board of Medical Examiners and Curriculum Change: What Do Scores Tell Us? A Case Study at the University of Balamand Medical School.

Objectives:This study describes the results of NBME (National Board of Medical Examiners) implementation in Balamand Medical School (BMS) from 2015 to 2019, after major curricular changes were introduced as of 2012. BMS students’ performance was compared with the international USMLE step 1 (United States Medical Licensing Examination, herein referred to as step 1) cohorts’ performances. The BMS students’ NBME results were analyzed over the successive academic years to assess the impact of the serial curricular changes that were implemented.Methods:This longitudinal study describes the performance of BMS preclinical second year medicine (Med II) students on all their NBME exams over 4 academic years starting 2015-2016 to 2018-2019. These scores were compared with the step 1 comparison group scores using item difficulty. The t test was computed for each of the NBME exams to check whether the scores’ differences were significant.Results:Results revealed that all BMS cohorts scored lower than the international USMLE step 1 comparison cohorts in all disciplines across the 4 academic years except Psychiatry. However, the results were progressively approaching step 1 results, and the difference between step 1 scores and BMS students’ NBME scores became closer and not significant as of year 4.Conclusions:The results of the study are promising. They show that the serial curricular changes enabled BMS Med II students’ scores to reach the international cohorts’ scores after 4 academic years. Moreover, the absence of statistical difference between cohort 4 scores and step 1 cohorts is not module dependent and applies to all clinical modules. Further studies should be conducted to assess whether the results obtained for cohort 4 can be maintained.