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Step 2 CS Predicts Resident Performance…Sometimes


Evaluating Validity Evidence for USMLE Step 2 Clinical Skills Data Gathering and Data Interpretation Scores: Does Performance Predict History-Taking and Physical Examination Ratings for First-Year Internal Medicine Residents?  Cuddy M et al.  Academic Medicine 2016; 91:133-139.

 

Reviewed by Elizabeth Christine Lee

 

What was the study question?

Do United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) data gathering and data interpretation scores predict ratings of examinees' subsequent performance in history taking and physical examination during their first year of internal medicine residency training?

 

How was the study done?

The study sample comprised 6,306 examinees from 238 internal medicine residency training programs who completed USMLE Step 2 CS for the first time in 2005 and whose residency directors' performance ratings from their first year of residency training were available.  Relationships between examinees' Step 2 CS data gathering and data interpretation scores and examinees' subsequent performance in history taking and physical examination during the first year of internal medicine residency training were analyzed using hierarchical linear modeling techniques. 

 

What were the results?

Examinees' USMLE Step 2 CS data interpretation scores were positively correlated with their history-taking and physical examination ratings from the end of their first year in internal medicine residency training.  However, step 2 CS data gathering scores showed no relationship to either history taking or physical examination ratings.

   

What are the implications of these findings?

The results of this study suggest the usefulness of USMLE Step 2 CS data interpretation scores in predicting subsequent performance in history taking and physical examination skills during the first year of internal medicine residency training.  Thus, the study provides validity evidence for using Step 2 CS data interpretation scores as an indication of readiness to enter supervised practice.  Unlike Step 2 CS data interpretation scores, this study shows that there is a lack of validity evidence supporting the predictive value of Step 2 CS data gathering scores.  These findings are significant for practitioners interested in using Step 2 CS scores as an indication of a medical student's future performance in practice settings.       

 

Editor’s Note:  Data gathering scores in Step 2 CS are determined by SP checklists, while data interpretation scores are determined by trained physician raters who may be better able to assess higher-order clinical reasoning skills.  Perhaps program directors expect more interpretation than is expected by the SP checklists (JG).

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