Do USMLE Steps and ITE Results Predict Performance in the American Board of Internal Medicine Certifying Exam?

Abstract

Objective To evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2, USMLE Step 3, and residency third-year in-service training exam (ITE) results predict performance of Internal Medicine (IM) residents in American Board of Internal Medicine Certifying Exam (ABIM-CE). Methods A retrospective review of USMLE Step 1, USMLE Step 2, USMLE Step 3 scores, residency third year ITE and ABIM-CE of IM residents at Michigan State University from 2004 through 2017 was conducted. Pearson correlation coefficient and two sample t-tests were used to assess the relationship between various scores and pass or fail results in ABIM-CE. Results Among 114 MD residents included in the study; 92% (n=105) passed the ABIM-CE. There was a significant correlation of passing ABIM-CE with USMLE Step 1 (OR 1.042; 95% CI 1.004- 1.082), Step 2 (OR 1.043; 95% CI 1.004-1.085) and Step 3 (OR 1.046; 95% CI 1.004- 1.089) independently, with the combined odds of all USMLE exams being 1.044 (p=0.031). Increase in ITE percentage increased the likelihood of passing ABIM-CE (OR 1.28, 95% CI 1.160-1.419). The increase in the gap was associated with decreased chances of passing ABIM-CE (OR 0.774; 95% CI 0.670-0.893). All residents who failed ABIM-CE had Step 1 scores <220. Among 31 residents with Step 2 score <220, 20% (n=6) failed ABIM. Similarly, 9% of residents with USMLE Step 3 score less than 220 failed ABIM-CE; all residents who failed had scores less than 220. The probability curve predicted that the chance of passing ABIM- CE was around 80% with USMLE scores greater than 200 and increased to almost 100% with USMLE scores of 250 or more. Conclusion There is a strong correlation between ABIM-CE results with scores of USMLE Steps and third-year ITE. Thus, performance in these exams may identify the internal medicine residents who might need more help in ABIM-CE. This helps the residents as well as the program to plan and implement various measures to improve the pass rate.