Fitz, MatthewAdams, WilliamHeincelman, MarcHaist, SteveWhelan, KarinaCox, LeeAnnCao, Uyen-ThiHingle, SusanRaff, AmandaHoughton, BruceFitzpatrick, JanetNall, RyanFoster, JenniferAppelbaum, JonathanGrum, CyrilDonovan, AnnaKiken, StuartAbraham, ReeniHlafka, MartiMiller, ChadBansal, SaurabhPaauw, DouglasLai, Cindy J.Pincavage, AmberAgarwal, GauriBurns, CynthiaHolzer, HoratioLappé, KatieJohn, VijuBarker, BlakeMingioni, NinaRao, DeeptiZakowski, LauraChakraborti, ChayanWilliams, WinterKelly, William2024-06-102024-06-102022Fitz M, Adams W, Heincelman M, et al. The Impact of Internal Medicine Clerkship Characteristics and NBME Subject Exams on USMLE Step 2 Clinical Knowledge Exam Performance. J Gen Intern Med. 2022;37(9):2208-2216. doi:10.1007/s11606-022-07520-6https://hdl.handle.net/1805/41341Background: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. Design: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees’ first Step 2 CK scores for analysis. Results: On multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = −3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78). Conclusion: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.en-USPublisher PolicyUnited States Medical Licensing Exam (USMLE)clinical knowledge (CK) examresidency applicationStep 2 CK performanceArticle