D. Jurich is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania. S.A. Santen is senior associate dean of evaluation, assessment and scholarship of learning and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. M. Paniagua is medical advisor, Test Development Services, National Board of Medical Examiners, and adjunct associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. V. Harnik is associate dean for curriculum and associate professor, Department of Cell Biology, New York University School of Medicine, New York, New York. A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. A. Swan-Sein is director, Center for Education Research and Evaluation, and assistant professor of educational assessment, Columbia University Vagelos College of Physicians and Surgeons, New York, New York. M.A. Barone is vice president of licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania. M. Daniel is assistant dean for curriculum and associate professor, Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119.
Acad Med. 2020 Jan;95(1):111-121. doi: 10.1097/ACM.0000000000002921.
To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change.
Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group.
Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships.
Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.
研究美国医师执照考试（USMLE）第 1 步考试时间的改变对第 2 步临床知识（CK）考试成绩的影响、延迟时间对第 2 步 CK 考试表现的影响，以及入学考试 MCAT 成绩与第 2 步 CK 考试成绩改变前后的关系。
分析了 2008-2009 学年至 2017-2018 学年期间，4 所将第 1 步考试安排在核心实习之后的学校。使用标准 t 检验比较改变前后第 2 步 CK 考试成绩的变化。使用比例差异检验评估课程改变组之间的第 2 步 CK 考试失败率是否存在差异。线性回归用于研究第 2 步 CK 考试表现、延迟时间和入学 MCAT 成绩与课程改变组之间的关系。
第 2 步 CK 考试成绩没有显著变化（P=0.20）。失败率保持高度一致（改变前：1.83%；改变后：1.79%）。回归分析表明，延迟时间对第 2 步 CK 考试表现有显著影响，随着延迟时间的增加，分数下降，MCAT 分数与第 2 步 CK 分数之间存在较小但显著的交互效应。入学 MCAT 分数较低的学生在第 1 步考试安排在实习之后，第 2 步 CK 考试成绩往往更好。
将第 1 步考试安排在核心实习之后似乎对第 2 步 CK 考试成绩或失败率没有显著影响，支持这种改变不劣于传统模式的观点。入学 MCAT 分数较低的学生从改变中受益最大。
