Do USMLE Steps, and ITE Score Predict the American Board of Internal Medicine Certifying Exam results?

Abstract Objective: To evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 CK, USMLE Step 3, and residency third-year in-service training exam (ITE) results predict the results of 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 our residency program from 2004 through 2017 was conducted. Pearson correlation coefficient and two-sample t-tests were used to assess the relationship between various scores. Multivariate logistic regression was used to predict pass or fail results in ABIM-CE using USMLE and third-year ITE test scores controlling for other covariates. Results: Among 114 MD residents included in the study; 92% (n=105) passed the ABIM-CE. USMLE score was a significant predictor of passing ABIM-CE. The OR of passing ABIM-CE was 2.70 (95 % CI=1.38-5.29), 2.31 (95% CI=1.33-4.01), and 1.63 (95% CI=0.81-3.29) with a ten-point increase in USMLE Step 1, USMLE Step 2 and USMLE step 3 scores respectively. OR of ABIM-CE passing chance was 2.96 (95% CI=0.95-9.20) with a ten-point increase in the average score of the above three exams. A five percent increase in ITE percentage raised the likelihood of passing ABIM-CE (OR 2.92, 95% CI 1.15-7.38). 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 < 220 failed ABIM-CE; all residents who failed had scored < 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: USMLE Step 1, USMLE Step 2, and third-year ITE scores strongly predict the chances of passing ABIM-CE. Thus, programs can identify internal medicine residents at risk of failing ABIM-CE and need intervention at an early stage. Various measures such as enrolling them in question banks or board review courses can then be implemented by programs to improve their chances to pass.