Skip to main content
SpringerLink
Log in

Relationships between preclinical course grades and standardized exam performance

  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

Abstract

Success in residency matching is largely contingent upon standardized exam scores. Identifying predictors of standardized exam performance could promote primary intervention and lead to design insights for preclinical courses. We hypothesized that clinically relevant courses with an emphasis on higher-order cognitive understanding are most strongly associated with performance on United States Medical Licensing Examination Step exams and National Board of Medical Examiners clinical subject exams. Academic data from students between 2007 and 2012 were collected. Preclinical course scores and standardized exam scores were used for statistical modeling with multiple linear regression. Preclinical courses were categorized as having either a basic science or a clinical knowledge focus. Medical College Admissions Test scores were included as an additional predictive variable. The study sample comprised 795 graduating medical students. Median score on Step 1 was 234 (interquartile range 219–245.5), and 10.2 % (81/795) scored lower than one standard deviation below the national average (205). Pathology course score was the strongest predictor of performance on all clinical subject exams and Step exams, outperforming the Medical College Admissions Test in strength of association. Using Pathology score <75 as a screening metric for Step 1 score <205 results in sensitivity and specificity of 37 and 97 %, respectively, and a likelihood ratio of 11.9. Performance in Pathology, a clinically relevant course with case-based learning, is significantly related to subsequent performance on standardized exams. Multiple linear regression is useful for identifying courses that have potential as risk stratifiers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Anderson, L., Krathwohl, D., Airasian, P., Cruikshank, K., Mayer, R., Pintrich, P., et al. (2000). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s taxonomy of educational objectives (Abridged ed.). Boston, MA: Pearson.

    Google Scholar 

  • Basco, W. T, Jr, Way, D. P., Gilbert, G. E., & Hudson, A. (2002). Undergraduate institutional MCAT scores as predictors of USMLE step 1 performance. Academic Medicine, 77(10 Suppl), S13–S16.

    Article  Google Scholar 

  • Briscoe, G. W., Fore-Arcand, L., Levine, R. E., Carlson, D. L., Spollen, J. J., Pelic, C., & Al-Mateen, C. S. (2009). Psychiatry clerkship students’ preparation, reflection, and results on the NBME Psychiatry Subject Exam. Academic Psychiatry, 33(2), 120–124.

    Article  Google Scholar 

  • Case, S. M., Ripkey, D. R., & Swanson, D. B. (1996). The relationship between clinical science performance in 20 medical schools and performance on Step 2 of the USMLE licensing examination. 1994–1995 Validity Study Group for USMLE Step 1 and 2 Pass/Fail Standards. Academic Medicine, 71(1 Suppl), S31-3.

    Google Scholar 

  • Cooke, M., Irby, D. M., Sullivan, W., & Ludmerer, K. M. (2006). American medical education 100 years after the Flexner report. New England Journal of Medicine, 355(13), 1339–1344.

    Article  Google Scholar 

  • Coumarbatch, J., Robinson, L., Thomas, R., & Bridge, P. D. (2010). Strategies for identifying students at risk for USMLE step 1 failure. Family Medicine, 42(2), 105–110.

    Google Scholar 

  • Donnon, T., Paolucci, E. O., & Violato, C. (2007). The predictive validity of the MCAT for medical school performance and medical board licensing examinations: A meta-analysis of the published research. Academic Medicine, 82(1), 100–106.

    Article  Google Scholar 

  • Green, M., Jones, P., & Thomas, J. X, Jr. (2009). Selection criteria for residency: Results of a national program directors survey. Academic Medicine, 84(3), 362–367.

    Article  Google Scholar 

  • Haist, S. A., Wilson, J. F., Elam, C. L., Blue, A. V., & Fosson, S. E. (2000). The effect of gender and age on medical school performance: An important interaction. Advances in Health Sciences Education Theory and Practice, 5(3), 197–205.

    Article  Google Scholar 

  • Hemmer, P. A., Szauter, K., Allbritton, T. A., & Elnicki, D. M. (2002). Internal medicine clerkship directors’ use of and opinions about clerkship examinations. Teaching and Learning in Medicine, 14(4), 229–235.

    Article  Google Scholar 

  • Hojat, M., Erdmann, J. B., Veloski, J. J., Nasca, T. J., Callahan, C. A., Julian, E., & Peck, J. (2000). A validity study of the writing sample section of the medical college admission test. Academic Medicine, 75(10 Suppl), S25–S27.

    Article  Google Scholar 

  • Holtman, M. C., Swanson, D. B., Ripkey, D. R., & Case, S. M. (2001). Using basic science subject tests to identify students at risk for failing step 1. Academic Medicine, 76(10 Suppl), S48–S51.

    Article  Google Scholar 

  • Huff, K. L., & Fang, D. (1999). When are students most at risk of encountering academic difficulty? A study of the 1992 matriculants to U.S. medical schools. Academic Medicine, 74(4), 454–460.

    Article  Google Scholar 

  • Julian, E. R. (2005). Validity of the Medical College Admission Test for predicting medical school performance. Academic Medicine, 80(10), 910–917.

    Article  Google Scholar 

  • Kassebaum, D. G., & Eaglen, R. H. (1999). Shortcomings in the evaluation of students’ clinical skills and behaviors in medical school. Academic Medicine, 74(7), 842–849.

    Article  Google Scholar 

  • Kleshinski, J., Khuder, S. A., Shapiro, J. I., & Gold, J. P. (2009). Impact of preadmission variables on USMLE step 1 and step 2 performance. Advances in Health Sciences Education Theory and Practice, 14(1), 69–78.

    Article  Google Scholar 

  • Koenig, J. A., Sireci, S. G., & Wiley, A. (1998). Evaluating the predictive validity of MCAT scores across diverse applicant groups. Academic Medicine, 73(10), 1095–1106.

    Article  Google Scholar 

  • Kozar, R. A., Kao, L. S., Miller, C. C., & Schenarts, K. D. (2007). Preclinical predictors of surgery NBME exam performance. Journal of Surgical Research, 140(2), 204–207.

    Article  Google Scholar 

  • Levine, R. E., Carlson, D. L., Rosenthal, R. H., Clegg, K. A., & Crosby, R. D. (2005). Usage of the National Board of Medical Examiners Subject test in psychiatry by U.S. and Canadian clerkships. Academic Psychiatry, 29(1), 52–57.

    Article  Google Scholar 

  • Miller, D. A., Sadler, J. Z., Mohl, P. C., & Melchiode, G. A. (1991). The cognitive context of examinations in psychiatry using Bloom’s taxonomy. Medical Education, 25(6), 480–484.

    Article  Google Scholar 

  • Palmer, E. J., & Devitt, P. G. (2007). Assessment of higher order cognitive skills in undergraduate education: Modified essay or multiple choice questions? Research paper. BMC Medical Education, 7, 49.

    Article  Google Scholar 

  • Patel, V. L., & Groen, G. J. (1986). Knowledge based solution strategies in medical reasoning. Cognitive Science, 10, 91–116.

    Article  Google Scholar 

  • Raymond, M. R., Mee, J., King, A., Haist, S. A., & Winward, M. L. (2011). What new residents do during their initial months of training. Academic Medicine, 86(10 Suppl), S59–S62.

    Article  Google Scholar 

  • Rikers, R. M., Loyens, S. M., & Schmidt, H. G. (2004). The role of encapsulated knowledge in clinical case representations of medical students and family doctors. Medical Education, 38(10), 1035–1043.

    Article  Google Scholar 

  • Ripkey, D. R., Case, S. M., & Swanson, D. B. (1997). Predicting performances on the NBME Surgery Subject Test and USMLE Step 2: The effects of surgery clerkship timing and length. Academic Medicine, 72(10 Suppl 1), S31–S33.

    Article  Google Scholar 

  • Ripkey, D. R., Case, S. M., & Swanson, D. B. (1999). Identifying students at risk for poor performance on the USMLE Step 2. Academic Medicine, 74(10 Suppl), S45–S48.

    Article  Google Scholar 

  • Rikers, R. M., Schmidt, H. G., & Moulaert, V. A. (2005). Biomedical knowledge: Encapsulated or two worlds apart? Applied Cognitive Psychology, 19(2), 223–231.

    Article  Google Scholar 

  • Rohe, D. E., Barrier, P. A., Clark, M. M., Cook, D. A., Vickers, K. S., & Decker, P. A. (2006). The benefits of pass-fail grading on stress, mood, and group cohesion in medical students. Mayo Clinic Proceedings, 81(11), 1443–1448.

    Article  Google Scholar 

  • Senecal, E. L., Askew, K., Gorney, B., Beeson, M. S., & Manthey, D. E. (2010). Anatomy of a clerkship test. Academic Emergency Medicine, 17(Suppl 2), S31–S37.

    Article  Google Scholar 

  • Simon, S. R., Bui, A., Day, S., Berti, D., & Volkan, K. (2007). The relationship between second-year medical students’ OSCE scores and USMLE Step 2 scores. Journal of Evaluation in Clinical Practice, 13(6), 901–905.

    Google Scholar 

  • Smith, S. R. (1998). Effect of undergraduate college major on performance in medical school. Academic Medicine, 73(9), 1006–1008.

    Article  Google Scholar 

  • Spring, L., Robillard, D., Gehlbach, L., & Simas, T. A. (2011). Impact of pass/fail grading on medical students’ well-being and academic outcomes. Medical Education, 45(9), 867–877.

    Article  Google Scholar 

  • Swanson, D. B., Ripkey, D. R., & Case, S. M. (1996). Relationship between achievement in basic science coursework and performance on 1994 USMLE Step 1. 1994–1995 Validity Study Group for USMLE Step 1/2 Pass/Fail Standards. Academic Medicine, 71(1 Suppl), S28–S30.

    Article  Google Scholar 

  • Torre, D., Papp, K., Elnicki, M., & Durning, S. (2009). Clerkship directors’ practices with respect to preparing students for and using the National Board of Medical Examiners Subject Exam in medicine: Results of a United States and Canadian Survey. Academic Medicine, 84(7), 867–871.

    Article  Google Scholar 

  • United States Medical Licensing Examination. (2014). Scoring and score reporting. http://www.usmle.org/bulletin/scores/ [3/25 2014].

  • USMLE. (2013). Bulletin of information. Philadelphia, PA: National Board of Medical Examiners.

    Google Scholar 

  • Wiley, A., & Koenig, J. A. (1996). The validity of the Medical College Admission Test for predicting performance in the first 2 years of medical school. Academic Medicine, 71(10 Suppl), S83–S85.

    Article  Google Scholar 

  • Zheng, A. Y., Lawhorn, J. K., Lumley, T., & Freeman, S. (2008). Application of Bloom’s taxonomy debunks the “MCAT myth”. Science, 319(5862), 414–415.

    Article  Google Scholar 

  • Zoller, U., & Pushkinb, D. (2007). Matching Higher-Order Cognitive Skills (HOCS) promotion goals with problem-based laboratory practice in a freshman organic chemistry course. Chemistry Education Research and Practice, 8(2), 153–171.

    Article  Google Scholar 

Download references

Funding

Funding support was provided by NIH T32 CA163177 (to YH).

Author information

Authors and Affiliations

  1. Department of Surgery, University of Virginia School of Medicine, P.O. Box 800679, Charlottesville, VA, 22908-0709, USA

    Yinin Hu, Eugene D. McGahren & Anneke T. Schroen

  2. Undergraduate Medical Education, University of Virginia School of Medicine, Charlottesville, VA, USA

    James R. Martindale & Casey B. White

  3. Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA

    Robin D. LeGallo

Authors
  1. Yinin Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James R. Martindale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robin D. LeGallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Casey B. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eugene D. McGahren
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anneke T. Schroen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yinin Hu.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hu, Y., Martindale, J.R., LeGallo, R.D. et al. Relationships between preclinical course grades and standardized exam performance. Adv in Health Sci Educ 21, 389–399 (2016). https://doi.org/10.1007/s10459-015-9637-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10459-015-9637-6

Keywords

Search

Navigation