Journal of General Internal Medicine

, Volume 23, Issue 7, pp 1016–1019 | Cite as

Associations Between United States Medical Licensing Examination (USMLE) and Internal Medicine In-Training Examination (IM-ITE) Scores

  • Furman S. McDonald
  • Scott L. Zeger
  • Joseph C. Kolars
Original Article



Little is known about the associations of previous standardized examination scores with scores on subsequent standardized examinations used to assess medical knowledge in internal medicine residencies.


To examine associations of previous standardized test scores on subsequent standardized test scores.


Retrospective cohort study.


One hundred ninety-five internal medicine residents.


Bivariate associations of United States Medical Licensing Examination (USMLE) Steps and Internal Medicine In-Training Examination (IM-ITE) scores were determined. Random effects analysis adjusting for repeated administrations of the IM-ITE and other variables known or hypothesized to affect IM-ITE score allowed for discrimination of associations of individual USMLE Step scores on IM-ITE scores.


In bivariate associations, USMLE scores explained 17% to 27% of the variance in IME-ITE scores, and previous IM-ITE scores explained 66% of the variance in subsequent IM-ITE scores. Regression coefficients (95% CI) for adjusted associations of each USMLE Step with IM-ITE scores were USMLE-1 0.19 (0.12, 0.27), USMLE-2 0.23 (0.17, 0.30), and USMLE-3 0.19 (0.09, 0.29).


No single USMLE Step is more strongly associated with IM-ITE scores than the others. Because previous IM-ITE scores are strongly associated with subsequent IM-ITE scores, appropriate modeling, such as random effects methods, should be used to account for previous IM-ITE administrations in studies for which IM-ITE score is an outcome.


United States Medical Licensing Examination (USMLE) Internal Medicine In-Training Examination (IM-ITE) medical knowledge assessment random effects modeling 



There was no external funding source for this study. This work was presented at the 13th Ottawa International Conference on Clinical Competence, Melbourne Australia, 3–8 March 2008.

Conflict of interest statement

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Furman S. McDonald
    • 1
  • Scott L. Zeger
    • 2
  • Joseph C. Kolars
    • 3
  1. 1.Residency Program Director and Associate Chair, Department of MedicineMayo Clinic College of MedicineRochesterUSA
  2. 2.Professor of Biostatistics and Epidemiology, Chair, Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Emeritus Program Director and Associate Chair, Department of Medicine, Professor of MedicineMayo Clinic College of MedicineRochesterUSA

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