Dropping the Shelf Examination: Does It Affect Student Performance on the United States Medical Licensure Examination Step 2?

Objective.—Does use of the pediatric shelf examination affect students' performance on the United States Medical Licensure Examination (USMLE) Step 2 pediatric subtest?

Methods.—The National Board of Medical Examiners Pediatrics Subject Examination (NBMEPSE) was used as the pediatric clerkship final examination at Brown Medical School through the 1996–97 academic year. The NBMEPSE was dropped in July 1997. Students' mean scores for the pediatric subtest of the USMLE Step 2 were compared for the years before and after the NBMEPSE was dropped. Performance on the internal medicine subtest of the USMLE Step 2 examination was used as a control because the National Board of Medical Examiners Internal Medicine Subject Examination (NBMEIMSE) remained the final examination in the internal-medicine clerkship.

Results.—USMLE Step 2 scores trended upward from 1993 to 2003. From 1993 to 1997, Brown medical students performed above the US/Canadian mean on both the USMLE Step 2 pediatrics and internal medicine subtests as well as on the overall examination. Students performed at or just below the mean on both the USMLE Step 2 pediatrics and internal medicine subtests from 1998 to 2001.

Conclusions.—Dropping the shelf examination coincided with a decrease in performance on the USMLE Step 2 pediatric subtest in comparison with the US/Canadian mean. Similar decreases in performance in overall and USMLE Step 2 internal medicine subtest scores also occurred. Numerous confounding variables make it difficult to determine the effect of the shelf exam on Step 2 performance.

KEY WORDS:  board examination , medical education , medical student , shelf examination , United States Medical Licensure Examination

• * USMLE indicates United States Medical Licensure Examination; NBMEPSE, National Board of Medical Examiners Pediatrics Subject Examination.