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UNITED STATES MEDICAL LICENSING EXAMINATION STEP 1 SCORES ARE A QUANTIFIABLY BETTER PREDICTOR OF AMERICAN BOARD OF SURGERY IN-TRAINING EXAMINATION SUCCESS COMPARED TO STEP 2 SCORES
H Lindsey, J Suchanek, A Davis, J Sbraccia
Sparrow Hospital

Background
United States Medical Licensing Examination Step 1 (STEP 1) and Step 2 (STEP 2) scores are currently used in the selection of general surgery residents. Previous studies demonstrated a correlation between STEP 1 and STEP 2 scores and American Board of Surgery In-Training Examination (ABSITE) performance. With STEP 1 converting to pass/fail January, 2022, we sought to determine if both STEP 1 and STEP 2 were predictive of ABSITE performance.

Methods
Using mixed effects modeling, a retrospective analysis of all PGY levels from 2010-2019 comparing STEP 1 and 2 scores with raw ABSITE scores and percentile rank was performed at our program. Further, STEP 1 and 2 scores were analyzed for likelihood of scoring above the 20th percentile on the ABSITE exam.

Results
When STEP 1 and STEP 2 scores were evaluated separately, both were independent predictors of ABSITE raw score (p<0.001) and percentile rank (p<0.001 STEP 1 and p<0.011 STEP 2). Each point increase in STEP scores corresponded to a raw score increase of 2.0 points (STEP 1) or 1.6 points (STEP 2) and a 0.6 (STEP 1) and 0.3 (STEP 2) increase in percentile rank.

However, when STEP 1 and STEP 2 scores were evaluated together, STEP 1 scores were predictive of ABSITE raw scores and percentile rank (p<0.001) whereas STEP 2 scores were not. Each point increase in STEP 1 scores corresponded to a 1.6 point higher raw ABSITE score and 0.6 higher percentile rank. STEP 1 and 2 scores correlated, but variance inflation factors were < 2.

Finally, STEP 1 scores were predictive (p<0.043) of scoring above the 20th percentile on the ABSITE whereas STEP 2 scores were not. A 10 point increase in STEP 1 score corresponded to a 1.5 fold greater chance of scoring above the 20th percentile.

Conclusion
STEP 1 scores are a quantifiably better predictor of ABSITE performance than STEP 2 scores. With STEP 1 converting to pass/fail soon, only STEP 2 will have a numerical score. This may provide a quandary for programs in the selection process of residents and, possibly, structuring of didactics.


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