How Doing Well on Shelf Exams Will Improve Your Step 2 CK Score

At most medical schools, your grades during your first clinical year of training are primarily determined by evaluations from your preceptors, and your performance on a shelf examination (family medicine, internal medicine, surgery, neurology, pediatrics, OB/GYN, and psychiatry). These grades will be a significant component of your residency application, in addition to letters of recommendation, co-curricular activities, research, and your personal statement. The USMLE board examinations (Step 1 and Step 2) serve as additional factors that program directors use to select their preferred candidates. Given that the USMLE Step 1 is now a pass-fail examination, more emphasis will be placed on the score that applicants receive on USMLE Step 2 Clinical Knowledge (CK). So how do you maximize your USMLE Step 2 CK score? Preparation! In this blog post, we will review the relationship between shelf exam scores and Step 2CK scores, and provide some tips on how to prepare for this exam.

Most evidence demonstrating a relationship between clinical performance and Step 2 CK scores is observational. For example, authors in 2019 showed that USMLE Step 1 and Step 2 CK scores moderately correlate with the number of honors grades per student in core clinical clerkships, even after correcting for gender, institution, and test-taking ability (Figure 1) (1). Similarly, the authors of a 2012 study found that the shelf examination scores and grade point averages were associated with 62% of the variance in USMLE Step 1 score and 61% of the USMLE Step 2 CK score (2). Together, these data demonstrate that scores on shelf examinations are moderately to highly correlated with success on the USMLE Step 2 CK. It is important to remember that these data are correlative and not causative – while a causative relationship most likely exists, the published literature does not allow us to make such a claim. For example, other authors have shown that success on USMLE practice exams, clinical evaluations, shelf examinations, and Step 1 score are also positively correlated with USMLE Step 2 CK scores. So a big takeaway: students who succeed on one examination, tend to succeed on other examinations (3, 4).

Figure 1 – From (1). Mean United States Medical Licensing Examination (USMLE) Step I (A) and Step 2 Clinical Knowledge (B) Scores per count of honors grades received in core clinical clerkships for medical students graduating in 2013-2017 from two US Medical Schools (N=1511).

As a result, multiple studies demonstrate that students who excel on their shelf exams tend to also excel on the USMLE Step 2 CK. In particular, there is evidence demonstrating that success on your shelf examinations is better correlated with USMLE Step 2 CK score rather than USMLE Step 1 score (2). This conclusion is somewhat unsurprising given that the material presented on the shelf examinations is more similar to that on USMLE Step 2 CK rather than Step 1.

So, what does this mean for you? Well, first off, try and be the best student you can be starting as early as possible. We recognize that this information is pretty obvious, however, it is important to remember that it is never too late to excel on your shelf and board exams, even if you may not have done so well during your first few years of medical school. Importantly, the resources that many students use to prepare for the USMLE Step 2 CK are the same resources that you will use to study for your shelf examinations. These include a question bank, textbooks, videos, and more. It is important to remember that studying for your shelf exams is also preparing you for Step 2 CK. The more preparation you do during your core clerkships, the better you will do on Step 2 CK. From our experience, we see that students who are proactive in studying during their clinical year primarily use their dedicated Step 2 CK study period to review content rather than learn new content. It is much easier to see an increase in your Step 2 CK score when you review details about specific material rather than learn that material for the first time.

Here are some important reminders to take with you as you head into your clinical year or dedicated study period: (1) there is data demonstrating that those who excel on their shelf exams tend to also succeed on USMLE Step 2 CK, (2) start preparing early for your shelf exams as this will pay off when you reach your dedicated Step 2 CK study period, (3) it is never too late to succeed on your shelf exams – coming up with a good study schedule and getting the right resources are critical, and (4) every student is different and try to follow a study regimen that works for you.

If you need help navigating the shelf examinations or USMLE Step 2 CK, Elite Medical Prep is here to help! We can help you identify your strengths and weaknesses, develop a study plan, and work through content material together. Schedule your free consultation call here.

References

1. Gauer JL, Jackson JB. The association between United States Medical Licensing Examination scores and clinical performance in medical students. Adv Med Educ Pract. 2019;10:209-16.
2. Zahn CM, Saguil A, Artino AR, Jr., Dong T, Ming G, Servey JT, et al. Correlation of National Board of Medical Examiners scores with United States Medical Licensing Examination Step 1 And Step 2 scores. Acad Med. 2012;87(10):1348-54.
3. Jacobparayil A, Ali H, Pomeroy B, Baronia R, Chavez M, Ibrahim Y. Predictors of Performance on the United States Medical Licensing Examination Step 2 Clinical Knowledge: A Systematic Literature Review. Cureus. 2022;14(2):e22280.
4. Monteiro KA, George P, Dollase R, Dumenco L. Predicting United States Medical Licensure Examination Step 2 clinical knowledge scores from previous academic indicators. Adv Med Educ Pract. 2017;8:385-91.