Comparison of Academic Performance within the First Year of Medical School with Performance on a National Board of Medical Examiners (NBME) Comprehensive Exam
Authors: Yang Wells , Nichols Carol A , Edmondson Anna C 
Published: November 2023

Introduction

The Medical College of Georgia (MCG) Phase 1 curriculum is organized as integrative systems‐based modules: Cellular & Molecular Basis of Medicine; Tissues/Musculoskeletal (TMSK); Cardiopulmonary; Gastrointestinal (GI); Genitourinary; Head, Neck, & Special Senses (HNSS); and Medical Neuroscience & Behavioral Health (MNBH). These modules are comprised of anatomy, biochemistry, development, histology, physiology and neuroscience components. A NBME Customized Exam is given at the end of the first year to test knowledge retention and provide students with an opportunity to practice taking a USMLE Step 1 style exam. The NBME Customized Exam consists of questions selected from the NBME database to assess content covered throughout the year.

Purpose and Hypotheses

The purpose of this study was to examine the effectiveness of a NBME Customized Comprehensive Exam as an indicator of academic performance in modules and components during the year and retention at the end of the year. We hypothesize that there is a significant relationship between student academic performance in modules and components and scores from the NBME Customized Exam.

Methods

To determine if there is a relationship between Phase 1 academic performance and the NBME Customized Exam, scores were examined from the Classes of 2018 (n=190) & 2019 (n=191). NBME Customized Exam questions were tagged with categories that corresponded to Phase 1 modules and components. Scores for each class were combined and tested with a homogeneity of slope model (α=0.05) to determine the significance of interaction between academic years and grades. Once no statistically significant difference was shown for homogeneity of slope, an ANCOVA (α=0.05) was used to compare scores for specific NBME tagged categories and module and component scores while controlling for academic year.

Results

When comparing overall NBME scaled scores to weighted, cumulative Phase 1 scores, students had a significant 1.6% NBME score increase for every 1% increase in cumulative Phase 1 score (R2=0.62, p<0.0001). Statistically significant relationships were found between all component scores analyzed and NBME scores: NBME Gross Anatomy & MCG Anatomy component (R2=0.46, p<0.0001), NBME Biochemistry & MCG Biochemistry component (R2=0.35, p<0.0001), NBME Histology & MCG Histology component (R2=0.34, p<0.0001), NBME Physiology & MCG Physiology component (R2=0.32, p<0.0001), and NBME Neuroscience & MCG Neuroscience component (R2=0.45, p<0.0001). In addition, statistically significant relationships were also found between NBME Gastrointestinal & MCG GI module scores (R2=0.30, p<0.0001), NBME Musculoskeletal & MCG TMSK module scores (R2=0.40, p<0.0001), NBME Neuroscience & MCG HNSS module scores (R2=0.41, p<0.0001), and NBME Neuroscience & MCG MNBH module scores (R2=0.44, p<0.0001).

Conclusion

Student performance during the year was a strong indicator of achievement on the NBME customized exam. Cumulative comparisons and comparison of NBME categories with modules and components showed significantly direct relationships, especially for the anatomical sciences. These results indicate that this end of year exam appropriately measures student performance during the year and retention at the end of the year. The relationship between customized exams such as this and weighted cumulative Phase 1 scores indicates that they may be used to build predictive models for student performance on subsequent high stakes exams.