USMLE and Otolaryngology: Predicting Board Performance

Objective To ascertain what relationship exists between the United States Medical Licensing Examination (USMLE) and the American Board of Otolaryngology Written Qualifying Examination (WQE). Study Design Retrospective, longitudinal study. Setting De-identified database. Subjects Residents entering otolaryngology-head and neck surgery (OHNS) residency between 2007 and 2009 and taking the WQE for the first time between 2012 and 2014. Methods Regression models were used to determine if the USMLE score predicts passage of the WQE on the first attempt, which step score was a better predictor, and whether an increase in the Step 2 score increased the chances of WQE passage. Results There were 611 Step 1 and 402 Step 2 scores. Mean (SD) Step 1 score was 238 (14.4), and the mean (SD) Step 2 score was 243 (16.8). The overall WQE first-time passage rate was 95.3%. Step 1 score was a better predictor than Step 2 for successful passage of the WQE on the first attempt ( P = .0026). An increase in the Step 2 score compared with the Step 1 score did not predict an improved first-time passage rate on the WQE. Conclusions There is an association between USMLE scores and successful first-time passage of the WQE, with Step 1 being a stronger predictor than Step 2. Residents with USMLE scores lower than the average successful OHNS applicant still have a high chance of passing the WQE. USMLE scores alone are of limited usefulness in identifying those applicants at risk of failing the WQE on the first attempt.