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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barzansky B
        • Jonas HS
        • Etzel SI
        Educational programs in U.S. medical schools, 1995–96.
        JAMA. 1996; 276: 714-719
        • Olson AL
        • Woodhead J
        • Berkow R
        • et al.
        A national general pediatric clerkship curriculum: the process of development and implementation.
        Pediatrics (J Ambulatory Pediatric Association). 2000; 106: 216-222
        • Kuo AA
        • Slavin SJ
        Clerkship curricular revision based on the Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics Guidelines: does it Make a difference?.
        Pediatrics (J Ambulatory Pediatric Association). 1999; 103: 898-901
        • Cooper RA
        Impact of trends in primary, secondary, and postsecondary education on applications to medical school. I: gender considerations.
        Acad Med. 2003; 78: 855-863
        • Smith SR
        • Dollase RH
        • Boss JA
        Assessing students' performance in a competency-based curriculum.
        Acad Med. 2003; 78: 97-107
        • Potts MJ
        • Phelan KW
        A drop in pediatric subject examination scores after curriculum changes that emphasize general pediatric topics.
        Arch Pediatr Adolesc Med. 1997; 151: 938-942
        • Goroll AH
        • Morrison G
        • Bass EB
        • et al.
        SGIM/CDIM Core Medicine Clerkship Curriculum Guide. Health Resources and Services Administration, Washington, DC1995
        • Elnicki DM
        • Lescisin DA
        • Case S
        Improving the National Board of Medical Examiners Internal Medicine Subject Exam for use in clerkship evaluation.
        J Gen Intern Med. 2002; 17: 435-440
        • Ludmerer KM
        Time to Heal: American Medical Education From the Turn of the Century to the Era of Managed Care. Oxford University Press, New York, NY1999
        • NBME Examiner.
        National Board of Medical Examiners. Fall/Winter 2004.
        (Accessed May 18, 2004)