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Study Links Performance on USMLE Exams to Medical School Accreditation Status

There is a link between medical student performance on the United States Medical Licensing Examination® (USMLE®) and the accreditation status of the medical schools those students attend, according to a recent study by the Educational Commission for Foreign Medical Graduates (ECFMG®) and the Foundation for Advancement of International Medical Education and Research (FAIMER®).

The study involved 39,650 individuals seeking ECFMG Certification who took one or more of the USMLE exams during the 2018-2020 study period. Examinees who attended medical schools accredited by an agency recognized by the World Federation for Medical Education (WFME) had higher pass rates on the exams than individuals who attended medical schools not accredited by a WFME-recognized accrediting body.

Making the Grade: Licensing Examination Performance by Medical School Accreditation Status,” authored by Marta van Zanten, PhD, Senior Associate for FAIMER; John R. Boulet, PhD, retired Vice President for Research and Data Resources for ECFMG and FAIMER; and Christine D. Shiffer, MBA, MSL, Manager, Regulatory Affairs and Governance for ECFMG, was published on January 14 in the journal BMC Medical Education.

The study is based on first attempt pass rates on the Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS) exams, all of which were required for ECFMG Certification during the study period. The Step 2 CS exam was discontinued in March 2020.

Of the three exams, the difference was greatest for Step 1, which assesses examinees’ ability to understand and apply important concepts of the sciences basic to the practice of medicine. On the Step 1 exam, 88.4 percent of individuals from medical schools accredited by agencies recognized by WFME passed on their first attempt, compared to 78.6 percent of individuals from medical schools not accredited by a WFME-recognized agency.

On the Step 2 CK exam, which assesses examinees’ clinical knowledge, 91.8 percent of individuals from medical schools accredited by a WFME-recognized accrediting agency passed on their first attempt compared to 88.8 percent for their counterparts from schools not accredited by a WFME-recognized agency.

On the Step 2 CS exam, which assessed examinees’ clinical and communication skills, 81.8 percent of individuals from medical schools accredited by a WFME-recognized agency passed on the first attempt compared to 73.8 percent of their counterparts at schools not accredited by a WFME-recognized agency.

“While accreditation systems are generally viewed as driving quality, such systems are resource intensive and require ongoing stakeholder support. Given these demands, and the growth of accreditation systems worldwide, evidence is needed to support the validity of medical education accreditation activities by conducting investigations that tie accreditation to improved outcomes,” the article states. “These results provide important positive evidence that external evaluation of educational programs is associated, on average, with better education outcomes, including in the domains of basic science, clinical knowledge, and clinical skills performance.”

ECFMG Certification is required for international medical graduates to enter accredited U.S. training programs and to obtain an unrestricted medical license in the United States. ECFMG established the 2024 Medical School Accreditation Requirement in 2010 to stimulate international accreditation efforts and to enhance the quality of medical education worldwide. The requirement is intended to encourage the development and implementation of standards for evaluating undergraduate medical education to provide greater assurance that medical students will be appropriately trained. Currently, 25 accrediting agencies functioning in 62 countries have been recognized by WFME and 15 agencies are in the process of recognition.

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