A Multilevel Analysis of Examinee Gender and USMLE Step 1 Performance

Background To examine the effects of (1) examinee gender on United States Medical Licensing Examination (USMLE) Step 1 performance, (2) examinee gender on the relationships between prematriculation measures and Step 1 performance, and (3) medical school characteristics on the relationships between examinee characteristics and Step 1 performance. Method A series of hierarchical linear models (examinees-nested-in-schools) was conducted predicting Step 1 scores. The sample included 66,412 examinees from 133 U.S. Liaison Committee on Medical Education-accredited medical schools/campuses. Results Controlling for prematriculation measures, men outperformed women slightly on Step 1. Undergraduate science grade point averages were more associated with Step 1 performance for women than men. Schools with higher mean Medical College Admission Test (MCAT) science scores had higher mean Step 1 scores, and MCAT science scores were slightly more associated with Step 1 performance for students from schools with higher percentages of female students. Conclusions Patterns of gender-related performance differences on Step 1 generally mirrored those reported in earlier research. School-level variables provided some additional insight into these relationships, but additional research is needed to fully understand why men and women perform differently on the USMLE.