Assessing the underlying structure of the United States Medical Licensing Examination Step 2 test of clinical skills using confirmatory factor analysis

Acad Med. 2006 Oct;81(10 Suppl):S17-20. doi: 10.1097/00001888-200610001-00006.


Background: The purpose of the present study was to assess the fit of three factor analytic (FA) models with a representative set of United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) cases and examinees based on substantive considerations.

Method: Checklist, patient note, communication and interpersonal skills, as well as spoken English proficiency data were collected from 387 examinees on a set of four USMLE Step 2 CS cases. The fit of skills-based, case-based, and hybrid models was assessed.

Results: Findings show that a skills-based model best accounted for performance on the set of four CS cases.

Conclusion: Results of this study provide evidence to support the structural aspect of validity. The proficiency set used by examinees when performing on the Step 2 CS cases is consistent with the scoring rubric employed and the blueprint used in form assembly. These findings will be discussed in light of past research in this area.

MeSH terms

  • Clinical Competence*
  • Communication*
  • Factor Analysis, Statistical
  • Humans
  • Interpersonal Relations*
  • Licensure, Medical*
  • United States