Associations Between Medical Education Assessments and American Board of Family Medicine Certification Examination Score and Failure to Obtain Certification

Acad Med. 2020 Sep;95(9):1396-1403. doi: 10.1097/ACM.0000000000003344.


Purpose: Family medicine residency programs can be cited for low pass or take rates on the American Board of Family Medicine (ABFM) certification examination, and the relationships among standardized medical education assessments and performance on board certification examinations and eventual board certification have not been comprehensively studied. The objective of this study was to evaluate the associations of all required standardized examinations in medical education with ABFM certification examination scores and eventual ABFM certification.

Method: All graduates of U.S. MD-granting family medicine residency programs from 2008 to 2012 were included. Data on ABFM certification examination score, ABFM certification status (as of December 31, 2014), Medical College Admission Test (MCAT) section scores, undergraduate grade point average, all United States Medical Licensing Examination (USMLE) Step scores, and all ABFM in-training examination scores were linked. Nested logistic and linear regression models, controlling for clustering by residency program, determined associations between assessments and both certification examination scores and board certification status. As many international medical graduates (IMGs) do not take the MCAT, separate models for U.S. medical graduates (USMG) and IMGs were run.

Results: The study sample was 15,902 family medicine graduates, of whom 92.1% (14,648/15,902) obtained board certification. In models for both IMGs and USMGs, the addition of more recent assessments weakened the associations of earlier assessments. USMLE Step 2 Clinical Knowledge was predictive of certification examination scores and certification status in all models in which it was included.

Conclusions: For family medicine residents, more recent assessments generally have stronger associations with board certification score and status than earlier assessments. Solely using medical school admissions (grade point average and MCAT) and licensure (USMLE) scores for resident selection may not adequately predict ultimate board certification.

MeSH terms

  • Accreditation
  • Clinical Competence
  • Educational Measurement / methods*
  • Family Practice* / education
  • Humans
  • Internship and Residency*
  • Licensure, Medical*
  • Logistic Models
  • Specialty Boards*
  • United States