Stepwise Predictors: Linking Preresidency Step 2 CK Scores to Emergency Medicine In-Training Exam Performance

Recent declines in ABEM Qualifying Exam pass rates have heightened the need to identify trainees who may benefit from early academic support. Early predictors of ITE scores, which are established predictors of ABEM board outcomes, may help programs recognize risk before residency even begins. Step 2 CK remains the most consistent pre-residency standardized assessment, but its predictive value for ITE performance throughout training has not been clearly established. This study aimed to determine whether Step 2 CK scores can provide early insight into EM ITE performance.

This retrospective cohort study included 114 residents from a single academic, urban EM residency program (2021-2025) with available Step 2 CK scores and PGY1 and/or PGY3 ITE percentiles; PGY1 represents the earliest standardized assessment, while PGY3 serves as a surrogate for ABEM board readiness. Residents with only COMLEX Level 2-CE scores were excluded due to low representation (n=3). PGY1 ITE percentiles were analyzed across the entire cohort (n=113); PGY3 ITE percentiles were analyzed only for residents who had complete terminal PGY1-3 ITE data (n=83). Pearson correlations assessed associations between Step 2 CK and ITE percentiles. Linear regression models evaluated PGY1 ITE percentile predicted by Step 2 CK and PGY-3 ITE percentile predicted by Step 2 CK, adjusting for PGY1 ITE.

In this cohort, Step 2 CK demonstrated a moderate, statistically significant correlation with PGY1 ITE percentile (r=0.39, p<0.001) and PGY3 ITE percentile (r=0.38, p<0.001). In linear regression, Step 2 CK predicted PGY1 ITE performance (β=0.34, p<0.001), explaining 15.4% of variance. Each 10 point increase in Step 2 CK was associated with an approximate 3.4 point increase in PGY1 ITE percentile. In the PGY3 model, Step 2 CK remained an independent predictor after adjusting for PGY1 ITE (β=0.19, p=0.049), though PGY1 ITE contributed more substantially to the model (β=0.54, p< 0.001). The combined model explained 38.1% of PGY3 ITE variance.

Step 2 CK scores can provide meaningful insight into ITE performance, supporting its role as an early indicator of test-taking ability and tool for advising and exam-preparation planning.