Is a faculty developed pretest equivalent to pre-third year GPA or USMLE step 1 as a predictor of third-year internal medicine clerkship outcomes?

Background: Preclinical grade point average (GPA), and United States Medical Licensing Examination (USMLE) Step 1 are well-known preclerkship methods of identifying students at risk of poor performance. These measures are not available at all medical schools and may be considered prejudicial. Purpose: Does an examination on the first day of a clerkship (pretest) correlate with grade point average (GPA) or USMLE Step 1 scores, and does it provide equivalent insight in predicting clerkship outcomes? Methods: At this medical school, students take a faculty-developed pretest on the first day of the internal medicine clerkship. At the end of the clerkship, teachers recommend "clinical points," and students take the National Board of Medical Examiners (NBME) subject test. Between 1997 and 2001, data from 585 students (88%) were available. Results: Correlations between the faculty-developed pretest, GPA, and USMLE Step 1 scores were good, r = 0.57 to 0.66; disattenuated, r = 0.70 to 0.85. All variables were similar significant predictors of NBME subject test and clinical point outcomes. Conclusions: A faculty-developed pretest given on the 1st day of the internal medicine clerkship can identify students at risk of poor performance and may offer advantages over USMLE Step 1 and preclinical GPA.