title: Sequence effects in the United States Medical Licensing Examination (USMLE) step 2 clinical skills (cs) examination.
abstract: BACKGROUND
  Systematic trends in examinee performance across the testing day (sequence effects) could indicate that artifacts of the testing situation have an impact on scores. This research investigated the presence of sequence effects for United States Medical Licensing Exam (USMLE) Step 2 clinical skills (CS) examination components.
  
  
  METHODS
  Data from Step 2 CS examinees were analyzed using analysis of covariance and hierarchical linear modeling procedures.
  
  
  RESULTS
  Sequence was significant for three of the components; communication and interpersonal skills, data gathering, and documentation. A significant gender x sequence interaction was found for two components.
  
  
  CONCLUSIONS
  The presence of sequence effects suggests that scores on early cases are influenced by factors that are unrelated to the proficiencies of interest. More research is needed to fully understand these effects.
authors: cramineni@nbme.org
authors: Chaitanya
authors: C
authors: Ramineni
authors: Polina
authors: P
authors: Harik
authors: Melissa J
authors: MJ
authors: Margolis
authors: Brian E
authors: BE
authors: Clauser
authors: David B
authors: DB
authors: Swanson
authors: Gerard F
authors: GF
authors: Dillon
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008007:Licensure, Medical; D016014:Linear Models; D008297:Male; D012737:Sex Factors; D013337:Students, Medical; D014481:United States