This is one school’s experience with NBME assessments. Results or outcomes may vary and depend on factors beyond NBME’s control, such as student participation, individual study habits, faculty support and engagement, and/or variations in curriculum, among other things.

Michigan State University College of Human Medicine has adopted a competency-based curriculum designed to foster integrated learning and early clinical experiences. To help ensure student progress is assessed with validity, reliability, and security, the institution recognized that internally written assessments alone were not sufficient. Instead, Michigan State University implemented progress testing using the NBME® Customized Assessment Service (CAS) and Subject Examinations, anchoring assessments to USMLE® Step 1, Step 2 CK, and Step 3 content. 

Students participate in progress tests twice each semester across ten core courses, allowing for longitudinal measurement of medical and scientific knowledge. During the initial two years, examinations are aligned with USMLE Step 1, utilizing CAS exams that provide detailed sub scores by discipline and organ system. In the fifth semester, the Comprehensive Basic Science Examination (CBSE) is administered to further prepare students for Step 1. Historical data from these assessments and Step 1 performance inform the Prospective Performance Graph, a tool that enables students and advisers to help forecast the likelihood of passing Step 1. 

In the third year, core clerkship assessments are anchored to USMLE Step 2, with CAS and Comprehensive Clinical Science Examinations (CCSE) supporting student preparation. The timing of clerkships is also analyzed in relation to progress examination performance. During the fourth year, students complete assessments aligned with USMLE Step 3, including the Comprehensive Clinical Medicine Self-Assessment (CCMSA) and CAS exams. 

This approach to progress testing and data-driven student support has been well received, providing valuable insights that guide learning and contribute to student success. 

“The Prospective Performance Graph has transformed the way MSU CHM students understand their progress. By visualizing their CBSE trajectories, they gain clear, actionable insight into their readiness — reducing anxiety and encouraging steady, strategic learning.”

“PPG data allows our faculty to identify students who need support early, align interventions with curricular goals, and measure outcomes over time. This proactive approach has improved student performance and strengthened our Step 1 preparation process.”

Sumugdha Rayamajhi, MD, FACP, Associate Professor, Department of Medicine

“With Step 1 being pass/fail, it is difficult to gauge progress and growth during the pre-clerkship years. By comparing my CAS and CBSE scores with our school’s Prospective Performance Graphs, I can reliably gauge progress and set new goals.”

Thomas Kelbel, Medical Student (MS3)

NBME PORTFOLIO PARTS USED 

Customized Assessment Services (CAS)

CAS examinations are used for progress testing during pre-clerkship, providing sub scores by discipline and organ system. During the third-year core clerkships, examinations are aligned with USMLE Step 2 content, with one semester incorporating a CAS examination. CAS examinations are also used during year four for examinations geared toward preparing students for the USMLE Step 3. 

NBME® Subject Exams

The Comprehensive Basic Science Examination (CBSE) is used for progress testing during the fifth semester of the pre-clerkship curriculum. During core clerkships in year three, the Comprehensive Clinical Science Examination (CCSE) is used for two semesters in preparation for the USMLE Step 2 CK.  

NBME Self-Assessments

The Comprehensive Clinical Medicine Self-Assessment (CCMSA) is used during year four to assess readiness for the USMLE Step 3. 

SUPPORTING DATA 

Wang L, Laird-Fick H, Parker C, Liao Z, Solomon D: Growth in basic science knowledge in first-year medical school and USMLE Step 1 results: a longitudinal investigation at one school. Adv Health Sci Educ Theory Pract. 2022 Aug;27(3):605-619. doi: 10.1007/s10459-022-10104-y. Epub 2022 Mar 7. PMID: 35254547. (Growth in basic science knowledge in first-year medical school and USMLE Step 1 results: a longitudinal investigation at one school – PubMed) 

Wang L, Laird-Fick HS, Parker CJ, Solomon D: Using Markov chain model to evaluate medical students’ trajectory on progress tests and predict USMLE step 1 scores — a retrospective cohort study in one medical school. BMC Med Educ. 2021 Apr 9;21(1):200. doi: 10.1186/s12909-021-02633-8. PMID: 33836741; PMCID: PMC8033658. (Using Markov chain model to evaluate medical students’ trajectory on progress tests and predict USMLE step 1 scores — a retrospective cohort study in one medical school – PubMed) 

Chang C, Laird-Fick HS, Mitchell JD, Parker C, Solomon D: Assessing the impact of clerkships on the growth of clinical knowledge. Ann Med. 2025 Dec;57(1):2443812. doi: 10.1080/07853890.2024.2443812. Epub 2024 Dec 28. PMID: 39731632; PMCID: PMC11703539. (Assessing the impact of clerkships on the growth of clinical knowledge – PMC) 

Chang C, Colón-Berlingeri M, Mavis B, Laird-Fick HS, Parker C, Solomon D: Medical Student Progress Examination Performance and Its Relationship With Metacognition, Critical Thinking, and Self-Regulated Learning Strategies. Acad Med. 2021 Feb 1;96(2):278-284. doi: 10.1097/ACM.0000000000003766. PMID: 33003039. (Medical Student Progress Examination Performance and Its Relationship With Metacognition, Critical Thinking, and Self-Regulated Learning Strategies – PubMed)

Laird-Fick HS, Solomon DJ, Parker CJ, Wang L: Attendance, engagement and performance in a medical school curriculum: early findings from competency-based progress testing in a new medical school curriculum. PeerJ. 2018 Jul 30;6:e5283. doi: 10.7717/peerj.5283. PMID: 30083445; PMCID: PMC6071618. (Attendance, engagement and performance in a medical school curriculum: early findings from competency-based progress testing in a new medical school curriculum – PubMed) 

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