Does the National Board of Medical Examiners' Surgery Subtest level the playing field?

We sought to determine if scores on the National Board of Medical Examiners' Surgery Subject Examination (NBME-SS) correlated with ward assessment of Fund of Knowledge and how the NBME-SS scores impacted surgery clerkship grade. Student evaluations from 4 academic years (1999-2003) were analyzed. Scores from the Fund of Knowledge subsection were compared with scores on the NBME-SS. Student final grades were calculated with (at a weight of 10%) and without NBME-SS score. Data were available for all 399 students who rotated on surgery during the study period. Fund of Knowledge score and NBME-SS scores correlated minimally (Pearson's r = 0.108, P = 0.031). Performance on the NBME-SS helped 11% of students' grades, but 64% of students' grades were hurt. Fifteen percent of the students missed receiving honors because of their performance on the NBME-SS. The NBME-SS negatively influenced the grades of a large proportion of students and correlated only minimally with Fund of Knowledge scores as assessed on ward evaluations.