COMLEX-USA and USMLE for Osteopathic Medical Students: Should we Duplicate, Divide, or Unify

[harrislakers123]

COMLEX-USA and USMLE for Osteopathic Medical Students: Should We Duplicate, Divide, or Unify?

In 2020, approximately 60% of osteopathic medical students took at least one portion of the United States Medical Licensing Examination (USMLE).1 At first, this may seem a curious statistic. After all, the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is the only...

meridian.allenpress.com

Thoughts ?

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[Neopolymath]

That's a lot of words to say what is obvious to those of us that aren't boomer DOs who make an income "working" for completely redundant and useless parasitic organizations.

Separate but equal is wrong and holding everyone back. Death to the NBOME.

 

[NotAProgDirector]

This topic has been discussed here multiple times. Most agree that the COMLEX should be removed, everyone takes the USMLE, and (perhaps) DO students take something just for OMM (or perhaps schools do that).

But, the referenced study in JGME shows the same uncomfortable truth that every other study comparing USMLE and COMLEX shows. That the bottom of the passing range on COMLEX is often failing on USMLE:

The minimum pass on Step 1 is currently 194. Those scoring 400-450 on level 1 are, on average, going to fail Step 1. There's enough spread in the data that some people may pass, but lots will fail.

 

[MDMechEngr]

One measuring stick for all. NBOME can test DOs on the OMM stuff and charge DO studundents the same price as they charge for COMLEX. I think most would be happy with this.

 

[NotAProgDirector]

Perhaps except for the medical schools who are certain to have an increased failure rate. And the students who would have passed COMLEX but fail USMLE. Except for them.

 

[AlbinoHawk DO]

This topic has been discussed here multiple times. Most agree that the COMLEX should be removed, everyone takes the USMLE, and (perhaps) DO students take something just for OMM (or perhaps schools do that).

But, the referenced study in JGME shows the same uncomfortable truth that every other study comparing USMLE and COMLEX shows. That the bottom of the passing range on COMLEX is often failing on USMLE:

View attachment 350504

The minimum pass on Step 1 is currently 194. Those scoring 400-450 on level 1 are, on average, going to fail Step 1. There's enough spread in the data that some people may pass, but lots will fail.

The problem with these statistics is that they aren't "fixed" for the score minus OMM portion. Personally, I did atrocious on the OMM and according to this I should have failed the step, yet I a passed step 1 in that 490 range, so COMLEX actually pulled me down 50 points. This also makes you wonder how much of this passing range discrepancy is because students are wasting time on OMM. If anything, this conversion should tell osteopathic schools to cut OMM stuff to the bare minimum and focus most teaching on USMLE

 

[Goro]

COMLEX-USA and USMLE for Osteopathic Medical Students: Should We Duplicate, Divide, or Unify?

In 2020, approximately 60% of osteopathic medical students took at least one portion of the United States Medical Licensing Examination (USMLE).1 At first, this may seem a curious statistic. After all, the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is the only...

meridian.allenpress.com

Thoughts ?

First, you need to get rid of the True Believers at NBOME, which will be as easy as getting a 100% vaccination rate against covid in the United States.

But at least, get rid of John Gimple

 

[Ho0v-man]

Everyone knows comlex needs to die. Everyone could pass step if they had to. Right now they don’t.

 

[Steve_Zissou]

Everyone knows comlex needs to die. Everyone could pass step if they had to. Right now they don’t.

Knowing some of my classmates, I’m not so convinced. I really think DO schools would have to decrease class sizes or somehow pull more academically accomplished applicants out of thin air.

Not saying this is a bad thing, especially given the unchecked expansion of DO schools of recent years.

 

[Goro]

Everyone knows comlex needs to die. Everyone could pass step if they had to. Right now they don’t.

There are MD students who fail Step I. So no, not all DO students will pass Step I either.

Based upon years of experience eat my school, I'd estimate that 67-75% of failures will be with the usual suspects, and the other 25-33% will be with students who got smack by a last minute life event.

Numbers will be worse with the newest DO schools, of course. That's a given.
Do keep in mind that the pass rate for the 2nd try on COMLEX is >95%, at least from what I remember.

Me personally, I'd like to see all students be required to stake Step I and have COMLEX limited to an exit exam at the COMs. I hope that this will happen in your lifetimes; it won't in mine.

 

[Neopolymath]

Let me give you another observation: moving to a USMLE plus separate OMM test is actually worse!

Current situation is that anyone can know the real medicine/science good enough to completely bomb OMM and pass comlex. Then take the USMLE with that same medical/science knowledge.

If we move to USMLE plus a test that is basically only OMM then the problem is that one has to actually study OMM some because the normal medical questions don't buffer your score.

As someone who studied OMM for my in-house exams M1-M2 and then studied OMM probably less than 4 days total afterwards this would suck. It would have made me waste more time and still wouldn't have helped because I'm sure the NBOME would still charge a fortune for this OMM only exam.

 

[Ho0v-man]

Knowing some of my classmates, I’m not so convinced. I really think DO schools would have to decrease class sizes or somehow pull more academically accomplished applicants out of thin air.

Not saying this is a bad thing, especially given the unchecked expansion of DO schools of recent years.

There are MD students who fail Step I. So no, not all DO students will pass Step I either.

Based upon years of experience eat my school, I'd estimate that 67-75% of failures will be with the usual suspects, and the other 25-33% will be with students who got smack by a last minute life event.

Numbers will be worse with the newest DO schools, of course. That's a given.
Do keep in mind that the pass rate for the 2nd try on COMLEX is >95%, at least from what I remember.

Me personally, I'd like to see all students be required to stake Step I and have COMLEX limited to an exit exam at the COMs. I hope that this will happen in your lifetimes; it won't in mine.

I think there’d just be higher attrition the first couple years while schools adjust. The people who can’t pass today aren’t incapable of doing so. They’re just at best disorganized and at worst lazy. Doesn’t help that when a DO student gets owned by a couple blocks of uworld in January of OMS-II the school tells them to just focus on comlex.

MDs struggle with it too obviously, but are given more time and support if they can’t pass step. The few that go through dedicated the way a typical SDN member does and aren’t quite able to pass still aren’t given the time to delay since step 1 is not required for graduation/licensing.

Let me give you another observation: moving to a USMLE plus separate OMM test is actually worse!

Current situation is that anyone can know the real medicine/science good enough to completely bomb OMM and pass comlex. Then take the USMLE with that same medical/science knowledge.

If we move to USMLE plus a test that is basically only OMM then the problem is that one has to actually study OMM some because the normal medical questions don't buffer your score.

As someone who studied OMM for my in-house exams M1-M2 and then studied OMM probably less than 4 days total afterwards this would suck. It would have made me waste more time and still wouldn't have helped because I'm sure the NBOME would still charge a fortune for this OMM only exam.

Agree. Barely survived the omm comats.

 

[Osminog]

This topic has been discussed here multiple times. Most agree that the COMLEX should be removed, everyone takes the USMLE, and (perhaps) DO students take something just for OMM (or perhaps schools do that).

But, the referenced study in JGME shows the same uncomfortable truth that every other study comparing USMLE and COMLEX shows. That the bottom of the passing range on COMLEX is often failing on USMLE:

View attachment 350504

The minimum pass on Step 1 is currently 194. Those scoring 400-450 on level 1 are, on average, going to fail Step 1. There's enough spread in the data that some people may pass, but lots will fail.

~20% of test-takers get 450 or lower on Level 1. Around one-fifth of DO students.

I’ve been saying this for a while on here, and I’ve gotten a massive amount of resistance for it, but DO students are, on average, of a lower academic caliber than US MD students. The COMLEX exams aren’t just a money-making scheme for the NBOME (though they absolutely are); they’re also a crutch for medical students who lack the knowledge and/or motivation to pass the Step exams.

If exam standards for MD and DO students were merged, DO schools would either need to raise their admission standards (and therefore cut class sizes) or accept the fact that they’ll have drastically higher attrition rates.

 

[FootballAndSkiing]

~20% of test-takers get 450 or lower on Level 1. Around one-fifth of DO students.

I’ve been saying this for a while on here, and I’ve gotten a massive amount of resistance for it, but DO students are, on average, of a lower academic caliber than US MD students. The COMLEX exams aren’t just a money-making scheme for the NBOME (though they absolutely are); they’re also a crutch for medical students who lack the knowledge and/or motivation to pass the Step exams.

If exam standards for MD and DO students were merged, DO schools would either need to raise their admission standards (and therefore cut class sizes) or accept the fact that they’ll have drastically higher attrition rates.

Im curious because my DO school is requiring USMLE step 1 as a requirement for graduation starting this year. Does any other school do this? What is the pass rate? I haven't seen a pass rate that doesn't pre select for the smarter students.

@Goro Ive been meaning to ask this, I thought maybe you would know.

Edit: Also trying to prove this guy wrong.

 

[Schwifty]

Im curious because my DO school is requiring USMLE step 1 as a requirement for graduation starting this year. Does any other school do this? What is the pass rate? I haven't seen a pass rate that doesn't pre select for the smarter students.

@Goro Ive been meaning to ask this, I thought maybe you would know.

Edit: Also trying to prove this guy wrong.

I think RVU requires students to take Step

 

[FootballAndSkiing]

I think RVU requires students to take Step

Yeah I go to RVU, this is the first year its required.

 

[Schwifty]

Yeah I go to RVU, this is the first year its required.

Oh I thought it was a thing for a while, my bad. I don’t know if any other DO schools that require it

 

[Ho0v-man]

Oh I thought it was a thing for a while, my bad. I don’t know if any other DO schools that require it

I recall talks of lecom requiring it. Don’t know if they ever followed through.

I’m almost positive RVU has required it for years.

 

[Lawpy]

Get rid of COMLEX immediately. Unfortunately from what I learned, this also dooms NBOME and AOA but honestly… we need to stop dividing physicians

 

[FootballAndSkiing]

I recall talks of lecom requiring it. Don’t know if they ever followed through.

I’m almost positive RVU has required it for years.

I think they've always encouraged it. But I don't think it was ever required to graduate. And I think having literally everyone take it makes a difference. Im sure past classes have done well enough that they feel comfortable implementing this policy. But I am also a little curious (and a little skeptical) if this has something to do with increasing the class size, and finding rotation sites for everyone. Potentially trying to weed out the bottom 5%?

 

[Lawpy]

Perhaps except for the medical schools who are certain to have an increased failure rate. And the students who would have passed COMLEX but fail USMLE. Except for them.

IMGs need to pass USMLE to match in US. There is zero reason to exempt DO students from USMLE. I’m certain most will pass if USMLE is the main exam to study

 

[FootballAndSkiing]

I think they've always encouraged it. But I don't think it was ever required to graduate. And I think having literally everyone take it makes a difference. Im sure past classes have done well enough that they feel comfortable implementing this policy. But I am also a little curious (and a little skeptical) if this has something to do with increasing the class size, and finding rotation sites for everyone. Potentially trying to weed out the bottom 5%?

Yeah just checked the handbook

"Effective with the Class of 2024, students are required to sit for and pass the USMLE Step 1 exam."

 

[Browns99]

Everyone knows comlex needs to die. Everyone could pass step if they had to. Right now they don’t.

I disagree with your assessment that everyone could pass step, like Goro said, there are MD candidates who fail every year.

 

[calivianya]

I also wish we didn't have two exams, but honestly, I'd take the current setup over step + a separate OMM exam.

Maybe I'm in the minority for thinking that, but really strong non-OMM stuff = great COMLEX score. You can know zero OMM and be 700+ on COMLEX. I didn't look at OMM at all before step 2, and I had no exposure to OMM during third year, and that's where I scored. Maybe I remembered some from before somehow, maybe I didn't, but the point is that right now you do not have to study OMM at all.

That's not going to be true if we have a separate OMM exam we have to pass.

 

[Ho0v-man]

I disagree with your assessment that everyone could pass step, like Goro said, there are MD candidates who fail every year.

I didn’t mean first attempt. MD schools don’t do that either. That’s unreasonable.

 

[harrislakers123]

DO students, if focusing on one exam such as the USMLE, would pass at a comparable rate to MDs. Our call is for a new single licensing exam anyway

 

[Lawpy]

I also wish we didn't have two exams, but honestly, I'd take the current setup over step + a separate OMM exam.

Maybe I'm in the minority for thinking that, but really strong non-OMM stuff = great COMLEX score. You can know zero OMM and be 700+ on COMLEX. I didn't look at OMM at all before step 2, and I had no exposure to OMM during third year, and that's where I scored. Maybe I remembered some from before somehow, maybe I didn't, but the point is that right now you do not have to study OMM at all.

That's not going to be true if we have a separate OMM exam we have to pass.

Is there that much of an overlap between USMLE and non-OMM COMLEX? Because i’m seeing posts of high USMLE/low COMLEX. Anecdotal and people could be lying yes but still

 

[DOVinciRobot]

I think they've always encouraged it. But I don't think it was ever required to graduate. And I think having literally everyone take it makes a difference. Im sure past classes have done well enough that they feel comfortable implementing this policy. But I am also a little curious (and a little skeptical) if this has something to do with increasing the class size, and finding rotation sites for everyone. Potentially trying to weed out the bottom 5%?

Yeah just checked the handbook

"Effective with the Class of 2024, students are required to sit for and pass the USMLE Step 1 exam."

I know for a fact that RVU used to have this policy, got rid of it, and then have re-instituted it

 

[Ho0v-man]

Is there that much of an overlap between USMLE and non-OMM COMLEX? Because i’m seeing posts of high USMLE/low COMLEX. Anecdotal and people could be lying yes but still

Yes. And the thing is, the stuff that isn’t on USMLE could still show up on comlex. However, if it’s not in BUFAPS, no one will know it anyway so that question gets tossed.

I’ve always found the comlex exams harder. Mainly because they’re stupid and I know the score is meaningless.

 

[FootballAndSkiing]

I know for a fact that RVU used to have this policy, got rid of it, and then have re-instituted it

Do you know why they got rid of it? Were people failing?

 

[Schwifty]

Is there that much of an overlap between USMLE and non-OMM COMLEX? Because i’m seeing posts of high USMLE/low COMLEX. Anecdotal and people could be lying yes but still

Yes its similar, but I'm one of those higher USMLE lower COMLEX people and if I had done more studying for complex specifically I probably would have done better on it. I did zero studying for comlex except for a couple days of OMM review. The questions on comlex are terribly written and just using UW does not prepare you for how bad some of the questions are on there. I know of several other people in my class and the class above me who did better on Step vs comlex and we all focused almost solely studying for step

 

[DOVinciRobot]

Do you why they got rid of it? Were people failing?

Not sure. The average score for their last year of requiring it was like a 223 I think.

 

[MDMechEngr]

Their abysmal match last year brought USMLE requirement back? plus step 1 is now P/F, so to pass it is a low bar that most should be able to hit. lets see if they report the result after requiring everyone to take Steps. LOL

 

[FootballAndSkiing]

Their abysmal match last year brought USMLE requirement back? plus step 1 is now P/F, so to pass it is a low bar that most should be able to hit. lets see if they report the result after requiring everyone to take Steps. LOL

I remember them telling us this during my interview, so it was planned years before the bad match, and before p/f decision. And its only STEP 1

 

[calivianya]

Is there that much of an overlap between USMLE and non-OMM COMLEX? Because i’m seeing posts of high USMLE/low COMLEX. Anecdotal and people could be lying yes but still

I think weird crap just happens with comlex. I thought comlex was harder bc the questions were so vague and idiotic. I thought coming out of both sets of exams that I was going to do better on the steps because I at least understood what the questions were asking for both steps and felt confident. I actually cried coming out of level 1 bc I was sure I failed... shocked me to death when I did better on level 1 than step 1, and then repeated that pattern for level 2/step 2.

Can confirm the difference was *not* OMM knowledge bc OMM was one of my weakest disciplines on level 2 per the score report and I still scored ~95th percentile on level 2 compared to ~70th percentile on step 2

 

[Prehealth1011]

I’m a sht test taker (NOT an sdn 240 guy)

I found comlex much easier and less stressful. You don’t really know what they’re asking so you say fk it and pick the answer associated to the question stem, but at end you do feel that you passed. Usmle was exhausting for me because of all the “thinking”

 

[Neopolymath]

I also wish we didn't have two exams, but honestly, I'd take the current setup over step + a separate OMM exam.

Maybe I'm in the minority for thinking that, but really strong non-OMM stuff = great COMLEX score. You can know zero OMM and be 700+ on COMLEX. I didn't look at OMM at all before step 2, and I had no exposure to OMM during third year, and that's where I scored. Maybe I remembered some from before somehow, maybe I didn't, but the point is that right now you do not have to study OMM at all.

That's not going to be true if we have a separate OMM exam we have to pass.

My experience as well. Some people got upset when I posted that a year or two ago. You don't have to know literally any OMM to pass any comlex exams based on the idea that even guessing gets some questions correct because the rest is just regular stuff you should know.

 

[Neopolymath]

Is there that much of an overlap between USMLE and non-OMM COMLEX? Because i’m seeing posts of high USMLE/low COMLEX. Anecdotal and people could be lying yes but still

Comlex score is meaningless for almost all students aside from former AOA surgical subs (and that's dwindling). I used it to get a half day on exam day and go chill before going back to real job. When you know it doesn't matter, you are tired from USMLE a couple days prior, and you don't study OMM at all you will of course do worse than your true potential....

 

[NotAProgDirector]

~20% of test-takers get 450 or lower on Level 1. Around one-fifth of DO students.

I’ve been saying this for a while on here, and I’ve gotten a massive amount of resistance for it, but DO students are, on average, of a lower academic caliber than US MD students. The COMLEX exams aren’t just a money-making scheme for the NBOME (though they absolutely are); they’re also a crutch for medical students who lack the knowledge and/or motivation to pass the Step exams.

If exam standards for MD and DO students were merged, DO schools would either need to raise their admission standards (and therefore cut class sizes) or accept the fact that they’ll have drastically higher attrition rates.

... or, we decide that the current graduates of DO schools getting 400-450 on the COMLEX are perfectly fine doctors, and we adjust the passing level on the USMLE downwards. Although that's never going to happen.

I also wish we didn't have two exams, but honestly, I'd take the current setup over step + a separate OMM exam.

Maybe I'm in the minority for thinking that, but really strong non-OMM stuff = great COMLEX score. You can know zero OMM and be 700+ on COMLEX. I didn't look at OMM at all before step 2, and I had no exposure to OMM during third year, and that's where I scored. Maybe I remembered some from before somehow, maybe I didn't, but the point is that right now you do not have to study OMM at all.

That's not going to be true if we have a separate OMM exam we have to pass.

This is certainly an issue. You could be the greatest student ever but still fail the OMM exam. Although, if it was a separate exam, I assume as the greatest student ever you'd actually study for it and pass it. If this were to come to be, I'd favor the schools simply certifying students as competent in OMM and not have a national exam.

DO students, if focusing on one exam such as the USMLE, would pass at a comparable rate to MDs. Our call is for a new single licensing exam anyway

This is a theory. It certainly might be true. Or it might not. Depends on how different the content and style of the exams are, and how much you can actually practice for the latter.

 

[deleted1129181]

The DO hard ons at the AOA will eventually retire soon. What really scares me are the students at my school who think OMM can cure cancer.

 

[deleted1129181]

Killing COMLEX doesn't necessarily mean we need an "OMM supplement" on top of USMLE. We still have the OPP COMAT.

 

[harrislakers123]

Comlex score is meaningless for almost all students aside from former AOA surgical subs (and that's dwindling). I used it to get a half day on exam day and go chill before going back to real job. When you know it doesn't matter, you are tired from USMLE a couple days prior, and you don't study OMM at all you will of course do worse than your true potential....

Former AOA surgical subs do not care about COMLEX. Many have MD faculty and/or chairs.

I found USMLE to be more straightforward and easier than COMLEX. Scored better percentile on USMLE. It was a fair test that reflected input of time. COMLEX more variable, a poor test

 

[Schwifty]

Killing COMLEX doesn't necessarily mean we need an "OMM supplement" on top of USMLE. We still have the OPP COMAT.

This is a good point, we already take the OPP COMAT. They could just use that as the "OMM supplement"

 

[dabagi]

Former AOA surgical subs do not care about COMLEX. Many have MD faculty and/or chairs.

I found USMLE to be more straightforward and easier than COMLEX. Scored better percentile on USMLE. It was a fair test that reflected input of time. COMLEX more variable, a poor test

This is confusing because I know people who say that USMLE is tougher. I'm confused... Either way, I'm a D.O. so as of now, I have no way around the comlex.

 

[calivianya]

This is confusing because I know people who say that USMLE is tougher. I'm confused... Either way, I'm a D.O. so as of now, I have no way around the comlex.

Straightforward/easy = bad when you're talking about standardization. The more straightforward a test is, the tighter the scores are going to be. You're more likely to have a higher percent correct with a smaller standard deviation, and that's going to make it very, very difficult to land a high score.

There's a major difference between "this test is tougher" vs. "it's tougher to get a high score on this test" when the test is standardized.

 

[SurgDoc95]

Former AOA surgical subs do not care about COMLEX. Many have MD faculty and/or chairs.

I found USMLE to be more straightforward and easier than COMLEX. Scored better percentile on USMLE. It was a fair test that reflected input of time. COMLEX more variable, a poor test

Yes they do…even the ones with md leadership still look at the comlex scores because that’s how they’ve always recruited. They definitely use step as well, but to say they don’t care is false.

 

[Please_Stand_By]

I remember making this lovely old graph in 2015 LOL with data from SDN. Full of biases and potentially flawed numbers 😆

 

[Goro]

I remember making this lovely old graph in 2015 LOL with data from SDN. Full of biases and potentially flawed numbers 😆View attachment 351131

There's a trend there, somewhere.

John Gimpel has just released a pathetic attempt with a VERY similar graph to show how COMLEX is equivalent to Step I. My eyes are still rolling from reading that, like the wheels on a slot machine.

 

[Schwifty]

I remember making this lovely old graph in 2015 LOL with data from SDN. Full of biases and potentially flawed numbers 😆View attachment 351131

The NBOME released this a couple weeks ago, so likes like you were pretty spot on

 

[Prehealth1011]

I'm fine with them wasting time with this kinda stuff than trying to bring back PE in some weird way