DO and USMLE

[incrediblexman]

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Below is recent performance data of DO students taking USMLE at USMLE site. Wondering if anyone cares to comment, particularly on lower scores (than allopathic which are never below 90%) of Step 1 and 2, and the high scores (actually higher than allopathic) of Step 3. Is it reasonable to infer that

a) there is some kind of bias in the test toward allopathic basic science curricula?
b) basic science curricula at DO is not as "aggressive", possibly due to the lower bar set for entering students.
c) basic science (as measured by Step 1 and 2) is just not as emphasized at DO schools.
d) DO schools are just not training their students as hard as allopathic schools.
e) DO students opting to take USMLE may have circumstances that are biasing the results.
f) the extreme differences in sample sizes (e.g. 17,691 allopathic vs 69 osteopathic) does not allow for any of these inferences.

percent passing Step 1
6/98 - 85%
10/98 - 54%

percent passing Step 2
8/97 - 77%
3/98 - 87%
8/98 - 78%

percent passing Step 3
5/98 - 93%
12/98 - 96%

 

[mig2k]

From what I have heard, not too many DOs take time out to study for it as much as MDs do. I heard MDs get anywhere from 2 wks to a month off to study EXCLUSIVELY for the USMLE (I could be wrong), while DOs study for the COMLEX. A few DOs will sit in for USMLE however. My point is DOs study for the COMLEX and MDs for the USMLE. Let 69 MDs sit in for the COMLEX (minus OMM) and see what happens.

I'm sure DOs will get just a good a score on the USMLE if they set aside time to study for it, which most don't.

 

[incrediblexman]

thanks miglo. You raise an interesting point that I hadn't considered, that prep time (and maybe focus) favors MD students for USMLE. Of course, the reason I'm thinking about all this is residency (and after of course). I'd be interested in finding out what difficulties pop up for DO students trying to take USMLE, and successful techniques for getting around them. Anyone have any suggestions for finding this out?

 

[mig2k]

I plan (once I get accepted of course

) to study early for the USMLE myself (and COMLEX too) because I want to stay in CA to do my residency (DO or MD) if I can.

Mig

 

[turtleboard]

I've always thought the numbers were attributed to the differences in curricula. The MD curriculum, supposedly, trains MD students to take the USMLE while the DO curriculum trains DO students to take the COMLEX.

Someone should get a bunch of MD students to take the COMLEX minus OMM and see what happens. That'd be kinda interesting.

Tim of New York City.

 

[Gregory Gulick]

These are all very good points. I've had this discussion with others in the past so here's my take on this.

We must remember one crucial thing when analyzing these numbers. These numbers are statistics only. They are not part of a research study that was designed to assess the differences in MD and DO performance. If we try to infer anything from these numbers, then we get into trouble. Why? Well, first and foremost we must consider the populations being studied. You are taking 100% of the MD population and comparing them to roughly 10% of the DO population. What do we know about this 10%? Absolutely nothing. They are a self-selected group of people and therefore not randomly assigned to take the USMLE. And therefore we don't know if these DO students are representative of the entire student population. There could, for example, be a disproportionate number of DO students from one particular medical school and insufficient numbers from another medical school. If this were the case, we'd have a problem with the weighting of the sample and this would possibly lead to a confounding variable situation. In a nutshell, be careful inferring anything from statistics that weren't part of a controlled research study.

But what is my personal take on it? It is entirely possible that there could be a difference in the first two years of MD and DO education. Here at NSU, I'm getting slammed with as much clinical education as I am basic science information. I did a short patient write-up my first week, and a full write-up my second week. I don't remember seeing any classes like these in the catalogs of MD schools. So this school is going to turn me into a great clinician (not to mention having an extra tool in my toolbox: OMM). And I'd gladly trade in some basic science knowledge for better Dx/Tx skills in the clinic.

 

[drusso]

I've wondered about these data too. I think that some of it can be explained by motivational factors. DO students know that there are no consequences for not passing the USMLE, but must pass the COMLEX to advance to clinical training. I think the selection bias is also important to consider. I've heard some DO opponents argue that the USMLE data **must** represent the best comparison because "best and brightest" DO's sit for the USMLE and the rest only take the COMLEX. This simply isn't true. It is my experience that those DO students who take the USMLE are usually interested in residencies in geographic areas where DO's are under-represented.

I took both tests and did pretty well on both. I thought that the USMLE did have more basic science information on it and tested it in a more "interpretative" fashion; i.e. asked examinees to explain and draw conclusions from laboratory data. One needed to understand the underlying basic science concepts to make any sense of the lab data. The COMLEX either put the basic science info in a clinical context or just asked about it in a straight-forward, choose the one best answer, format.

It's interesting that differences between MD DO performance improves with each subsequent step, and according to some information presented at the Josiah Macy conferences, MD's and DO's have nearly equivalent first-time pass rates on internal medicine specialty boards. What gives?

 

[OldManDave]

Just off the top of my head...I would say the equal pass rates on IM boards would suggest that both curriculum types prepare the practitioner well, just in different sequences. Supposedly, according to several clinical faculty [KCOM President, Dr. McGovern, same guy who is immediate past Pres. for Case-Western med school] DO grads are likely sought after by post grad programs because of "advanced" level of clinical preparation as compared to the typical MD grad. However, the gap is not momentous and the MD grads rapidly close it.

------------------
'Old Man Dave'
KCOM, Class of '03

 

[jawurheemd]

I don't think that the basic sciences are underempahsized in DO schools -- my wife who's a third year DO student now had much more basic science nitty-gritty stuff than I did at an MD school -- I don't think you can tell too much from the pass rates of DO v. MD. Another factor that may play a roll, however, is the fact that it seems allopathic schools place much more emphasis on good MCATs while osteopathic schools tend to favor those with life experiences. If a person is a good standardized test taker, then they are a good standardized test taker -- it doesn't mean that he or she will be a good clinician. By the way, I studied some of the COMLEX sample questions and compared questions against my wife -- it seems that the COMLEX is just as hard or harder than the USMLE. I was surprised that I could answer a lot of the OMM/OMT questions using my poor allopathic education -- guess that makes me a good guesser (not necessarily a good clinician).

 

[Ponyboy]

I wouldn't really worry about pass rates on the USMLE 1. I hardly think that there is a significant difference between the two rates and the raw data that is presented is too non-specific to really extrapolate anything. Additionally, I don't think that you really have to worry about whether DO or MD school graduates have more clinical or basic science knowledge. What you learn in school will be small fries compared to what you'll pick up in your residency and fellowships. You're only given a small taste of what medicine is like while you're in med school and I don't think what pathways you know or what muscles you've memorized are really going to have an enormous impact on your performance as a doctor.

 

[rhillstr]

I would have to argue straight statistics! You don't have a large enough sample of DO med students to draw ANY reasonable conclusion. What if 7 students, a measly 7, did better. That's 10%!!!! 7 MD takers could die and the numbers would never miss them! Thus this sample is BUNK. On the other hand 69 MD students could ace COMLEX and raise an eyebrow or two but the end result is the same. It all means bunk....

 

[mig2k]

I have a friend in WesternU who just took the boards, both COMLEX and USMLE, and he told me that the USMLE was A LOT easier! Strange huh?

Incidently he passed both exams. I did not ask for his score though, but he said he did pretty well.



------------------
Ryan
Western U/COMP Class of 2004
thedigitaldoctor.com

 

[incrediblexman]

I originally posted these queries and have been interested in the responses. I'm sure everyone would agree that the sample sizes make any inferences worthless. However, these few data would seem to be thought provoking.

There have been a few observations here and elsewhere that exceling at basic sciences doesn't necessarily make a great doctor. Again, I think just about everyone would agree with this. However, I have been doing some research into the history of developments in biochemistry and microbiology, and I have been astounded at how recently most of the facts that are taught in basic courses were discovered. A lot (perhaps even most) rudimentary biochemical knowledge expected of doctors now wasn't even discovered before the 1950s, and this would include much pharmacological knowledge.

I think this makes an interesting footnote to the USMLE comments and the importance of science to medical practice, as well as the expectation that it will increase in years to come. Perhaps we will see a divide in the future between folks practicing doctoring the "old" way and those who are fully up to speed with the rapid scientific and technological advances. In any case, it's a pretty good bet that medical schooling will continue to become more intense over time and only seriously prepared students are going to get in and through.

Finally, it does make me wonder how doctors who have been practising for a while deal with the onslaught of scientific developments. I'm sure they would also agree that you can be a good doctor without being a good scientist. Where the knowledge required to diagnose and treat "common" ailments is concerned, I'm sure this is true. But when the understanding of the mechanisms of disease have "matured", there is something to be said for being up to speed where one's effectiveness as a physician is concerned.

 

[Medicine Man]

MD schools are "old school" and are much more research oriented. With few exceptions, there is not a lot of research going on at D.O. schools. This is not necessarily bad. It's nice to know that your professor will be in his office when you need them and not burried in research lab in a basement somewhere. Point being is that the curriculum at most MD schools is very research and minutia based. Is it necessary to know every step and every enzyme in glycolysis (as well as how to draw the structures)? Or is it more important to know the starting and ending products as well as the rate-limiting enzyme? This is a fundamental difference in the two curricula.

Another factor is that until this year, with the advent of USMLE on computer, you had to sit for the COMLEX and USMLE in the same week (most years). Taking it on computer allows you to take the USMLE anytime within a 3 month period instead of on a pre-chosen day (that just happens to be 3 days after the COMLEX). This accounts for some of the poor performance in past years. As for this year, your guess is as good as mine.

Sample size is an important issue but you are correct in saying that the numbers are certainly though provoking. D.O. students who take the USMLE are certainly not the "best and brightest" of the bunch. It is very mixed, some are at the top and some are not even close. It would be interesting to see some more numbers on this issue.

[This message has been edited by Medicine Man (edited September 22, 1999).]

 

[incrediblexman]

I just read a book by Arthur Kornberg on his work with enzymes and production of DNA etc. He rejects the idea that medical schools are technical schools. In his opinion, they exist to "advance the spirit of knowledge of medicine and imbue the students with this spirit . . . who will remain attentive to new knowledge . . . in whom we entrust the care of our families." (For The Love of Enzymes, p317).

Of course, having been professor of biochemistry at Stanford, he would think this. However, if scientific investigation can be interpreted to mean being able to look beyond accepted notions and being motivated enough to pursue your curiosity, then not only would you be a better clinician over time, but you would make contributions to medicine in general. Kornberg's final point in his book is to imagine the cumulative advances in medicine and people's lives if doctors actually approached medicine this way.

As an aside, I also read an article in the Boston Globe recently (9/13) about JoAnn Manson. She treats 400 people in her endocrinology practice (who apparently like her), has published over 300 papers, is head of Preventive Medicine at Brigham and Women's hospital in Boston, is a professor at Harvard, is responsible through her research for the an aspirin a day, brisk walks, and antioxidant vitamins in lowering risk of heart disease as well has many women's health issues, and takes care of two kids.

Imagine, indeed.