Originally posted by ADRIANSHOE:
actually drusso, YOUR points make a VERY COMPELLING reason for ONE exam.
IF as YOU say the exams are comparable.
Then what possible logic is there to having the confusion of two separate tests?
what possible efficiency gain is there from such a system?
What confusion? DO's take the COMLEX as their route to PRIMARY licensure (but have the option of taking the USMLE) and MD's take the USMLE has their route to primary licensure. I've spoken to several DME's (directors of medical education) and none have complained about being confused about this system. Scoring at the 80%tile on the COMLEX means you did better than 80% of DO students taking the exam. From my experience, DME's are very knowledgable about how to interpret %tile scores.
Now, with respect to comparing scores ACROSS exams, yes, this is difficult. There is no conversion factor to turn COMLEX scores into USMLE scores, just as there is no conversion factors to turn ACT scores into SAT scores. Just as there is no conversion factor to turn scores on the Zung depression inventory into comparable scores on the Beck depression inventory. In fact, when it comes to measuring complex things like "achievement", "competence", "academic potential" or even "depression" it is possible to have several competing instruments or exams that tap into different dimensions of the domain being meaured and are still equally valid and reliable. The COMLEX and USMLE are both equally valid and reliable examinations for establishing thresholds of basic science and clinical science mastery. By the way, there is an important distinction between achievement tests (like the MCAT, SAT, ACT, PSAT, etc) and licensing exams (like the COMLEX, USMLE, or many others). The latter are not strictly designed to stratify performance (although they get inappropriately used by residency directors to for this purpose). They are only designed to identify students who have not mastered basic material. That's why someone with board scores in the 99+%tile can still be complete idiot on rotations...
IT ONLY HURTS THE DO STUDENTS, without having ANY negative impact on the MD students
How does it HURT them? I think that DO students might be HASSLED by having to choose whether or not to take both exams, but actively HARMED?? I took both and hardly feel that any great harm has come to me.
(actually it benefits the MD students, as they arent faced with the same biases that DO students are at some of the ACGME residencies (NOTE: I DID NOT SAY ALL!!!!) ANY biases due to the comlex that result in any decreased percentage of DOs getting into MD programs is an argument for a single testing format.
Or, it's an argument for educating residency directors about how to interpret COMLEX scores; or, it's an argument for DO students doing their homework and finding which programs want USMLE scores and which could care less; or it's an argument for the entire medical profession to rethink how board scores should be used in applicant selection in general.
I find it curious that some people believe that residency programs will be less biased against a DO if they have USMLE scores. Biases are usually not rational things. If a program director is, in general, biased against DO's, then why would they be LESS biased against a given DO if he has USMLE scores? Does that make him less of a DO? I'm confused...I don't think I would want to attend a program that didn't value my profession's licensing exam. That probably hints at other "issues" in the program.
The osteopathic/OMM portion could be a separate requirement, but there is NO logic to the MEDICINE portions of the test being maintained in a separate but ostensibly equal environment...
Well, it comes back to MEDICINE being one of those inherently complex domains to measure in the first place, like "achievement", "academic potential", or "depression." There is more than one way to measure mastery of basic concepts in MEDICINE just as there is more than one way to measure the dimensions of the other domains listed above. What matters less is that the two systems are strictly equivalent (which would be impossible, even if a conversion factor were available, because of the overall complexity of measuring things like "mastery" and "achievement"), than that the two ways of measuring the same things are make similar kinds of predictions (which the USMLE and COMLEX have been shown to do.) Those who do poorly on either test are more likely to have difficulty applying fundamental basic science and clinical principles to real life patient encounters.
this logic is similar to the two toilets for blacks and whites....hey as long as the toilets are equal.....didnt make sense then and it doesnt make sense now...
No, not really, because DO's can use either toilet. We can take the USMLE too. We can apply to ACGME-approved residencies. If anything, it's the MD's who are really victims here because they can't take the COMLEX (which is a requirement for applying to AOA-approved residencies). But, I haven't heard too many (although a few) MD's complain about this.
IT BENEFITS US DOS to demand a single test format as it levels the playing field and forces us to live up to our claims of equality....as well we should!
How does the two test format help the DO student who comes up against the MANY program directors who DONT feel the COMLEX is a good comparison?
If DO's want to show their equality, then take the USMLE! However, I'm almost certain that it will do NOTHING to change the biases of residency directors. Good candidates get turned away from residency programs for all kinds of reasons, some of which reflect the inherent biases of the person doing the interviewing. Yes, in a strictly logical world where two candidates, a DO and a MD, applying to a given program with identical board scores on identical exams, with identical GPA's, identical letters of rec., and identical interviewing performance, you would be right. But, you over-estimate how logical program directors are: If there is only one spot, the program director will make a decision probably based on some whimsical preference or "gut feeling" that has nothing to do with any predictive data in his possession and everything to do with factors that he or she might not even fully comprehend.
There is absolutely NO logic to keeping two tests other than the PRESERVATION OF THE DO IDENTITY...and that is the political goal of the powers that be in the DO community... giving up on this issue would be a form of surrender for them, so they will fight against all logic and/or enemies imagined and real and as a result MANY DO students will continue to have to take BOTH tests to A: compete for spots at the HIGH LEVEL ACGME programs and B: to meet the DO SCHOOL GRADUATION REQUIREMENTS.
Well, the fact of the matter is that no one is really complaining about this too much except a proportion of DO students. It's not like ACGME residency program directors are calling the AOA and screaming, "My God, we're so confused. We really want to take your students in droves, but just can't figure out how to interpret this darn COMLEX thing. You think you could change it??" And, every year, just about every DO student in the nation matches into a residency program. The majority of those I've spoken to are pleased with their decision. They basically look at all programs on their own merits and rank them accordingly. If it's AOA-approved fine; ACGME-approved, that's good too.
I'm not Pollyanna-ish about this whole matter. I think that some students need to take the USMLE to feel like they measure up to MD students. I do believe, and sincerely advise, DO students to take the USMLE if they're applying to non-primary care residencies or especially geographically competitive areas of the country. But, I don't think that taking it makes one a shoe-in for a program. If a program director is biased against DO's, they're not going to be less biased against a DO with USMLE scores.
...But, you do raise an interesting point about the responsibility that a given profession has for maintaining its identity and policing itself. Osteopathic medicine was founded as a social reform movement. All social reform movements have political agendas. People rail against the politics of the AOA and its political agenda, but what about the politics and agenda of the AMA? I think they're both bad guys. It just so happens that the AOA is more or less our bad guy. Remember, it is the stated policy of the AMA that there is only "one house of medicine", "one federation of medicine." The AMA was founded to absorb and assimilate competing systems of medicine. Kind of creepy, eh? Reminds me of the whole "one China" policy. How does it feel to be Tiawan?
http://www.ama-assn.org/apps/pf_online/pf_online?f_n=browse&doc=policyfiles/HOD/H -530.948.HTM
The AOA was founded to advance a competing system of medicine. Naturally, there is going to be some tension here.
http://www.aoa-net.org/AOAGeneral/AOA%20facts%202000.pdf
By the way...I'm a member of both! And, just to go on the record, I support and would actively work to create a new national physician licensing organization that was an amalgam of the NBME
http://www.nbme.org and the NBOME
http://www.nbome.org/. It could be the National Board of Physican Examiners (NBPE). Its Board of Govenors would consist of PROPORTIONAL representation of MD's and DO's, it's test-writers would be recruited from both DO and MD schools. It would write one single exam, and, yes, there would probably be a separate section for OMM. But, I wouldn't hold your breath. I've heard no one at either the NBME or NBOME complain about the redundancy and inefficiency of the current system. It would take some pretty hard negoiating to get the two to merge. But, if there is enough will among future physicians on both sides of the practice pathway, anything could happen.
[This message has been edited by drusso (edited 07-02-2000).]