Dropping all COMLEX exams for USMLE+OMM exam

[osli]

From what people are saying, USMLE asks much deeper questions about how and why, and makes sure students can actually understand & apply concepts. This makes sense, and if you can't do that - should you really be a physician?

I'd probably be a little more cautious in drawing such searing conclusions from "what people say." So you haven't taken either, and have to rely on what other people say... in that case, it would be safer to just wait until you have taken one, and then perhaps state your "questions" about who is qualified to be a physician.

For my part, I'll provide you with another "what someone says" perspective. I took both, two days apart. The USMLE IMO does not ask deeper questions about how and why - they simply ask more questions about how and why. The USMLE does make it harder to get to the diagnosis (the first step) IMO, by being less specific with presentation than the COMLEX, but past that first step it was pretty easy to answer the "how and why" part, even if it was a bit obscure at times.

What do I mean? Well, I've heard people complain that for the COMLEX you "either know the diagnosis or you don't" and that's true... but if you don't then you don't deserve to get that question correct because the vast majority of diagnoses are just not that difficult. The findings are usually classic, and even in the cases where they give just one symptom instead of four or five it is nearly pathognomonic. USMLE, on the other hand, teases you with less specific findings (i.e., they might say "right sided systolic murmur" instead of "grade 4 systolic murmur with late peaking and delay and decrease of carotid upstroke") and you have to put together the constellation of vague findings to arrive at a "most likely" diagnosis, and then proceed with the relatively straightforward second level question based on your presumptive diagnosis. COMLEX makes you take your easy diagnosis and answer a tough question about it... USMLE makes you take a tough presentation, and through asking easy second or third level question finds out if you made the correct diagnosis. At least, that's my impression.

Here's an example (completely made up - don't get your panties in a wad anyone):

COMLEX: 47 yo male presents with 4 week history of increasing dyspnea on exertion and general fatigue, with an episode of syncope three hours before admission. Physical findings include a grade 3 crescendo-descrescendo systolic murmur with late peaking, loudest at the upper right sternal border and radiating into the neck. A delay in the carotid upstroke is noted, along with an increased thrusting of the apex beat. What would be the appropriate first step in management of this patient?
a. 12 lead EKG
b. Emergent heart catheterization
c. Transthroacic echocardiogram
d. CT series of cervical and thoracic levels
e. IV fluid bolus followed by continued cardiac monitoring

USMLE: 47 yo male presents with 4 week history of dyspnea and general fatigue. Physical findings include loud systolic murmur with narrowed pulse pressure that decreases with isometric muscle contraction, and increased thrusting of the apex beat. What would be the most likely associated finding?
a. Sterile vegetations attached to the valve cusps
b. Non-malignant neoplasm blocking an outflow tract
c. Calcified bicuspid valve
d. Large infective vegetations on the valve cusps
e. Thrombus occluding a perfusing artery


Not all questions are like this, obviously. Both USMLE and COMLEX had their fair share of very short straightforward one-step questions. Probably a few more on COMLEX. But you can see from this hypothetical example that the focus is different, not necessarily the difficulty. And I don't think you can look at the COMLEX version and say that you aren't going to be a good physician because that is the way you were tested. If anything, COMLEX questions tended to be more clinically relevant, though the USMLE was more clinically challenging.

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[Lamborghini1315]

I'll take a stab at this one. I feel like the quality of education may be comparable (i.e. there are good and bad DO schools just as there are good and bad MD schools... while there may not be a John Hopkins of DO land, I think the "average" DO education is roughly comparable in quality to the "average" MD education), but the focus is different.

We learn the same drugs and bugs. We learn the same anatomy, even if the average DO student gets a little more exposure to it. We learn the same physiology and the same pathology. But past that, differences do start to become more apparent, and I for one do not think that osteo and allo are the same except for the inclusion or exclusion of OMM. Osteopathic education may cover biochem, but at least at my school (which seems to teach more biochem than many others) not to the degree necessary to do well on that part of the USMLE. And molecular is even further behind (though we did have several lectures on this at my school, and I did have several molecular biology questions on my COMLEX).

On the other hand, I'm not convinced that all allopathic students are prepared for the clinical aspects of the COMLEX exam, which I found to be quite different between the two. While the USMLE put a heavy emphasis on clinical diagnosis, the COMLEX goes further and puts a heavy emphasis on clinical management. I didn't have a single question on my USMLE asking what the appropriate drug was (unless it was a very obvious "which one does not have a contraindicated side effect" type of question), or what the best imaging study to order would be, or what the next best step in clinical management would be. I didn't have a single question on how to handle a certain obstetrics case, or manage a guy in back pain. Never was I asked when pharmacotherapy was appropriate or inappropriate, or when medical management was preferred over surgical management. At least a quarter of my COMLEX consisted of just that type of question.

But you could argue that this is more "step II" material, and you'd be right... if you are talking about the USMLE step II. Perhaps this type of early clinical education isn't stressed at many allopathic schools, or perhaps it just isn't tested on step 1. I'm not positive which is the case, but from talking to friends I have to wonder if it is the former.

And I'm not knocking the allopathic education approach in any way... if they think it makes more sense to teach basic science in the preclinical years (and test that), and clinical management in the clinical years, it would be hard to argue with their logic. But it is true that osteopathic education seems to emphasize an early dose of clinical training, well before we are actually on clinical rotations. And I can't say that this approach has no merit either... after all, the end goal is to train us to be physicians, not science teachers.

Bottom line is that the answer to your question is that while many pay lip service to the two extremes (osteo is just allo + OMM, or on the other end osteo has an entirely different philosophy in every way than allo), the truth is that the education is different... perhaps not in quality of teachers, or difficulty, or scope, but rather focus. There are some things that may be taught and tested in one branch that isn't so much in the other, and that is not limited to manipulation techniques.

Thus, being taught to "pass the COMLEX" isn't short sighted... it isn't just that the NBOME/AOA thinks that it is a good test, but also that this clinical-heavy approach makes for a good education - i.e., to "be a good doc" as you state. AOA believes those goals are one and the same, as they should be if you design a test to cover what you feel are essential competency areas.

But not all of those competency areas overlap between the two. And I might catch some flak for saying this, but I believe that if you removed all of the OMM specific content and questions from the COMLEX, pass rates for MD students taking it (hypothetically) would be lower than is the case for the USMLE, just as DO students have lower pass rates for the USMLE than for the COMLEX. I'll catch flack for this as well... but I don't think the difference would be quite as pronounced, even though I think it would exist. MD students have, on average, proven themselves to be better test takers (whether from intelligence, knowledge, discipline, test taking skills, whatever) and I'm sure that would carry over to some degree to the respective board exams.

Ok COMLEX more clinically inclined while USMLE has more emphasis on basic sciences. But an argument that an exam which is clinically oriented gives osteopathic education a different dimension or even an edge is hard to prove. The reason being is you are preparing from what you have learned during your "Pre-clinical years"..if you expect to be tested on something you won't be as good at until may be during your 4th year rotations then we are really kidding ourselves. Osteopathic schools have great curriculums, competent faculties but they have the wrong infrastructure. USMLE better suits our education, and eventually you would be tested on your clinical knowledge on step 2. By being tested during step 1 on COMLEX doesn't necessarily deprive MD's of any clinical prowess that DO's might possess because its not a question about if you were tested on something but if you were more ready than your fellow MD's? I read the same books as MD's and i don't find a difference in approach or knowledge when it comes to taking an exam..i find it hard pressed to believe that i would be asked about lets say how to manage a patient's treatment regimen on COMLEX when i haven't even taken care of a sick patient practically? Instead if they wanted to test me on parkinson's etiology it would put me in a position to fully utilize what i have taken from my "pre-clinical" years. My 2 cents.

 

[osli]

Ok COMLEX more clinically inclined while USMLE has more emphasis on basic sciences. But an argument that an exam which is clinically oriented gives osteopathic education a different dimension or even an edge is hard to prove. The reason being is you are preparing from what you have learned during your "Pre-clinical years"..if you expect to be tested on something you won't be as good at until may be during your 4th year rotations then we are really kidding ourselves. Osteopathic schools have great curriculums, competent faculties but they have the wrong infrastructure. USMLE better suits our education, and eventually you would be tested on your clinical knowledge on step 2. By being tested during step 1 on COMLEX doesn't necessarily deprive MD's of any clinical prowess that DO's might possess because its not a question about if you were tested on something but if you were more ready than your fellow MD's? I read the same books as MD's and i don't find a difference in approach or knowledge when it comes to taking an exam..i find it hard pressed to believe that i would be asked about lets say how to manage a patient's treatment regimen on COMLEX when i haven't even taken care of a sick patient practically? Instead if they wanted to test me on parkinson's etiology it would put me in a position to fully utilize what i have taken from my "pre-clinical" years. My 2 cents.

I completely understand where you are coming from. And I didn't mean to imply that I thought the COMLEX was a superior exam because of its different focus... but rather only to highlight that there is a different focus. I understand the logic of testing preclinical knowledge with a basic science exam, and clinically gained knowledge during rotations with a clinically oriented exam. Makes a lot of sense. But I'd also like to think that students venturing out into rotations are actually prepared to be there, not just completely thrown to the wolves. Is it really so absurd to think that teaching (and, gasp, testing) a student on basic clinical knowledge before they find themselves in the grinder is perhaps a good idea? That seems to make a lot of sense too.

On the other hand, after taking both I can't unequivocally state that I believe the USMLE is a superior exam either. Some of the details tested will never again be relevant in my professional life. I understand that we are supposed to learn them, but there is so much important and relevant material that we learn I just find it hard to justify spending a quarter of the test questions covering these details. Some, yes. 10%, maybe. USMLE has a ton.

Ideally, I think both exams offer insight into how each can be improved. The question writing for USMLE is generally better... it felt like more thought and editing had been put into each question... if a question was vague, I really believed it was that way on purpose that that given enough time I could and would figure it out. The scope of questions on USMLE however was rather more limited than COMLEX, and not because of the OMM component. I was asked enough questions on COMLEX about biochem, molecular biology, tumor genetics, etc. to make it worth having studied, but there were many more questions that tested aspects of DOC and management that were simply missing from the USMLE. I also felt like although the general scope (from one end to the other) of the COMLEX was broader, it was "clumpier" if that makes any sense. I had gaps where certain organs got no love (kidneys... are some people just missing these altogether or something?), and others had multiple questions asking the exact same thing (and not pneumonia, but like ankle sprains or something ridiculous). And while the USMLE didn't have quite as broad of a scope, the questions were much more uniformly distributed within that scope.

USMLE... better written, constructed, and edited. The better content? Not so sure. So I'd love to see a merger wherein some of the better COMLEX clinical questions were incorporated into the USMLE question pool. However, as pointed out earlier... beggars can't be choosers, and it would make more sense to simply adopt the USMLE as is with the addition of a separate OMM test. It is interesting though that the NBME has been talking about the combination of steps 1 and 2, or a revamping of the USMLE structure. Apparently not everyone there believes the current solution to be the only, superior, and unavoidable option. Maybe their desire to change will open the door to some of the ideas proposed in this thread.

 

[Lokhtar]

I'd probably be a little more cautious in drawing such searing conclusions from "what people say." So you haven't taken either, and have to rely on what other people say... in that case, it would be safer to just wait until you have taken one, and then perhaps state your "questions" about who is qualified to be a physician.

Of course. I never said I 'knew' which was better. I completely profess my ignorance on the matter, and I am not in a position to judge the exams, I have no clue. I'm an ignorant pre-med, and I don't presume to know **** about practicing medicine, or the medical curriculum itself. And I'm certainly not going to presume to know whether someone is qualified to be a physician. I hope I didn't come across that way, and if I did, I apologize.

I simply said that whichever (as decided by people more qualified than me) exam is superior should be the one used. If that's the COMLEX, that's fine too. I don't think it makes sense to have two exams, that's all. However, I do like the idea of 3rd and 4th order questions in general, because (IMO), it tests your ability to reason better, and understand the problem on a deeper level than a PA or NP. However, again, this is just me talking out of my ass, and if clinicians and researchers in the field believe that one is better than the other, it certainly does not matter to me. If they think COMLEX is better, fine, if they think the USMLE is better, fine, and if they want to do a combination of the two as you suggested, that's great too.

I am just not convinced of this 'separate but equal' thing. USMLE + OMM for DO, or COMLEX - OMM for MD should be the way to go. If everyone is going to be practicing the same type of medicine, it makes sense to have the same requirements.

Just my 2 cents.

 

[Jimmi]

Definitely, should keep it the way it is. We need osteopaths to foster the growth and development of DO residencies. Don't forget, there is an osteopathic outlook on medicine and life that differs from the allopathic one. It's emphasized in our curriculums whether you realize it or not. We need DOs to keep carrying the banner.

 

[bonesawz]

Definitely, should keep it the way it is. We need osteopaths to foster the growth and development of DO residencies. Don't forget, there is an osteopathic outlook on medicine and life that differs from the allopathic one. It's emphasized in our curriculums whether you realize it or not. We need DOs to keep carrying the banner.

The only different outlooks I have seen in three years at a DO school, are the ones that think you can detect someone's aura, or adjust someone's life force. So, I guess you are right that there is a different outlook, but only by those DOs who are way out in left field that promote their wacky star trek medicine with religious zeal. When they talk about their magical healing theories, it makes me want to tell everyone, "I may have the same initials as those guys, but please don't lump me in with them." I know M.D's have their wacky docs as well, but why are ours so vocal? It's downright embarrassing.

 

[travoltage]

has the AOA even come across this topic? i think students need to start addressing this if it is to happen anytime soon.. (taking the USLME + OMM part)

 

[JLM]

Took step I & II of both USMLE and COMLEX. Only my opinion. Flame away.

Comlex is awful. It is poorly written, filled with grammar errors, and covers a lot of completely irrelevant topics. To top it, in my experience, they tested the easy stuff to excess. Need I diagnose hypothyroidism 9 times on the same test ??

It took me all day to finish USMLE because I was required to stop and ponder the questions. I had to correlate all of the clinical information given and come up with the best possible answer.

My COMLEX(s) required little thought. The answers were largely memorization. You either knew the answer before you finished the question, or you re-read 6 times trying to understand why they had not given you nearly enough information to make a diagnosis. I walked out of COMLEX at 1:30.

Guess which one really test your knowledge??

My vote is a switch to USMLE. I believe there is a standard which all diagnosticians must meet. In my humble opinion, the COMLEX does not test to that standard. When I signed up for DO school, I assumed that the two exams would be similar. I was quite wrong. I didnt take USMLE for residency . . . I wanted to see how much I really knew about MEDICINE.

My COMLEX scores are simply a ticket to that diploma.

If you really want to challenge yourself and take a measure of what you learned . . . USMLE. And again, in my own opinion, I think USMLE should be the standard for medical practice in the US. Practical and written OMM exam if you want to crunch . . . maybe it could replace this $1100 scam they call COMLEX-PE.


you may now begin throwing your sharp objects.

 

[wingbowlchamp3]

hey lamborghini...

what i was suggesting in my post was a comlex exam with omm AND more molecular biology/biochemistry. the nbome should adjust the percentages a little bit so our exam is updated. maybe you're defensive because a more comprehensive exam would be too much for your to handle.

also...by suggesting that d.o. students need help in the form of a new exam to get residencies...you're automatically saying that we are inferior right now. don't displace this inadequacy you seem to feel by telling me i'm contradicting myself. i'm proving every day on rotations that i'm as smart as the allopathic students in my hospital...so i don't feel like i need help...and i especially don't need help from some kind of new board exam that would only be a small indicator of what kind of clinician i'll be.

 

[Lamborghini1315]

hey lamborghini...

what i was suggesting in my post was a comlex exam with omm AND more molecular biology/biochemistry. the nbome should adjust the percentages a little bit so our exam is updated. maybe you're defensive because a more comprehensive exam would be too much for your to handle.

also...by suggesting that d.o. students need help in the form of a new exam to get residencies...you're automatically saying that we are inferior right now. don't displace this inadequacy you seem to feel by telling me i'm contradicting myself. i'm proving every day on rotations that i'm as smart as the allopathic students in my hospital...so i don't feel like i need help...and i especially don't need help from some kind of new board exam that would only be a small indicator of what kind of clinician i'll be.

You lost me, i am assuming you are trying to tell me that i am wrong in pointing out that DO's are better off by taking USMLEs. My friend USMLE is neither a new exam nor a measure of your clinical prowess. We are all talking about residencies and how it can make your residency process less complicated. I don't know where you get the idea that i am being defensive?, i doubt i am defending anything..i am just speaking for many of my future DO colleagues who share my opinions. If you choose not to take USMLE's because that would be against your beliefs..then go for it. I sure as heck won't be urging you to do something when you are clearly capable of discerning the problem at hand and act rationally. I have no problem with anyone choosing to take comlex because the point of this thread happens to be about having an exam that provides residency directors an opportunity to compare you against most of their applicants. Its a matter of simplifying things not about some "ego boost." I hope you continue doing well in your rotations...

 

[DrWBD]

Took step I & II of both USMLE and COMLEX. Only my opinion. Flame away.

Comlex is awful. It is poorly written, filled with grammar errors, and covers a lot of completely irrelevant topics. To top it, in my experience, they tested the easy stuff to excess. Need I diagnose hypothyroidism 9 times on the same test ??

It took me all day to finish USMLE because I was required to stop and ponder the questions. I had to correlate all of the clinical information given and come up with the best possible answer.

My COMLEX(s) required little thought. The answers were largely memorization. You either knew the answer before you finished the question, or you re-read 6 times trying to understand why they had not given you nearly enough information to make a diagnosis. I walked out of COMLEX at 1:30.

Guess which one really test your knowledge??

My vote is a switch to USMLE. I believe there is a standard which all diagnosticians must meet. In my humble opinion, the COMLEX does not test to that standard. When I signed up for DO school, I assumed that the two exams would be similar. I was quite wrong. I didnt take USMLE for residency . . . I wanted to see how much I really knew about MEDICINE.

My COMLEX scores are simply a ticket to that diploma.

If you really want to challenge yourself and take a measure of what you learned . . . USMLE. And again, in my own opinion, I think USMLE should be the standard for medical practice in the US. Practical and written OMM exam if you want to crunch . . . maybe it could replace this $1100 scam they call COMLEX-PE.


you may now begin throwing your sharp objects.

Heretic!!

 

[DOCTORSAIB]

I didnt take USMLE for residency . . . I wanted to see how much I really knew about MEDICINE.

Hey smarty-pants, you just dumped $1000 into NBMEs pockets.

You took the USMLE to see how much "medicine" you knew? Foolish at best. You could have taken a NBME practice test for $45 and saved yourself ~ $950.

Come here. I want to tell you something...

 

[DrWBD]

Hey smarty-pants, you just dumped $1000 into NBMEs pockets.

You took the USMLE to see how much "medicine" you knew? Foolish at best. You could have taken a NBME practice test for $45 and saved yourself ~ $950.

Come here. I want to tell you something...

The practice USMLEs are not the equivalent of the real test.

It's admirable that JLM has the courage of his convictions. I'd rather pay $1000 to the NBME than pay $0.10 to the NBOME for their piss-poor attempts at writing a licensing examination.

 

[DOCTORSAIB]

The practice USMLEs are not the equivalent of the real test.
It's admirable that JLM has the courage of his convictions. I'd rather pay $1000 to the NBME than pay $0.10 to the NBOME for their piss-poor attempts at writing a licensing examination.

I agree with the NBOME part. The COMLEX exams blow.

I disagree with the NBME practice tests not being equivalent. I'm not sure when you took USMLE Step 1. I'm willing to be it was years ago when there was only NBME 1 (and maybe 2). Now there are 6 NBME tests and at least 4 out of the 6 are EXCELLENT predictors of your actual score.

Ive been reading Step 1 study strategies for the past 4+ years and Ive been teaching it for the last 2+ years. You will lose this argument very quickly my friend!

 

[jdinovit]

I like the style of the COMLEX better since it is a more clinically relevant and down to earth exam. The only problem is that it is very poorly written. The USMLE is a more academic exam. It is a much better written exam than the COMLEX by far. I prefer a clinically focused exam since that is what matters in residency, not if you memorized the citric acid cycle. But I like how the USMLE is solidly written.

All in all, I would prefer for all DOs to just take the USMLE plus an OMM exam and end this separtist philosophy the AOA has. I also want DOs to simply be MDs + a separate DO degree based on passing a manipulation exam. One exam for everyone. One title for everyone. End the separation.