The USMLE, Double Jeopardy for Osteopathic Students

[harrislakers123]

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Double Jeopardy: The USMLE for Osteopathic Medical Students : Academic Medicine
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Interestingly, there is a SOMA resolution being voted on in the Fall that is calling for the elimination of the COMLEX.

 

[BoneWizard]

Interestingly, there is a SOMA resolution being voted on in the Fall that is calling for the elimination of the COMLEX.

There are 660+660+1295+875=2,830/student reasons why this won't happen.
Also once Step 1 goes P/F I imagine most students will just take Step 2 CS instead.

 

[harrislakers123]

There are 660+660+1295+875=2,830/student reasons why this won't happen.
Also once Step 1 goes P/F I imagine most students will just take Step 2 CS instead.

They used to say the same about Residency Training.

Don’t understand your Step 2 CK point. With Step 1 pass/fail, DO students will feel more pressure than ever to take Step 2 CK.
I believe all DO students should transition to taking the USMLE series only.

 

[BoneWizard]

Oh no, I agree completely with doing away with COMLEX and having everyone take Step only. I just don't think NBOME is going to voluntarily give up $20m a year in testing fees and there's no way or reason really for ACGME to force them to.

 

[mathnerd88]

Oh no, I agree completely with doing away with COMLEX and having everyone take Step only. I just don't think NBOME is going to voluntarily give up $20m a year in testing fees and there's no way or reason really for ACGME to force them to.

If they get rid of COMLEX, then they have to add on some component for OMM for boards. After all, we are DOs, not MDs.

If all it takes to license a DO is Step scores, might as well just change our degree to MD (which I am completely fine with.)

I really doubt that they will eliminate COMLEX for this specific reason. And yes, also the $$$.

 

[Fat_Albert]

Not gonna happen, as others have said, we’re DOs not MDs, there needs to be something to differentiate ourselves besides the holistic care bs they try to shove down our throat. A famous saying on here is Omm being a punishment for not having the stats to get into an md school

 

[DennisReynolds]

Education is all about money.

NBOME is a company and a business at the end of the day.

If somebody proposed a way for my company to lose $20 mill... yeah... NOT gonna happen EVER.

If you can't pass the COMLEX, I don't know what to tell you. Honestly.

Prepare for the step exam by using what everybody else uses... brush in OMM... and you'll be fine. Don't dilly dally around like most of my classmates who screwed the pooch on COMLEX did.

These exams are surmountable. You are smart and you are capable.

Just buck up and get it done and move on.

 

[DNC127]

Education is all about money.

NBOME is a company and a business at the end of the day.

If somebody proposed a way for my company to lose $20 mill... yeah... NOT gonna happen EVER.

If you can't pass the COMLEX, I don't know what to tell you. Honestly.

Prepare for the step exam by using what everybody else uses... brush in OMM... and you'll be fine. Don't dilly dally around like most of my classmates who screwed the pooch on COMLEX did.

These exams are surmountable. You are smart and you are capable.

Just buck up and get it done and move on.

This.

/thread

Also, paying more for 2 sets of boards is your punishment for your low MCAT / GPA / living in an unlucky state. Sorry, life is hard, deal with it.

 

[deleted947265]

Dr. Carmody being right as usual. COMLEX should just be eliminated. I hate it when people say it can't be done, it can be. You just have to kick all of the bums and the dumbs out.

If they get rid of COMLEX, then they have to add on some component for OMM for boards. After all, we are DOs, not MDs.

No they don't. OMM is only taught to justify the existence of the AOA. Nobody will care if there are no OMM boards.

 

[deleted859689]

Dr. Carmody being right as usual. COMLEX should just be eliminated. I hate it when people say it can't be done, it can be. You just have to kick all of the bums and the dumbs out.



No they don't. OMM is only taught to justify the existence of the AOA. Nobody will care if there are no OMM boards.

Why not call DO, MD then?

 

[BoneWizard]

Is there anyway we can just convince NBOME to get rid of COMLEX but then levy a $3,000 "licencing" fee on each student instead? Like, I'll gladly fork over their $3k if I don't have to take two sets of board exams.

 

[harrislakers123]

No one thought a ACGME-AOA residency unification was possible either.

One HUGE element many on this thread are missing is that the AOA has ALREADY determined that OMM is not necessary for an Osteopathic physician. Their new boards allow for DOs to opt out of OMM questions.

Also, the NBOME can create a DO specific subject test that tests uniquely DO aspects not captured by the USMLE.

This is far more straightforward than you may believe but will take support from many.

For those critically worried about NBOME finances, they can charge students the same amount of $$$ as a fee instead of the tests, at least that will eliminate the mental burden of multiple exams

 

[mathnerd88]

No one thought a ACGME-AOA residency unification was possible either.

One HUGE element many on this thread are missing is that the AOA has ALREADY determined that OMM is not necessary for an Osteopathic physician. Their new boards allow for DOs to opt out of OMM questions.

Also, the NBOME can create a DO specific subject test that tests uniquely DO aspects not captured by the USMLE.

This is far more straightforward than you may believe but will take support from many.

For those critically worried about NBOME finances, they can charge students the same amount of $$$ as a fee instead of the tests, at least that will eliminate the mental burden of multiple exams

I believe OMM should be tested regardless if you're going to be using it in practice or not. After all, every DO school devotes several hours a week to OMM curriculum. Whether they continue to use COMLEX or just have an add on OMM certification to USMLE is up to them.

Also, I have a strong feeling that making every DO student take the USMLE may make failure board rates much higher for DO schools. Traditionally, only the higher performing DO students take the USMLE, and no DO school (or minority) would recommend any student who is in the bottom quartile to take the USMLE or those scoring below 450-500. The reason why I am saying this is because DO students have the extra curriculum dedicated to OMM while the MD students do not, thus putting DOs at a disadvantage. Also, there seems to be a universal agreement that the USMLE is more difficult than the COMLEX.

I believe this will become a very tricky scenario.

 

[DameJulie]

I read it in another site that in order to get rid of COMLEX, all 50 states need to agree to do so since the states are the ones that issues licensure.

 

[Mad Jack]

There are major legal issues involved in this. Even if there COCA didn't require it, rewriting the laws to have DOs take the USMLE instead of COMLEX in all 50 states would take many years. And let's not even talk about the money...

 

[harrislakers123]

There are major legal issues involved in this. Even if there COCA didn't require it, rewriting the laws to have DOs take the USMLE instead of COMLEX in all 50 states would take many years. And let's not even talk about the money...

Can we expand on this, what about grandfathering in previous DOs who took COMLEX only.
Also which laws, would that be state government or state medical boards?

Thank you all for the valuable feedback!

 

[TwistedTea]

Even if it’s hard to get rid of we should. Waste of money and poorly written. Not sure if I would consider comlex to even test minimal competency. You can pass it just knowing omm probably.

 

[Ho0v-man]

Y’all really think you’re gonna change the minds of an organization that’s spent over 50 years pretending that cranial bones move? Also rewriting laws/licensing etc. Just seems like a lot of work to do so you can make less money.

I believe OMM should be tested regardless if you're going to be using it in practice or not. After all, every DO school devotes several hours a week to OMM curriculum. Whether they continue to use COMLEX or just have an add on OMM certification to USMLE is up to them.

Also, I have a strong feeling that making every DO student take the USMLE may make failure board rates much higher for DO schools. Traditionally, only the higher performing DO students take the USMLE, and no DO school (or minority) would recommend any student who is in the bottom quartile to take the USMLE or those scoring below 450-500. The reason why I am saying this is because DO students have the extra curriculum dedicated to OMM while the MD students do not, thus putting DOs at a disadvantage. Also, there seems to be a universal agreement that the USMLE is more difficult than the COMLEX.

I believe this will become a very tricky scenario.

I know this sentiment is popular on this site, but I tend to disagree. I think every DO student can pass USMLE exams. The reason they don’t is because they simply don’t have to.

 

[harrislakers123]

This is all great feedback. The question is, do we abandon approaching this because it would take years of a transition period and affect legal language in 50 states?

I don’t tend to agree with that. SAS was in my opinion more complex and gargantuan of a task.

 

[deleted610572]

Even if it’s hard to get rid of we should. Waste of money and poorly written. Not sure if I would consider comlex to even test minimal competency. You can pass it just knowing omm probably.

false. There isn’t enough OMM on the comlex to pass solely on those questions

 

[TwistedTea]

false. There isn’t enough OMM on the comlex to pass solely on those questions

Add in the guesses on the other questions I would bet to differ. Not that we have any hard data either way. Level one was so much omm level two somewhat less so I may agree with you on that one. Maybe

 

[deleted610572]

Add in the guesses on the other questions I would bet to differ.

have you taken one? No.

 

[TwistedTea]

have you taken one? No.

have you taken one? No.

I have taken both of course. We can agree to disagree. Nontheless it was a substandard exam compared to the step. Mostly omm, micro, random ethics and should be attempted to be done away with.

 

[deleted610572]

I have taken both of course. We can agree to disagree. Nontheless it was a substandard exam compared to the step. Mostly omm, micro, random ethics and should be attempted to be done away with.

Comlex is horribly written and can be changed for USMLE+plus with no complaints from me. But for you you to claim that you can pass it alone by knowing the pseudoscience portion woefully devalues your knowledge base and degree. Don’t do that to yourself. It’s just not true. OMM is easy and plenty of people do well on those sections even those that fail the test.

 

[TwistedTea]

Comlex is horribly written and can be changed for USMLE+plus with no complaints from me. But for you you to claim that you can pass it alone by knowing the pseudoscience portion woefully devalues your knowledge base and degree. Don’t do that to yourself. It’s just not true. OMM is easy and plenty of people do well on those sections even those that fail the test.

It may have just been my form seething with OMM. We have likely just had a very different experience with comlex. From personal experience I had ALOT of omm on it. And not much else besides that micro and again ethics. I would assume it depends on the year taken as well since they do standard setting. I know they give ranges on how much is on each test per subject, but after having 5-6 OMM cases on the PE (legit asking for it not me OMMing someone that did not need it) also I lost some respect for the NBOME. maybe other forms were different but the test is not well balanced as they claim on NBOME website. But yes let’s ditch it!

 

[deleted610572]

It may have just been my form seething with OMM. We have likely just had a very different experience with comlex. From personal experience I had ALOT of omm on it. And not much else besides that micro and again ethics. I would assume it depends on the year taken as well since they do standard setting. I know they give ranges on how much is on each test per subject, but after having 5-6 OMM cases on the PE (legit asking for it not me OMMing someone that did not need it) also I lost some respect for the NBOME. maybe other forms were different but the test is not well balanced as they claim on NBOME website. But yes let’s ditch it!

i 100% agree it is not standardized like USMLE and that’s a big problem. My level 1 was lower than all of my practice tests by a good portion because it was vast majority neuro. Compared to my friends that took it two weeks later and it was largely cardiology.They scored above their practice tests per them

 

[deleted610572]

It may have just been my form seething with OMM. We have likely just had a very different experience with comlex. From personal experience I had ALOT of omm on it. And not much else besides that micro and again ethics. I would assume it depends on the year taken as well since they do standard setting. I know they give ranges on how much is on each test per subject, but after having 5-6 OMM cases on the PE (legit asking for it not me OMMing someone that did not need it) also I lost some respect for the NBOME. maybe other forms were different but the test is not well balanced as they claim on NBOME website. But yes let’s ditch it!

And that’s crummy about the PE. Mine was 2 OMM cases

 

[deleted978973]

i 100% agree it is not standardized like USMLE and that’s a big problem. My level 1 was lower than all of my practice tests by a good portion because it was vast majority neuro. Compared to my friends that took it two weeks later and it was largely cardiology.They scored above their practice tests per them

Like neuroanatomy?

 

[TwistedTea]

And that’s crummy about the PE. Mine was 2 OMM cases

So much for standardized. Omm was easiest part tho not complaining lol

 

[deleted610572]

Like neuroanatomy?

Yes. Find the lesions. The terrible stuff

 

[Neopolymath]

If they get rid of COMLEX, then they have to add on some component for OMM for boards. After all, we are DOs, not MDs.

If all it takes to license a DO is Step scores, might as well just change our degree to MD (which I am completely fine with.)

I really doubt that they will eliminate COMLEX for this specific reason. And yes, also the $$$.

No, they absolutely don't "have to" have OMM as a component of board exams. Being a part of the board exam is the only thing that makes it a requirement in and of itself. This is nitpicky but there isn't a law saying you can only be a DO if you pass a board WITH OMM in it. The old people just made that a thing on the test.

Obviously, the logical sequence of events is to make an add-on of OMM to appease old DOs on boards but let's keep it real, it should be taught in school as an extra optional qualification and that should be the ultimate goal of DO schools before they all disappear in a couple decades.

 

[AnatomyGrey12]

No, they absolutely don't "have to" have OMM as a component of board exams. Being a part of the board exam is the only thing that makes it a requirement in and of itself. This is nitpicky but there isn't a law saying you can only be a DO if you pass a board WITH OMM in it. The old people just made that a thing on the test.

Obviously, the logical sequence of events is to make an add-on of OMM to appease old DOs on boards but let's keep it real, it should be taught in school as an extra optional qualification and that should be the ultimate goal of DO schools before they all disappear in a couple decades.

This. Make the OMM comat an exit exam for COMs. Problem solved. There is zero need for it to be on a board exam.

 

[Lawpy]

I support getting rid of COMLEX mainly because i think it's a stupid exam that serves as an unneceseary headache. MDs and DOs are the same so there's no reason to punish the DOs to do stuff to make them unique/different

 

[Mad Jack]

Can we expand on this, what about grandfathering in previous DOs who took COMLEX only.
Also which laws, would that be state government or state medical boards?

Thank you all for the valuable feedback!

Depends on the state, but generally the legislature sets the standards while tr he medical boards apply those standards.

 

[DNC127]

I believe OMM should be tested regardless if you're going to be using it in practice or not. After all, every DO school devotes several hours a week to OMM curriculum. Whether they continue to use COMLEX or just have an add on OMM certification to USMLE is up to them.

Also, I have a strong feeling that making every DO student take the USMLE may make failure board rates much higher for DO schools. Traditionally, only the higher performing DO students take the USMLE, and no DO school (or minority) would recommend any student who is in the bottom quartile to take the USMLE or those scoring below 450-500. The reason why I am saying this is because DO students have the extra curriculum dedicated to OMM while the MD students do not, thus putting DOs at a disadvantage. Also, there seems to be a universal agreement that the USMLE is more difficult than the COMLEX.

I believe this will become a very tricky scenario.

if someone can’t pass USMLE should they be practicing medicine? If they were at an MD school the answer would be “No”. So why not for DO schools?

Make everyone take it.

make everyone pass it.

 

[putmeincoach]

I can get behind this. Will it be tough? Probably, but it doesn't mean we shouldn't try just cause it's hard lol. Merge NBME and NBOME. Make an OMM exit exam. Everyone gets their dough. Redundancies solved.

 

[hallowmann]

I wish I could believe this would happen in the next decade. I don't think it will. Maybe in my career, but probably not soon.

Is there anyway we can just convince NBOME to get rid of COMLEX but then levy a $3,000 "licencing" fee on each student instead? Like, I'll gladly fork over their $3k if I don't have to take two sets of board exams.

Would gladly pay that extra fee to take a 1-2 hr COMAT and save the days of planning, travel, and actually taking those exams.

if someone can’t pass USMLE should they be practicing medicine? If they were at an MD school the answer would be “No”. So why not for DO schools?

Make everyone take it.

make everyone pass it.

There are plenty of currently practicing physicians that didn't take the USMLE or took arguably easier versions of it. There ate also plenty that did quite well and should never practice. Do not fool yourself into thinking it truly assesses your value as a physician.

That said, I agree that it won't be as big of an issue as people are implying for DOs to pass it if they're expected to and their schools teach to it.

 

[Oligodinero]

I believe OMM should be tested regardless if you're going to be using it in practice or not. After all, every DO school devotes several hours a week to OMM curriculum. Whether they continue to use COMLEX or just have an add on OMM certification to USMLE is up to them.

Also, I have a strong feeling that making every DO student take the USMLE may make failure board rates much higher for DO schools. Traditionally, only the higher performing DO students take the USMLE, and no DO school (or minority) would recommend any student who is in the bottom quartile to take the USMLE or those scoring below 450-500. The reason why I am saying this is because DO students have the extra curriculum dedicated to OMM while the MD students do not, thus putting DOs at a disadvantage. Also, there seems to be a universal agreement that the USMLE is more difficult than the COMLEX.

I believe this will become a very tricky scenario.

LECOM made taking USMLE step 1 MANDATORY for all students beginning with the class of 2022 and the 2021 APAP and PHCS students

 

[Fat_Albert]

Yall act like DOs have a history of making their student's lives easier, lmao. The only reason the MD and DO merger happened is because MD threatened to prevent DOs from obtaining fellowships in allopathic residencies if they don't. They had no other choice. DOs are all about making the quick buck, hence the five new schools opening this year and increased expansion in classroom size in poorly maintained schools. The goal of every DO mission statement is to make more PCP; they couldn't care less if we want to go into something else other than FM, which you can get with just a comlex score. I don't see the comlex being taken away for a very, very long time. It'll probably just go pass/fail, but there's no way in hell they'll eliminate it completely

 

[Cath Up]

LECOM made taking USMLE step 1 MANDATORY for all students beginning with the class of 2022 and the 2021 APAP and PHCS students

They get a lot of crap and they are opening a 3rd campus (4th site) but this is a move I support.

 

[Goro]

Is there anyway we can just convince NBOME to get rid of COMLEX but then levy a $3,000 "licencing" fee on each student instead? Like, I'll gladly fork over their $3k if I don't have to take two sets of board exams.

Do NOT underestimate the power of the True Believers.

This. Make the OMM comat an exit exam for COMs. Problem solved. There is zero need for it to be on a board exam.

I've subtlety suggested this, but it always gets ignored.

LECOM made taking USMLE step 1 MANDATORY for all students beginning with the class of 2022 and the 2021 APAP and PHCS students

That's actually a step forward (forgive the pun). LECOM joins RVU in this requirement; I don't know if other COMs are doing this as well. I've tried to get mine to do it and have the school cover the fees, but the Powers That Be won't go for it (hint, has something to do with $). The overall idea of requiring Step was actually taken well.

IF more schools do this, I think that might very well be the impetus to get rid of COMLEX. But I doubt that I'm going to live to see it. It will have to happen on your watches.

 

[Dr. Foresight]

Do NOT underestimate the power of the True Believers.



I've subtlety suggested this, but it always gets ignored.


That's actually a step forward (forgive the pun). LECOM joins RVU in this requirement; I don't know if other COMs are doing this as well. I've tried to get mine to do it and have the school cover the fees, but the Powers That Be won't go for it (hint, has something to do with $). The overall idea of requiring Step was actually taken well.

IF more schools do this, I think that might very well be the impetus to get rid of COMLEX. But I doubt that I'm going to live to see it. It will have to happen on your watches.

I feel like if schools start requiring USMLE, they should cover the cost. However my school doesn't the cost for step 2. When we brought this up at a class meeting our dean said, "The financial aid office can factor that in to your loan amount." Is this the norm at other schools as well?

 

[Goro]

I feel like if schools start requiring USMLE, they should cover the cost. However my school doesn't the cost for step 2. When we brought this up at a class meeting our dean said, "The financial aid office can factor that in to your loan amount." Is this the norm at other schools as well?

Haven't a clue

 

[harrislakers123]

The house of medicine intended for USMLE to be the single licensing exam for all physicians MD/DO

After showing interest early the AOA decided not to join in and instead created the NBOME + COMLEX

30 years later it’s time to unify licensing as originally intended.

See below!! @Goro

 

[12jas]

I feel like if schools start requiring USMLE, they should cover the cost. However my school doesn't the cost for step 2. When we brought this up at a class meeting our dean said, "The financial aid office can factor that in to your loan amount." Is this the norm at other schools as well?

Yes at RVU it is just added to your cost of attendance and you are expected to pay for it with loan money.

 

[2021Doctor]

Do NOT underestimate the power of the True Believers.



I've subtlety suggested this, but it always gets ignored.


That's actually a step forward (forgive the pun). LECOM joins RVU in this requirement; I don't know if other COMs are doing this as well. I've tried to get mine to do it and have the school cover the fees, but the Powers That Be won't go for it (hint, has something to do with $). The overall idea of requiring Step was actually taken well.

IF more schools do this, I think that might very well be the impetus to get rid of COMLEX. But I doubt that I'm going to live to see it. It will have to happen on your watches.

RVU stopped publishing their USMLE scores after 2017. Imo that sends a message that the USMLE scores are not going in the right direction.

http://www.rvu.edu/wp-content/uploads/2015/05/RVU-2017-Institutional-Snapshot.pdf

http://www.rvu.edu/wp-content/uploads/2020/02/2019-RVU-Institutional-Snapshot-Final.pdf

Nationwide COMLEX Level 1 Averages
Class of 2012: 492
Class of 2013: 515
Class of 2014: 514
Class of 2015: 517
Class of 2016: 527
Class of 2017: 512
Class of 2018 517
Class of 2019: 555
Class of 2020: 525
Class of 2021: 535

RVU Classes of 2019 and 2020 showed significant dip vs. national average compared to 2015-2018.
????Beginning of Medforth effect???
????Ivins Expansion Effect?????
Unclear to me how the change in ownership to Medforth in 2019 will affect the school over the next 5 years.

 

[deleted978973]

Do NOT underestimate the power of the True Believers.

So... behind the scenes are the True Believers self-aware? As in, are they aware that most of us hate OMM, hate the policies they impose on us, etc. or are they in denial about all of it? Or do they genuinely believe that most of us think the same way they do?

Or are they only worried about their cash cow?

 

[Goro]

So... behind the scenes are the True Believers self-aware?

NO.


As in, are they aware that most of us hate OMM,

NO


hate the policies they impose on us, etc.

YES

or are they in denial about all of it?

Mostly in denial I believe, but they definitely don't care, especially about your career aspirations. If 100% of DO grads go into, say , FM or Peds, they're fine with that. I'm not.

Or do they genuinely believe that most of us think the same way they do?
I suspect that this is more a cognitive dissonance thing. Anti-vaxxers and flat erathers definitely know that people don't accept their viewpoints.

Or are they only worried about their cash cow?
Honestly, I've never heard people in medical education think about this in terms of the motivations of the AOA and NBOME. I suspect it's more a student mindset, but you're not alone. In my own hobby of board wargaming, there of plenty of people who rail at"bean counters" and "MBAs at game companies" as to why their favorite subject isn't done as a game, or why some out-of-production classic games are made.

 

[NotAProgDirector]

I know this sentiment is popular on this site, but I tend to disagree. I think every DO student can pass USMLE exams. The reason they don’t is because they simply don’t have to.

That's not what the best data available would suggest. Every study that's looked at the correlation between USMLE and COMLEX has shown that exam performance tends to correlate (with some scatter, of course), and that the minimum pass rate for COMLEX is somewhat below that of USMLE.

For example:

The Use of COMLEX-USA and USMLE for Residency Applicant Selection This study looked at three different schools. They only performed a pearson's correlation and not a regression, but you can look at their image and see the results. If you draw a line down the middle of their elipse (on the graph), you'll see that the minimum pass of USMLE 194 is well above the minimum pass of COMLEX (400). They also include a 2x2 table of pass/fail for the two exams, show moderate correlation (a stretch, at best) with the majority of the discordance a pass on COMLEX and a fail on USMLE.

Reliability and validity of conversion formulas between comprehensive osteopathic medical licensing examination of the United States level 1 and Un... - PubMed - NCBI This article looks at only a single school but over a large number of years. You can take their regression formula and plug in a USMLE of 194, and you'll get a COMLEX of 440 or so.

There are many more, all show the same thing. They all are hampered by similar problems -- not all DO's take both exams, and difficulty getting a non-biased sample (either all one school, or all applying to one residency program, etc). Proponents will point out that the pass rate on S1 is basically equal for MD and DO now, clearly improved over the years. But if those that score poorly on the COMLEX are more likely to forgo the USMLE, then that statistic may be biased upwards.

So I don't expect COMLEX to go anywhere, as I think schools would be very concerned about ultimate pass rates on USMLE alone.

 

[Neopolymath]

That's not what the best data available would suggest. Every study that's looked at the correlation between USMLE and COMLEX has shown that exam performance tends to correlate (with some scatter, of course), and that the minimum pass rate for COMLEX is somewhat below that of USMLE.

For example:

The Use of COMLEX-USA and USMLE for Residency Applicant Selection This study looked at three different schools. They only performed a pearson's correlation and not a regression, but you can look at their image and see the results. If you draw a line down the middle of their elipse (on the graph), you'll see that the minimum pass of USMLE 194 is well above the minimum pass of COMLEX (400). They also include a 2x2 table of pass/fail for the two exams, show moderate correlation (a stretch, at best) with the majority of the discordance a pass on COMLEX and a fail on USMLE.

Reliability and validity of conversion formulas between comprehensive osteopathic medical licensing examination of the United States level 1 and Un... - PubMed - NCBI This article looks at only a single school but over a large number of years. You can take their regression formula and plug in a USMLE of 194, and you'll get a COMLEX of 440 or so.

There are many more, all show the same thing. They all are hampered by similar problems -- not all DO's take both exams, and difficulty getting a non-biased sample (either all one school, or all applying to one residency program, etc). Proponents will point out that the pass rate on S1 is basically equal for MD and DO now, clearly improved over the years. But if those that score poorly on the COMLEX are more likely to forgo the USMLE, then that statistic may be biased upwards.

So I don't expect COMLEX to go anywhere, as I think schools would be very concerned about ultimate pass rates on USMLE alone.

I think what he is saying is that there is no pressure to rise to the occasion because of a mandatory test/hurdle. I don't know if I agree that all DO students would pass but I do agree for these FM or bust types it might be hard to put effort into something you know you don't need to actually do such as a second non-mandatory board exam.