The USMLE, Double Jeopardy for Osteopathic Students

[Ho0v-man]

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.

No doubt that USMLE is harder to pass. But in my experience, a DO student who intends to take step 1 but gets owned by a couple weeks of uworld just gives up because they think they won’t do well and have the option to not try. If we fail step 1, it’s a bigger red flag than not trying. When this exact same thing happens to MD students, they just have to suck it up. A lot of MD students would skip step1 if they could, too.

If we were all forced to take step 1 I think we could pass at a similar rate to MD students and comlex first time pass rates would be in the 90s nationwide. We would have lower averages over all as our curricula are probably inferior and our students are on average a little weaker academically.

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.

Edit: beat me to it.

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[BeLikeH2O]

"If we were all forced to take step 1 I think we could pass at a similar rate to MD students "

I want some of whatever it is you're smoking.

 

[harrislakers123]

USMLE is actually a better written exam and more straightforward than COMLEX.
Our students would have no issue passing USMLE. Passing is like a 195 or something. To think otherwise is really ridiculous. Especially if their entire focus is one exam

 

[AnatomyGrey12]

USMLE is actually a better written exam and more straightforward than COMLEX.
Our students would have no issue passing USMLE. Passing is like a 195 or something. To think otherwise is really ridiculous. Especially if their entire focus is one exam

Most would pass. There would be a higher percentage of failure than with MDs.

Right now about 60% of DOs take it with a pass rate equal to MDs, I think it’s disingenuous to say that the pass rate wouldn’t drop when you add in that other 40%, particularly when it is our weakest students that forego Step.

As was shown above there are studies that show the minimum standard of 400 on COMLEX is actually lower than the 194 for Step. Passing COMLEX is easier than passing Step.

 

[Chibucks15]

Most would pass. There would be a higher percentage of failure than with MDs.

Right now about 60% of DOs take it with a pass rate equal to MDs, I think it’s disingenuous to say that the pass rate wouldn’t drop when you add in that other 40%, particularly when it is our weakest students that forego Step.

As was shown above there are studies that show the minimum standard of 400 on COMLEX is actually lower than the 194 for Step. Passing COMLEX is easier than passing Step.

Most DOs that I know that decided not to take it wasn't because they weren't going to pass, it just that their practice scores weren't as high as they would like on USMLE, so why subject yourself to another expensive and long exam? I'm at one of the DO schools that has entrance stats higher than some MD schools though so maybe its school specific

 

[TwistedTea]

Most DOs that I know that decided not to take it wasn't because they weren't going to pass, it just that their practice scores weren't as high as they would like on USMLE, so why subject yourself to another expensive and long exam? I'm at one of the DO schools that has entrance stats higher than some MD schools though so maybe its school specific

A lower step is still more useful than just comlex at most non former DO. Everyone says they can pass it but unless they have they have not. I know for university IM you almost need it to get good spots unless you do very well on comlex, very well as in much better than one would need on step. At least at most places. It’s a better test and PDs know that. Of course it’s going pass fail now so who cares. So glad we dodged that bullet. Everyone in my class with amazing matches got there with high step. Now that that’s out of the bag we are screwed. Don’t say auditions cuz most used to have a decent high cutoff just to audition LOL.

 

[Chibucks15]

A lower step is still more useful than just comlex at most non former DO. Everyone says they can pass it but unless they have they have not. I know for university IM you almost need it to get good spots unless you do very well on comlex, very well as in much better than one would need on step. At least at most places.

Sure, but also a majority of these people are just content doing rural FM. That's definitely just the region of the country I'm in. Of course FM in no way requires a step. Sorry should've specified. Most people don't feel the need to do more exams if they're projecting to get like a 205-210. Even in IM around me there's plenty of success stories with no step. Lots of Puml/CC guys actually. Like I said, might be school specific

 

[TwistedTea]

"If we were all forced to take step 1 I think we could pass at a similar rate to MD students "

I want some of whatever it is you're smoking.

Ugh yeah. Most do students are pretty good. But there is some ambiguous bottom percentile where they get really bad really fast. I mean Really bad. The bad MD schools do not have. Like if you fail comlex you are borderline not all there. Or just got a crappy form.

 

[TwistedTea]

Sure, but also a majority of these people are just content doing rural FM. That's definitely just the region of the country I'm in. Of course FM in no way requires a step. Sorry should've specified. Most people don't feel the need to do more exams if they're projecting to get like a 205-210. Even in IM around me there's plenty of success stories with no step. Lots of Puml/CC guys actually. Like I said, might be school specific

Yeah that’s true. If I was deadset on FM I wouldn’t take it. But most other things I would. Maybe not peds. I’m also in the south where things are more comlex forgiving. Idk though I know I got invited at places just cuz I had step.

 

[AnatomyGrey12]

Most DOs that I know that decided not to take it wasn't because they weren't going to pass, it just that their practice scores weren't as high as they would like on USMLE, so why subject yourself to another expensive and long exam? I'm at one of the DO schools that has entrance stats higher than some MD schools though so maybe its school specific

Sample bias as your school has a lower percentage of the weak students in the pool. The bottom of the DO student pool is very weak academically and would not pass Step. MD schools just don’t have the same floor in their student population.

I do think most would pass, but I think most people would be shocked at how low the box and whisker for the DO population reaches. When you have that many weaker students academically your board pass rate will be lower.

 

[harrislakers123]

Sample bias as your school has a lower percentage of the weak students in the pool. The bottom of the DO student pool is very weak academically and would not pass Step. MD schools just don’t have the same floor in their student population.

I do think most would pass, but I think most people would be shocked at how low the box and whisker for the DO population reaches. When you have that many weaker students academically your board pass rate will be lower.

Most will pass, seems we agree here. Regardless, this type of conjecture on our parts will not progress the discussion much further.

 

[FourniersGreenGang]

Sample bias as your school has a lower percentage of the weak students in the pool. The bottom of the DO student pool is very weak academically and would not pass Step. MD schools just don’t have the same floor in their student population.

I do think most would pass, but I think most people would be shocked at how low the box and whisker for the DO population reaches. When you have that many weaker students academically your board pass rate will be lower.

Totally agree. In fact, there are a ton of students at DO schools who are actually great students (high GPAs, went to top undergrad schools, etc) but who are terrible at standardized tests. They scored just enough on the MCAT to get into DO school with the rest of their app but they have a VERY difficult time passing boards.

On another note, if we are to be thought of as equal physicians I don’t see why we expect to be held to a different standard for the purposes of licensure. I’m not saying that step makes good doctors and comlex makes bad doctors, as the exams are completely irrelevant for those purposes, but I am saying that in the eyes of the public, being able to say we all take and pass the same exams is beneficial.

 

[UnoMas]

If you can't pass the USMLE, perhaps, just perhaps you don't have what it takes to become a doctor. Don't ask me for a multi-generational peer-reviewed study to back up this claim because I don't have it; it is what it is.

The USMLE is hard to do really well on but easy-peasy to pass, what the hell have you been doing for 2 years that you can't score a 195 on the USMLE?

I never buy the whole "bad at standardized exams" argument. All excuses. Buy all the QBanks and do all 10k something questions to get better at it. DO school gave you a free-pass with the MCAT, bought you 2 more years to improve.

Can't say DO=MD if you are being held to different standards.

 

[harrislakers123]

I just think it’s wild to think people would have trouble passing the USMLE. Sure a small percentage will fail but it won’t be a significant number. Passing is not difficult, scoring well is.

 

[shadowlightfox]

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.

Well the OMM COMAT can easily take care of that.

 

[meliora27]

I am of the opinion (and probably unpopular amongst some) that any physician (MD/DO/MBBS/Etc.) who wishes the practice in the United States should be required to take the same set of licensing exams. If state medical boards held this belief, that would likely be the first card to fall.