why do DO students have lower USMLE passing rate

Started by Igor4sugry
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Igor4sugry

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15+ Year Member
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From the #s I've seen the DOs have a passing rate that is 13 points (95% vs 82% for 2007 data) lower than their MD counterparts on the USMLE Step I.

Can anyone provide some light as to the reasons behind this?
Is it mainly a curriculum issue?
Do MDs have better students?
 
Students who go to MD schools are more likely to pass because students who are more likely to pass the USMLE would rather go to an MD school. It's no secret that MD schools are more competitive. It's not a curriculum issue.
 
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Students who go to MD schools are more likely to pass because students who are more likely to pass the USMLE would rather go to an MD school. It's no secret that MD schools are more competitive. It's not a curriculum issue.
:troll:
 
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But it also is important to note that 100% of MD students take the USMLE vs <50% of DO students. And those students taking the USMLE are probably driven to prepare for it because they are aware that it is a more difficult test. Yet the passing rate is still lower.
 
Sigh.

MD students often have more support for studying for the USMLE, it is their main board exam. DO students have the COMLEX as their main board exam, and from what I understand, DO schools really aren't too concerned with prepping their students for the USMLE.
 
Its probably related with the lower avg MCAT scores and standardized testing ability somehow. Makes sense at a glance.
 
Here is an interesting article that sort of relates to this topic.

I used to think that better grades equals a better doctor (overall this may in fact be true), but now I think there are too many little things, which are not testable, that more accurately calculate our competency as a doctor/future doctor.

I do think grades do show some of our capabilities, but not all. Unfortunately there is no other grading system out there.
 
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Unlike the Belgians (from the article), the US already has info on how that student has done in those first 4 years since we break up college and medical school. The belgians only know about the student's high school. We know what happens in college. So that personality test which could predict their academic performance is probably a poor substitute for actual performance data. Furthermore, what do you think an interview gauges? Under the stress of an interview it is pretty easy to ID who is the neurotic ones, and to some extent who are the conscientious ones.

I think the US does a pretty good job of picking adequate candidates since there is roughly a 2% attrition rate.
 
I certainly agree with you, and am not suggesting we adopt this approach. But I do find the information interesting. The interview process is definitely the chance to see beyond the scores.

I am more concerned with the correlation between MCAT scores or board scores and the quality of doctor a person becomes. I imagine a correlation does exist, however, I know that there are several outstanding doctors who received lower average MCAT/board scores. And that the opposite is also true with doctors who score well but I would not recommend them to an enemy. However, my examples are only anecdotal.

I don't know if a study exists where doctors who have received lower scores initially but perform average or above average clinically. I would like to read it if it does.
 
From the #s I've seen the DOs have a passing rate that is 13 points (95% vs 82% for 2007 data) lower than their MD counterparts on the USMLE Step I.

Can anyone provide some light as to the reasons behind this?
Is it mainly a curriculum issue?
Do MDs have better students?

The COMLEX and the USMLE are two very different style tests. For whatever reason, at least in my class, more than a few DO students studied for the COMLEX, kinda blew off the USMLE and at the last minute decided to take it and tanked.

Of the dozen or so people I hang out with, we studied for the USMLE and made sure we were ready for it. Our scores ranged from 234-242. It's not the curriculum, or the students, its a matter of proper preparation.
 
The COMLEX and the USMLE are two very different style tests. For whatever reason, at least in my class, more than a few DO students studied for the COMLEX, kinda blew off the USMLE and at the last minute decided to take it and tanked.

Of the dozen or so people I hang out with, we studied for the USMLE and made sure we were ready for it. Our scores ranged from 234-242. It's not the curriculum, or the students, its a matter of proper preparation.

👍
 
I know this will be an unpopular opinion, in my opinion, the reason that DO students pass at a lower rate is they tend to be poorer students. MDs averages are 3.55 and 30, DOs are 3.45 and 27 on the MCAT. This is on the average and is not representative on the individual level. In terms of these standardized exams there tends to be a correlation between GPA and entrance exam score and licensure test pass rates. Although medical schools are generally opaque about scores and percent that pass, there tends to be a correlation. For professional schools where there is better data i.e. law schools the better the school the better the bar passage rate. While the differences between the "best" and "worst" med school will be smaller than between law schools it is likely true that higher scores and better pass rates will be associated with those with the best entrance stats. This implies that the individual as opposed to the school is the main determinant of pass or failure.
 
I am more concerned with the correlation between MCAT scores or board scores and the quality of doctor a person becomes. I imagine a correlation does exist, however, I know that there are several outstanding doctors who received lower average MCAT/board scores. And that the opposite is also true with doctors who score well but I would not recommend them to an enemy. However, my examples are only anecdotal.

I don't know if a study exists where doctors who have received lower scores initially but perform average or above average clinically. I would like to read it if it does.

I dont really think "quality of a doctor" can be reliably measured. But this study helps a little with the correlations you are looking for.
http://www.springerlink.com/content/av6u31k0j3qk0470/fulltext.pdf

Correlation between
Ugrad GPA predicting clinical performance was 0.09 (not statistically significant)
MCAT predicting clinical performance was 0.22 ( p< 0.01))
M2 predicting clinical performance was 0.39 ( p< 0.001 )
USMLE score and clinical performance was 0.36 (p< 0.001)

Correlation between MCAT and USMLE scores 0.37 (p< 0.001)

So USMLE scores predict clinical performance relatively well and MCAT scores predict USMLE scores relatively well. The correlations are moderate so if you did poorly on the MCAT you are by no means fated to do poorly clinically.

I used to hear on SDN that the people who do well the first 2 years aren't going to do well on the wards. My experience has been that those who crush the first 2 years, also crush the boards and are superstars on the wards. The data seems to support this. I can think of exceptions in my class who are incredibly awkward but for the most part, people seem to be very personable in my class so the knowledge base, work ethic, and ability to pick up information is really what separates the wheat from the chaff clinically.
 
our curriculum doesn't lend itself to USMLE, it's gonna lend itself to COMLEX. the MDs would tank the COMLEX.

Unless you have a good study to back this up, 😴😴😴.

The curriculum isn't the problem. Medicine is mostly self-taught. You can never attend class and score 230+ on Step 1.

Taking Step exams is all about the individual's preparation. Who cares about averages? Do your best and that is all that matters.
 
From the #s I've seen the DOs have a passing rate that is 13 points (95% vs 82% for 2007 data) lower than their MD counterparts on the USMLE Step I.

Can anyone provide some light as to the reasons behind this?
Is it mainly a curriculum issue?
Do MDs have better students?

What percentage of DOs take the USMLE versus MDs who take the USMLE? Are these numbers reported above accurate given the answer to my question?
 
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Only the OMM portion. They'd be fine with the remaining sciences.

-J1515, DO

I don't know, the questions on the Comlex are confusing and poorly worded enough that I found myself loudly asking the computer, "you have to be ****ting me.." I am sure our allo brothers would come across the same stress.
 
So USMLE scores predict clinical performance relatively well and MCAT scores predict USMLE scores relatively well....

Yet, that still doesn't answer the question of why DO students score lower because you don't know the MCAT scores of the DOs taking USMLE. You cannot assume that the students with the highest MCAT scores are the ones taking it. I know that just as many mediocre and bottom-of-the-barrel students from my class took it as good students. I also know a lot of top students in my class who didn't take USMLE. The ones taking USMLE are the ones who are dead set on ACGME residencies and not necessarily "top" residencies. I also know a number of folks who took it as a "let's just see how I do" and really didn't prepare for it well.

I think a whole lot of it has to do with attitude. As a DO student you really don't have to do well, for the most part, because you always have AOA residencies to fall back on. The DO students I know who want competitive ACGME residencies, OTOH, tend to have a different work ethic. They HAVE to do well in order to get the spot they want.
 
I've seen other calculations done by a guy at my school showing that MCAT really doesn't correlate well with USMLE. There are quite a few ways to toy with the numbers and plenty of factors that contribute to it.
 
Yet, that still doesn't answer the question of why DO students score lower because you don't know the MCAT scores of the DOs taking USMLE. You cannot assume that the students with the highest MCAT scores are the ones taking it. I know that just as many mediocre and bottom-of-the-barrel students from my class took it as good students. I also know a lot of top students in my class who didn't take USMLE. The ones taking USMLE are the ones who are dead set on ACGME residencies and not necessarily "top" residencies. I also know a number of folks who took it as a "let's just see how I do" and really didn't prepare for it well.

I think a whole lot of it has to do with attitude. As a DO student you really don't have to do well, for the most part, because you always have AOA residencies to fall back on. The DO students I know who want competitive ACGME residencies, OTOH, tend to have a different work ethic. They HAVE to do well in order to get the spot they want.

Personally I think it is a multitude of factors. The argument that "we learn different things" or "our courses aren't tailored to the USMLE" is a very weak argument. I also thing the idea that people don't take the USMLE seriously is a specious argument at best.

I think the main factors are worse aptitude on standardized tests/weaker students on average and having to take 2 exams and the difficulties of weighing what each is going to ask and preparing accordingly.


I've seen other calculations done by a guy at my school showing that MCAT really doesn't correlate well with USMLE. There are quite a few ways to toy with the numbers and plenty of factors that contribute to it.

There's a metaanalysis out there of the MCAT/USMLE studies that showed that MCAT was correlated to USMLE with an R value of 0.39.
 
Same reason people who go to Harvard get better MCAT scores than people who go to average state school... Better students + better preparation= better outcome. It's not really a mystery that this happens on USMLE too with MD and DO schools.
 
I think we need to stop beating around the bush here for the sake of political correctness. Yes, it is certainly true that there is absolutely NO way to measure how dedicated/good a physician candidate will be once they get on the job; however, there are unspoken truths as to the nature of acceptance and academic function.
There are DO students who are DO students (like myself) because we had "too good a time" in undergraduate and at the time were not mature or ready to truly undertake med school preparations. I got into a school with a little bit of luck and some natural ability. After I got in, I decided to buckle down and work my butt off with complete understanding of just how lucky I was to be given this opportunity.

MCAT: 26P (first time)
USMLE Step I: 235/98

There are also DO students who may well be dedicated, warm, outstanding human beings in every way. Sadly though, they simply don't have the intellectual firepower to excel or do well on the USMLE or in class. And don't give me the BS about the COMLEX and USMLE being completely different tests ontologically; the USMLE like the COMLEX tests minimal competency, but it is a much harder and better written exam. As noted prior, if the tests were completely different, why should we have the same practice rights?
Of course, the above may be a gross oversimplification of a topic that contains many other factors and arguments, but I believe that it needed to be said as it is contributory to answering the OP's question.
That said, these truths should NOT give MD or DO student alike any right to defame or minimize the accomplishments of the folks who bust their asses 16 hours a day to simply pass a class or their boards. Such struggles bring humility, which is monumentally more valuable than a 260/99 in functioning as a physician.
 
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I think it's a multitude of factors:

1. Standardized test-taking ability. I think this may be a factor in some cases. There are many non-trads like myself in DO school, and our test-taking ability isn't as finely honed as some of you young-uns. Stem? What's that? lol.

2. Math skills. IMO, the real difference between MD's and DO's is our math skills. Most DO students I've talked to (myself included) suck at math. The reason our MCATs "suck" is largely due to low scores in physical sciences, which is largely math based. When I took the MCAT, I hadn't taken a math course in 15+ years. Is it any surprise that I scored 10's in Bio and VR, but an 8 in physics, despite strong A's in both Physics and Chemistry in Undergrad?

3. Poor research-related skills. I hate research. I have never honed these skills and I don't care. I went to med school to be a community doc, not be locked into academia. That being said, there are more than a few "research-related" questions on the USMLE. Types of studies, epidemiology, etc. We are NOT taught this in school (at least, not at my school), and you can be pretty much assured that DO students regularly miss these questions on the USMLE.

4. COMLEX was too easy. This happens to all standardized exams from time to time. This is why they are adjusted every few years. This year (lucky me) COMLEX has "raised the bar". This means you now need to get more questions correct to get the same score as previous years. There will be more failures this year (~600...it used to be ~400/yr) than in previous years. This occurs every few years in USMLE-land too. I think a new USMLE change is coming next year, if I recall correctly.

5. Different material, harder/easier questions, etc. Hard to tell. The rumor is that the COMLEX questions are more straight forward. First or 2nd order. USMLE questions, judging by the ones I've been doing on USMLE-world are 3rd order or greater. So, maybe the USMLE questions are "harder". Who knows. I think this argument is the weakest of the bunch, as it's very personal. I, for example, suck at Micro and Pharm. If I get some 3rd order micro questions, I will find the test very hard. Give me some phys and path and it'll be a piece of cake, no matter what the order is.

I also don't buy the argument that DO students are "dumber" or "not as good students" or whatever. I will buy the fact that we are a different population, with different goals, and different skills. I, myself, am a non-trad with a wife and an 8yo daughter. I would love to be a gunner and get straight A's, but I can't do that and maintain a stable family life. So, I live with my B's and like it. DO school has been a much better fit for us than almost any MD school could ever have been, largely due to locations (MD schools tend to be in not-so-family-friendly areas) and the PBL curriculum at LECOM-B (which allows me more flexibility in time management than most lecture based curriculums found at most MD schools). So, I don't care that we do "worse" on the USMLE, as a group. I feel prepared, and that's enough for me.
 
I think we need to stop beating around the bush here for the sake of political correctness. Yes, it is certainly true that there is absolutely NO way to measure how dedicated/good a physician candidate will be once they get on the job; however, there are unspoken truths as to the nature of acceptance and academic function.
There are DO students who are DO students (like myself) because we had "too good a time" in undergraduate and at the time were not mature or ready to truly undertake med school preparations. I got into a school with a little bit of luck and some natural ability. After I got in, I decided to buckle down and work my butt off with complete understanding of just how lucky I was to be given this opportunity.

MCAT: 26P (first time)
USMLE Step I: 235/98

There are also DO students are are DO students who may well be dedicated, warm, outstanding human beings in every way. Sadly though, they simply don't have the intellectual firepower to excel or do well on the USMLE or in class. And don't give me the BS about the COMLEX and USMLE being completely different tests ontologically; the USMLE like the COMLEX tests minimal competency, but it is a much harder and better written exam. As noted prior, if the tests were completely different, why should we have the same practice rights?
Of course, the above may be a gross oversimplification of a topic that contains many other factors and arguments, but I believe that it needed to be said as it is contributory to answering the OP's question.
That said, these truths should NOT give MD or DO student alike any right to defame or minimize the accomplishments of the folks who bust their asses 16 hours a day to simply pass a class or their boards. Such struggles bring humility, which is monumentally more valuable than a 260/99 in functioning as a physician.

You hit the nail right on the head. It's refreshing to see a DO student who can admit this. People need to stop with the "We're not taught to the USMLE" or "I'm a bad test taker but I'll still be a good doctor" crap.
 
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Well, our curriculum isn't really taught toward the USMLE. Aside from that, I'm really not a good test-taker. I will still be a great doctor.
 
3. Poor research-related skills. I hate research. I have never honed these skills and I don't care. I went to med school to be a community doc, not be locked into academia. That being said, there are more than a few "research-related" questions on the USMLE. Types of studies, epidemiology, etc. We are NOT taught this in school (at least, not at my school), and you can be pretty much assured that DO students regularly miss these questions on the USMLE.

Are those bio-stats type questions? This doesn't seem right for it to be knowledge gained only through research because some people in MD schools don't have research experience either.
 
Are those bio-stats type questions? This doesn't seem right for it to be knowledge gained only through research because some people in MD schools don't have research experience either.

Yeah, that kind of stuff. Obviously, it doesn't account for a huge part of the USMLE, and the info is easily obtained from various review books, but it's not something that we have much focus on...at least at my school...although I'd wager that there aren't many DO schools that teach much about study design, types of bias, etc.

Again, I think that it's a combination of factors. The other thing to remember is that we don't have such a great pass rate on the COMLEX either...~90% I believe...which leads me to believe that most (but not all) of the reason is due to poor testing skills or older brains with poorer memory like mine. 😀

Like many diseases, USMLE-itis is probably multifactorial.
 
2. Math skills. IMO, the real difference between MD's and DO's is our math skills. Most DO students I've talked to (myself included) suck at math. The reason our MCATs "suck" is largely due to low scores in physical sciences, which is largely math based. When I took the MCAT, I hadn't taken a math course in 15+ years. Is it any surprise that I scored 10's in Bio and VR, but an 8 in physics, despite strong A's in both Physics and Chemistry in Undergrad?


😕 Math skills? That's definitely not it.
 
😕 Math skills? That's definitely not it.

I'm not so sure. My math skills, while great when I was 5-16, have taken a sharp nose dive, having not been used for 15 years. Many of my classmates feel similarly. Anecdotal, I know, but still...

When I prepared for the MCAT, I had to spend a good amount of time reviewing how to do relatively simple operations. Examcrakers was a huge help here. That was time that would have been better spent studying something else. Guess what, I haven't done much math since then either, so I'm sure that any math that shows up on the boards I will also suck at.

I'm not even talking real calculations here...but even conceptually, being able to do things, like manipulate fractions or ratios quickly in your head, can really help. It takes me a LONG time to do that stuff...just sayin.
 
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+1.. that's a ridiculous argument. I tutor high school and college kids in calculus and biostatistics.

Ok, ok! My theory may be wrong! After all, it was only based on myself and about 20 or so DO students I've talked with it about...

Maybe it's just a problem for us non-trad, non-math-major types... :/

I'm not trying to make any generalizations with my above "possible reasons" list. I'm just trying to explain a few of the many reasons we may do more poorly on these standardized exams.

For me, my rusty math skills (and rusty may be a better word for it), and my lack of research-related skills may play a role. For the MCAT, more than a few of my classmates had Bio and VR scores >10, but crappy physics scores. Just anecdotal people, and doesn't apply to all.
 
lets face it, 90-95% of DO students applied for MD spots but did not make it, so they went for DO, which is a very smart choice rather than quitting or sitting out. Simply put, they do not do as well on tests than the MD students do. nothing to feel bad about. DO students can shine if they master OMM and can help the patient in ways the MD could never think of. It really is a shame that only about 5% of DO students actually use OMM.


rohit kedia
lecom 2011
 
lets face it, 90-95% of DO students applied for MD spots but did not make it, so they went for DO, which is a very smart choice rather than quitting or sitting out. Simply put, they do not do as well on tests than the MD students do. nothing to feel bad about. DO students can shine if they master OMM and can help the patient in ways the MD could never think of. It really is a shame that only about 5% of DO students actually use OMM.


rohit kedia
lecom 2011

I don't think the percentage is that high. Probably more like 50-75%...maybe.

I do fine on tests. I had a 3.8 science GPA. 10 on bio MCAT, 10 on VR. Not the best, but I can, for the most part, take a test. My physics score sucked (8) because I suck at math because I'm old and it's rusty. I could've spent more time improving it, but it just didn't get there. I could've taken another year or two slaving away to improve my MCAT, or I could've gone to a DO school that I love.

I have absolutely ZERO doubt about my (or 95% of my classmates') ability to get into an MD school. We just didn't. We each have our own reasons. For some it was financial...LECOM has almost the lowest tuition of any private school (I think we're 2nd lowest) AND it was cheaper than 2/3 of my state MD schools. For others, the choice was location (I have a family, and this is a great town to raise a kid in...not to mention to weather). For others, PBL was a deciding factor. Others wanted to do OMM. The list goes on and on.

Again, I think making generalizations about DO's (or MD's, or anyone else, really) is a mistake. People are complex. There are many reasons for going to DO school, just as there are many reasons why we may not do as well on boards.
 

Eh...I think a large part of med school is figuring out what interests you. I think the fact that so few DOs ultimately choose not to use OMM says much more about OMM than it does about the students/physicians. If you're not into OMM, then why should you be expected to utilize it in the future?? Serious question.
 
Eh...I think a large part of med school is figuring out what interests you. I think the fact that so few DOs ultimately choose not to use OMM says much more about OMM than it does about the students/physicians. If you're not into OMM, then why should you be expected to utilize it in the future?? Serious question.

Actually, most people think that the percentage dropped so low due to a huge drop in reimbursement in the 90's. That, combined with the poor reimbursement of primary care as a whole, has made it financially unviable for most docs to do OMM.

Doing OMM takes time. Why do it if you could make 2 or 3 times as much by seeing another patient instead?

The percentages have been rising since the rates were increased a couple of years ago. If all the money stuff works itself out somehow, I'd expect that it'd be much higher.

Also, doing OMM depends on your skill and comfort level. Perhaps many students don't think they're very good at it. Most DO's aren't trained in an OMM residency, you know. Maybe they don't think they have the necessary skills. I know I won't after just 2 years of OMM in med school, that I likely won't use again for who knows how long.
 
90-95% of the students at UMDNJ-SOM certainly could have went to MD schools.

Like in the same application cycle? Lies. Complete and utter lies.

Its a great school though, I just visited the campus a few weeks ago. I think you'll be happy with your decision to attend there 👍
 
Actually, most people think that the percentage dropped so low due to a huge drop in reimbursement in the 90's. That, combined with the poor reimbursement of primary care as a whole, has made it financially unviable for most docs to do OMM.

Doing OMM takes time. Why do it if you could make 2 or 3 times as much by seeing another patient instead?

The percentages have been rising since the rates were increased a couple of years ago. If all the money stuff works itself out somehow, I'd expect that it'd be much higher.

Also, doing OMM depends on your skill and comfort level. Perhaps many students don't think they're very good at it. Most DO's aren't trained in an OMM residency, you know. Maybe they don't think they have the necessary skills. I know I won't after just 2 years of OMM in med school, that I likely won't use again for who knows how long.

To be truthful, I have no idea exactly how reimbursement for OMM has changed historically over the past 20 years. I do know that you can definitely make a lot of money doing some pretty basic crap on just a few pts every week. The OMM faculty at DMU actually presented a pretty convincing argument towards the end of our 2nd year showing just how much money you could make incorporating OMM into your practice, while actually seeing less patients. The way that OMM billing is set up, it's very easy to max out on a pt in a very short period of time. So time really isn't the issue at all. Maybe some current FP/Internist DOs out there can shed some additional light on this (my experience is limited to what DMU OMM faculty presented and my FP rotations experience).

And to preempt any attacks, I'm not implying money/financial gain is a reason to do any procedure (OMM, imaging, etc.).

In regards to most DOs not being trained in OMM residencies - if you do a DO residency (esp primary care), OMM is supposed to be an integral part of your training.

Possibly my post came off differently, but I didn't mean to imply that all DOs are choosing not to do it simply because they don't like it. I'm just say that there are those individuals out there that simply didn't fall in love it, and if they choose not to practice it, then great for them.
 
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Based on stats, I think my statement is much more reasonable than the former.

And thanks! I haven't fully decided where I'll be going yet. I feel like I'm close to a decision but I'm going to give it more time.

Students accepted to the 2009 entering class had an average GPA of 3.54 and an average MCAT score of 27

http://som.umdnj.edu/education/admissions/faq.html

Definitely on the higher end for DO schools, but I think it's safe to say that no more than half the class would likely be competitive for MD based on #'s alone. Not that they wouldn't perform just fine. But, nobody really cares about these numbers anymore after about a month of medical school.
 
Ok, ok! My theory may be wrong! After all, it was only based on myself and about 20 or so DO students I've talked with it about....

:laugh: I love SDN-post theories, percentages, assumptions and "studies"

"I talked to 15 people from my class and they all said the same thing.....it must be true."