Double Jeopardy: The USMLE for Osteopathic Medical Students : Academic Medicine

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Letters to the Editor

Double Jeopardy: The USMLE for Osteopathic Medical Students

Ahmed, Harris MPH; Carmody, J. Bryan MD, MPH

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doi: 10.1097/ACM.0000000000003180
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To the Editor:

In 1997, 307 osteopathic medical students took Step 1 of the United States Medical Licensing Exam (USMLE). By 2018, that figure had increased to 4,136,1 representing nearly 60% of all osteopathic medical students in the class of 2020. Yet unlike the allopathic medical students taking the exam, none of these 4,136 students were required to take the test for licensure. Rather, they were all obligated to take a different test (the Comprehensive Osteopathic Medical Licensing Examination of the United States [COMLEX-USA]) and took the USMLE only to improve their residency selection candidacy.

In 2014, the American Osteopathic Association, American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education (ACGME) agreed to transition to a single accreditation system for both allopathic and osteopathic residency programs. Among other things, this single accreditation system was intended to eliminate unnecessary duplication.2 Unfortunately, for osteopathic medical students seeking to match at ACGME-accredited programs, this change has thus far only increased the wasteful redundancy in licensure examinations.

Although the American Medical Association has recommended treating the USMLE and COMLEX-USA examinations equally,3 many residency programs do not consider COMLEX-USA scores.4 The costs of “double jeopardy” for licensing exams are significant. Students who take USMLE Step 1 and USMLE Step 2 Clinical Knowledge in 2020 will incur an additional $1,290 in examination fees—not to mention the added costs of test preparation.

With the transition to a single accreditation system nearing completion, what should be done about this de facto 2-test system? Multiple solutions are possible, ranging from providing program directors with score conversion calculators or adopting a standard scoring system, to more dramatic measures such as developing a consolidated licensing exam. Yet any meaningful solution will require collaboration between the parent organizations of both exams—and financial incentives do not exist to pursue such efforts, despite the potential benefits for students. We therefore call upon the “house of medicine” to address this issue and improve the system for all.

Harris Ahmed, MPH
Fourth-year medical student, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.
J. Bryan Carmody, MD, MPH
Assistant professor, Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia; [email protected]


1. United States Medical Licensing Examination. USMLE performance data. Accessed January 24, 2020.
2. Buser BR, Swartwout J, Gross C, Biszewski BA. The single graduate medical education accreditation system. J Am Osteopath Assoc. 2015;115:251–255.
3. Murphy B. DO and MD licensing exams should be viewed equally, says AMA. American Medical Association. Accessed January 24, 2020.
4. National Board of Osteopathic Medical Examiners. COMLEX-USA for program directors.,a%20number%20of%20international%20jurisdictions. Accessed January 24, 2020.
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