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Letters to the Editor

Should Osteopathic Medical Students Take the USMLE?

Lenchus, Joshua DO

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doi: 10.1097/ACM.0000000000003826
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To the Editor:

Ahmed and Carmody recently discussed the case of “double jeopardy” for osteopathic medical students who sat for the United States Medical Licensing Examination (USMLE) Step 1.1 I completely agree with their proposed solutions.

As an osteopathic physician who completed Step 1 of the USMLE and the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) series, I can personally attest to the differences. At the time, the USMLE Step 1’s focus was on textbook facts, and included embryology and genetics. The COMLEX-USA had a more clinically integrated slant and did not include either of the former subjects, but did incorporate osteopathic manipulative medicine—something completely lacking from the USMLE. Hence, although both tested my knowledge of biochemistry, for example, they did so in a different manner. The USMLE and COMLEX-USA tests have clearly been designed to reflect the education of medical students and osteopathic medical students, respectively.

After completing my allopathic Accreditation Council for Graduate Medical Education (ACGME)-approved internal medicine residency, I was fortunate to spend 9 years as its associate program director. This enabled me to interview dozens of osteopathic medical students in search of a coveted residency position at my institution. Some completed both exams, while others only required the COMLEX-USA. Those seeking to use their USMLE score to boost their marketability were generally sorely mistaken, undoubtedly because the tests are indeed different. In fact, I routinely advocated against taking the USMLE.

At this point, there is no sound reason for an osteopathic medical student to sit for the USMLE any more than there is for an allopathic medical student to sit for the COMLEX-USA. I credit the ACGME and the American Osteopathic Association (AOA) with the foresight to combine the nation’s residencies under a single umbrella. The next step is to educate all program directors about the validity of the required COMLEX-USA for osteopathic students; require acceptance of those scores; and not foist additional time, effort, and cost on students who need not take the USMLE at all—especially as there are discussions about abandoning such scores in resident selection processes. Further, these scores are poor predictors of future success as a physician. This joint effort between the ACGME and AOA will be successful for all and eliminate the double jeopardy that currently exists.


1. Ahmed H, Carmody JB. Double jeopardy: The USMLE for osteopathic medical students. Acad Med. 2020;95:666.
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