To the Editor:
As the president and chief executive officer of the National Board of Osteopathic Medical Examiners (NBOME), I thank Ahmed and Carmody 1 for their interest in the Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA), and for their advocacy for osteopathic medical students. However, their argument as to why doctors of osteopathic medicine are placed in “double jeopardy” requires some clarification.
The curriculum of osteopathic medical school incorporates distinctive osteopathic principles, and COMLEX-USA reflects these principles and is validated based on practice patterns unique to doctors of osteopathic medicine (DOs), including the use of osteopathic manipulative treatment. 2 The United States Medical Licensing Examination (USMLE) does not meet these criteria for assessing osteopathic medical students.
DO-granting medical schools use COMLEX-USA for curricular evaluation and accreditation. COMLEX-USA performance is associated with performance in residency 3 and with decreased odds for state medical board disciplinary actions in future practice. 4 Comparability of exam performance with the COMLEX-USA percentile tool 5 and published score concordance data 6 have been helpful for program directors, and the NBOME continues its advocacy and outreach.
Ahmed and Carmody recognize that the single accreditation system creates the misconception that DO students need to take Step 1 of the USMLE in addition to COMLEX-USA for residency application. The escalation of applications in the 2020 National Resident Matching Program (NRMP) Match illustrates the anxiety permeating the residency application process. These could be unintended consequences of the single accreditation system, but will hopefully be attenuated with the exceptional results (99.29% placement) for DO applicants in the 2020 NRMP Match. 7
I applaud the Accreditation Council for Graduate Medical Education for advocating for the equitable treatment of applicants in residency program selection. 8 Further progress in understanding the distinct and valid credentials of all applicants without requiring DOs to take USMLE will contribute to diversifying the educational milieu and improving the quality of GME, helping to collectively take better care of our patients.
1. Ahmed H, Carmody JB. Double jeopardy: The USMLE for osteopathic medical students. Acad Med. 2020; 95:666
2. Horber DT, Gimpel JR. Enhancing COMLEX-USA: Evidence-based redesign of the osteopathic medical licensure examination program. J Med Regul. 2018; 104:11–18
3. O’Neill TR, Peabody MR, Song H. The predictive validity of the National Board of Osteopathic Medical Examiners’ COMLEX-USA examinations with regard to outcomes on American Board of Family Medicine examinations. Acad Med. 2016; 91:1568–1575
4. Roberts WL, Gross GA, Gimpel JR, et al. An investigation of the relationship between COMLEX-USA licensure examination performance and state licensing board disciplinary actions. Acad Med. 2020; 95:925–930
5. National Board of Osteopathic Medical Examiners.. COMLEX-USA percentile score converter. https://www.nbome.org/cbt_score_conv
. Accessed April 12, 2021
6. Sandella JM, Gimpel JR, Smith LL, Boulet JR. The use of COMLEX-USA and USMLE for residency applicant selection. J Grad Med Educ. 2016; 8:358–363
7. National Resident Matching Program, Data Release and Research Committee. Results of the 2020 NRMP Program Director Survey. https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/08/2020-PD-Survey.pdf
. Published August 2020 Accessed April 20, 2021
8. Accreditation Council on Graduate Medical Education. We are all part of the solution: A call to action from ACGME CEO Thomas J. Nasca, MD. https://www.acgme.org/Newsroom/Blog/Details?articleId=6300
. Published March 3, 2018 Accessed April 20, 2021