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Letters to the Editor  |   June 2007
Is Estimating USMLE Performance Useful?
Author Affiliations
  • Isaac J. Kirstein, DO
    Director of Medical Education Associate Professor of Medicine Midwestern University/Chicago College of Osteopathic Medicine Downers Grove, Illinois
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   June 2007
Is Estimating USMLE Performance Useful?
The Journal of the American Osteopathic Association, June 2007, Vol. 107, 213. doi:10.7556/jaoa.2007.107.6.213
The Journal of the American Osteopathic Association, June 2007, Vol. 107, 213. doi:10.7556/jaoa.2007.107.6.213
To the Editor: Should I take the USMLE? 
With a large proportion of graduates from colleges of osteopathic medicine (COMs) continuing to apply for residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME),1 this question is being asked of COM educators more than ever. In the September 2006 issue of JAOA—The Journal of the American Osteopathic Association, Philip C. Slocum, DO, and Janet S. Louder2 proposed a mathematical method to estimate performance on the United States Medical Licensing Examination (USMLE) based on Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) scores. The authors note that the impetus of their analysis was to reduce potential selection bias against COM graduates seeking ACGME-accredited residency training. 
Although the method used by the authors is sound, the equation generated is valid only for evaluating graduates of the A.T. Still University-Kirksville College of Osteopathic Medicine in Mo—because these graduates were the only members of the cohort. The various COMs use an array of curriculum models and assessment methods.1 It is possible that each COM, when surveyed separately, will have variation in its regression analysis. Thus, the authors' proposed method may be validated only if the study is completed in aggregate, with all COMs sharing their data. 
Should we undertake such a profession-wide study? An accurate tool for estimating USMLE performance might be useful for program directors at residency programs accredited by the ACGME, but it would have a debatable effect on removing selection bias against COM graduates. The tacit reality behind the study by Slocum and Louder2 is that the medical profession has been enabled by the ACGME graduate surplus to expand at a hurried pace. The sanctioned increase in allopathic medical school size3 is placing the academic leadership of COMs on alert. The method that allopathic medical schools will use to provide postdoctoral training for their increasing number of graduates was clearly stated by Michael E. Whitcomb, MD,4 of the Association of American Medical Colleges: 

...some IMGs [international medical graduates] and DOs who might otherwise have been accepted into allopathic GME [graduate medical education] programs will not be accepted in the future.

 
Residency programs approved by the American Osteopathic Association are faced with increasing pressures to remain competitive in an ever-tightening match with ACGME-accredited programs. In the 2004-2005 academic year, the COMs had only roughly half of their participating graduates accept positions through the American Osteopathic Association's Intern/Resident Registration Program.5 If the ACGME starts shutting its doors on our graduates, will new “translation” methods help? 
Walk a mile in our students' shoes and ask yourself, “Would I take the USMLE?” 
American Association of Colleges of Osteopathic Medicine. 2006 Annual Statistical Report on Osteopathic Medical Education. Chevy Chase, Md: American Association of Colleges of Osteopathic Medicine; February 2007. Available at: http://www.aacom.org/data/annualreport/. Accessed May 9, 2007.
Slocum PC, Louder JS. How to predict USMLE scores from COMLEX-USA scores: a guide for directors of ACGME-accredited residency programs. J Am Osteopathic Assoc. 2006;106:568-569. Available at: http://www.jaoa.org/cgi/content/full/106/9/568. Accessed May 9, 2007.
US Department of Health and Human Services. Council on Graduate Medical Education Sixteenth Report: Physician Workforce Policy Guidelines for the United States, 2000-2020. Rockville, Md: US Department of Health and Human Services, Health Resources and Services Administration; January 2005. Available at: http://www.cogme.gov/16.pdf. Accessed May 9, 2007.
Whitcomb ME. Increasing the aggregate supply of physicians. Acad Med. 2006;81:593-594.
Obradovic JL, Winslow-Falbo P. Osteopathic graduate medical education. J Am Osteopathic Assoc. 2007;107:57-66 Available at: http://www.jaoa.org/cgi/content/full/107/2/57. Accessed May 9, 2007.