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Letters to the Editor  |   August 2012
Graduating Osteopathic Medical Students' Perceptions and Recommendations on the Decision to Take the USMLE
Author Affiliations
  • Joshua D. Lenchus, DO, RPh
    Associate Professor, Division of Hospital Medicine, Department of Medicine, University of Miami Miller School of Medicine; Associate Program Director, Jackson Memorial Hospital Internal Medicine Residency; Miami, Florida
Article Information
Medical Education
Letters to the Editor   |   August 2012
Graduating Osteopathic Medical Students' Perceptions and Recommendations on the Decision to Take the USMLE
The Journal of the American Osteopathic Association, August 2012, Vol. 112, 480-481. doi:10.7556/jaoa.2012.112.8.480
The Journal of the American Osteopathic Association, August 2012, Vol. 112, 480-481. doi:10.7556/jaoa.2012.112.8.480
To the Editor: 
As an osteopathic physician who took the United States Medical Licensing Examination (USMLE) and an associate program director of one of the nation's largest allopathic internal medicine residency programs, I read the medical education article by Robert T. Hasty, DO, and colleagues1 in the February issue with great interest. On the basis of a survey of graduating osteopathic medical students, Hasty et al1 attempted to evaluate students' perceptions related to the USMLE. As the primary reason for taking the USMLE, 46% of the respondents cited keeping their options open, and 35.5% cited enhancing their chances of getting into an allopathic residency.1 
It is important to point out that graduating osteopathic medical students need not take the USMLE to better their chances of being accepted into an allopathic residency—with rare exceptions. These exceptions include training programs in highly competitive fields, such as neurosurgery, ophthalmology, dermatology, and orthopedic surgery. The fact is that most allopathic residency program directors know nothing about the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA). They do not know about the general validity of COMLEX-USA, and they do not know what information is tested or how to accurately compare this test's scores to those of the more familiar USMLE. Thus, allopathic residency program directors typically make baseless, assumed, and subjective comparisons between the 2 examinations. 
Osteopathic medical students who score higher on COMLEX-USA than the USMLE will foster a belief that the former is not as rigorous as the latter. As a result, some allopathic residency program directors may direct students to take the USMLE in order to be considered for residency training. The motivation for this recommendation is a lack of knowledge about COMLEX-USA, an unwillingness to accept osteopathic medical students (by using the test as an obstacle to overcome), or a lack of trust in the scores of COMLEX-USA. 
I disagree with the contention of Hasty et al1 that “the present study represents the first reasonably objective findings specific to this issue that might aid faculty in their ability to counsel osteopathic medical students on this topic.” If their study described a survey of allopathic residency program directors—as they suggest be done in the future—then this statement could be valid. However, a survey of osteopathic medical students who have no role in making allopathic residency acceptance decisions hardly makes the results objective. Rather, the results are incredibly subjective, replete with potential hearsay, second-hand knowledge, and supposition. 
The American Osteopathic Association (AOA) should take a proactive role in ensuring that allopathic residency program directors understand the nuances of COMLEX-USA and that this test cannot be compared directly to the USMLE. The AOA should also work to ensure that osteopathic medical students not be disadvantaged if they do not take the USMLE. However, the AOA must accept the fact that a majority of osteopathic medical students seek allopathic residency training.2,3 Between 2007 and 2011, the percentage of graduating osteopathic medical students who applied to the National Resident Matching Program varied between 52.4% (in 2011) and 56.3% (in 2010).2,3 During that period, the number of osteopathic medical students who applied to the National Resident Matching Program increased from 1652 in 2007 to 2178 in 2011.2,3 
Graduating osteopathic medical students want the best postgraduate training—regardless of whether it is osteopathic or allopathic. The osteopathic medical profession should attempt to understand why osteopathic medical students do not choose our own institutions for training, rather than continue to keep allopathic training programs in the dark about COMLEX-USA and its usefulness in student assessment. 
I, along with most of the allopathic residency program directors at my institution, Jackson Memorial Hospital, suggest that osteopathic medical students not take the USMLE unless absolutely necessary. It is a costly, time-consuming, and stressful examination that the vast majority of osteopathic medical students need not take. Furthermore, taking parts of the USMLE series does not bolster one's chances at acceptance into an allopathic residency training program, but rather will stimulate the interviewer to ask about the rationale for so doing. 
Osteopathic medical students should choose residency institutions at which they want to train. The AOA should make every effort to ensure that the osteopathic medical profession's examinations are understood by all—so that graduates of osteopathic medical schools can be privy to a quality education at any facility, even if it is allopathic. 
References
Hasty RT, Snyder S, Suciu GP, Moskow JM. Graduating osteopathic medical students' perceptions and recommendations on the decision to take the United States Medical Licensing Examination. J Am Osteopath Assoc. 2012;112(2):83-89. [PubMed]
American Association of Colleges of Osteopathic Medicine. Trends in Osteopathic Medical School Applicants, Enrollment and Graduates. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine; March 2012. http://www.aacom.org/data/Documents/Trends-apps-enroll-grads.pdf. Accessed May 25, 2012.
National Resident Matching Program. Results and Data: 2012 Main Residency Match. Washington, DC: National Resident Matching Program; April 2012. http://www.nrmp.org/data/resultsanddata2012.pdf. Accessed May 25, 2012.