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: 

 

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?”