Thank you for the opportunity to respond to the letter to the editor by Joshua D. Lenchus, DO, RPh, regarding the JAOA article I coauthored, “Graduating Osteopathic Medical Students' Perceptions and Recommendations on the Decision to Take the United States Medical Licensing Examination.”¹ I agree with most of the comments made by Dr Lenchus, particularly with his assertion that “graduating osteopathic medical students need not take the USMLE [United States Medical Licensing Examination].” In addition, I agree that most osteopathic medical students are served well by their Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) scores as credentials for entry into residency programs accredited by either the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA). The COMLEX-USA scores are also essential credentials for licensure in all 50 states.^2-4 

Furthermore, Dr Lenchus brings an important perspective and his personal observations regarding the current practices of ACGME program directors. This perspective serves as an important contrast to the opinions of graduating osteopathic medical students, as reported in our study.¹ 

I would like to point out that the AOA and the National Board of Osteopathic Medical Examiners (NBOME) are actively working together on educating residency program directors regarding COMLEX-USA.⁵ The NBOME has made 6 major presentations on COMLEX-USA at national or regional meetings of residency program directors during the past year. The NBOME also includes a COMLEX-USA informational handout as part of the new residency program directors' orientation program. This handout was made available at the recent ACGME Annual Meeting, in March 2012, and can be obtained from the NBOME Web site⁶ and in various graduate medical education newsletters. Since 2010, all ACGME residency program directors receive the NBOME Annual Report, and representatives from graduate medical education (eg, ACGME, Association of Osteopathic Directors and Medical Educators, Organization of Program Directors Associations [of the Council of Medical Specialty Societies]) participate in a number of NBOME committees and activities, including NBOME's Liaison Committee. Upon the request of the NBOME, the AOA has added communicating with residency program directors about COMLEX-USA to its 2011-2013 Strategic Plan.⁷ 

I would further add that the discrepancies between the perceptions of graduating osteopathic medical students reported in our article¹ and the observations of Dr Lenchus articulate a need to better educate osteopathic medical students on these important issues.