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NBOME FAQs- DRAFT
1. Remind Me Again Why I Take COMLEX-USA?
COMLEX-USA is the licensure examination series that has an evidence-based design for
assessing the practice of osteopathic medicine, and recognized as such for its exemplary validity
by the Federation of State Medical Boards (FSMB), which is the leading organization in medical
licensure regulation in the United States and is comprised of the nation’s medical and
osteopathic medical licensing boards as members.
The FSMB co-owns the USMLE examination for MDs and has official policy supporting COMLEXUSA and USMLE for respective physician licensure. Having an evidence-based design and valid
licensure examination that tests the distinctive practice of osteopathic medicine is critical to
protecting the public and patient safety; patients need to know that the DOs from whom they
seek osteopathic medical care have shown competency in the osteopathic medical knowledge
and clinical skills considered essential for an osteopathic generalist physician to practice
medicine without supervision.
The very essence of having the choice for patients to see DOs is protected by having COMLEXUSA, which is designed with the distinctive curricular focus incorporating the tenets of
osteopathic medicine. The acquisition of declarative knowledge in the art and science of
osteopathic medicine and progressive transformation into procedural knowledge and skills leads
the osteopathic physician in the construction of problem and task-specific knowledge and skill
bases that contribute to the foundation of quality, patient-centered osteopathic medical care.
The primary reason osteopathic medical students and DOs take COMLEX-USA is for licensure.
In addition, passing COMLEX-USA Level 1, Level 2-Cognitive Evaluation (CE) and Level 2Performance Evaluation (PE) is a requirement for graduating with the DO degree from an
AOA-COCA (Commission on Osteopathic College Accreditation) accredited college of osteopathic
medicine. AOA-COCA is the recognized accrediting authority for osteopathic colleges by the US
Department of Education. Many schools require passing COMLEX-USA Level 1 in order to
progress into clinical clerkships or to be allowed to continue into year 3 or 4 in their osteopathic
medical school. Residency program directors use COMLEX-USA as a selection tool (see next
question), and passing of Level 3 is also required by all AOA-approved residency programs (and
numerous ACGME-accredited programs) in order to enter the third year of residency.
1 2. What about Residency Program Directors? Will They Accept Me As a DO
Student, and Will I Also Need to Take the USMLE Examination For Applying
for GME Programs and/or Board Certification? Does the Single Accreditation
System (SAS) for Graduate Medical Education (GME) Change This?
All AOA-approved residency program directors (over 1000 programs, 46% of current 2015 OMS
4s/graduates matching) require COMLEX-USA and look at pass/fail and scores for screening
applicants to interview or rank for their residency programs. According to the National
Resident Matching Program (NRMP) Program Directors (PD) Surveys in 2012 and 2014,
licensure board examination scores (COMLEX-USA and USMLE) are very highly utilized by
residency program directors in selecting applicants for interviews. The survey results show
that 77% of residency program directors in ACGME-accredited programs use
COMLEX-USA for evaluating DO applicants for their programs.
However, in the same 2014 PD Survey, only 71% of PDs report typically interviewing or ranking
osteopathic applicants to their programs. Both the percentage of ACGME-accredited programs
that accept DO applicants, and the percentage of these programs that use COMLEX-USA for DO
applicants, varies across specialties (as per the survey) and may vary in different geographical
regions of the country. This is why students are advised to do specialty and program-specific
research and seek counsel from their faculty advisors and mentors in making residency-related
application decisions.
The good news is, based upon entering-student and graduating-student surveys by AACOM, DO
students align very well with those specialties in ACGME programs that both typically interview
and rank DO students, AND that accept COMLEX-USA for DO applicants. These happen to be
most of the residency program specialties of highest interest to DO applicants. For example,
over 70% of DO students who matched in the NRMP program to ACGME programs in 2014 fell
into the following six specialties:
Internal Medicine
Family Medicine
Pediatrics
Emergency Medicine
Psychiatry
OB-GYN
In these specialties in ACGME programs in aggregate, over 84% of program directors use
COMLEX-USA, and 84% of ACGME PDs report typically interviewing and/or ranking DO
applicants.
Those ACGME program specialties that typically do not interview and/or rank DO applicants at
all, or at least report doing so less than or equal to 35% of the time (examples:
otorhinolaryngology, orthopedic surgery, plastic surgery, dermatology), have low match rates
overall for applicants, and very low match rates for any applicants (including DOs) who are not
2 current seniors graduating from United States LCME-accredited medical schools. Moreover, very
few applicants from DO medical schools apply to these specialty programs.
More good news for DOs— the 2015 NRMP Match Rate for osteopathic applicants is the
highest ever (79.3%). At the same time, the percentage of osteopathic students in the 2015
graduating class cohort who elected to take USMLE Step 1 in their second year, in addition to
the required COMLEX-USA Level 1, remain at just below 50% nationally, just as in the prior
year. The data suggests that many of these students could have spared themselves the
duplication in costs, time, and anxiety of taking USMLE. But again, individual research is
suggested.
The Single Accreditation System (SAS) for GME is very exciting indeed and should actually
provide further clarification to DO students and others that COMLEX-USA is the
examination for DOs. Research on COMLEX-USA increasingly demonstrates predictive
validity for performance in residency programs, resident in-service exams, and board
certification exams (AOA and ABMS), as well as significant score concordance and, therefore,
comparability of COMLEX-USA and USMLE scores for DOs.
The ACGME has repeatedly stated that COMLEX-USA and USMLE are both acceptable licensure
examinations and meet eligibility criterion for applications and entrance into ACGME-accredited
residency programs. The ACGME has also recently clarified that the Common Program
Requirements that come into effect in 2016 and address additional requirements necessary for
“exceptionally qualified applicants” for subspecialty Fellowship training programs apply only to
graduates of international medical schools (IMGs) and not to DOs. Further, COMLEX-USA and
USMLE are both acceptable. Finally, the ACGME clarifies that completion of COMLEX-USA is
acceptable and that USMLE is not required for Board Certification by any AOA or ABMS
certification board. For more information on the statistics and facts presented above, please see
the following links.
http://www.nrmp.org/2014-program-director-survey-report-now-available/
http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf
http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf
http://www.aacom.org/reports-programs-initiatives/aacom-reports/entering-and-graduatingclass-surveys
https://natmatch.com/aoairp/stats/2015prgstats.html
http://www.fsmb.org/
www.nbome.org
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