› Forums › Spring 2020 Resolution Forum › Resolution: S-20-30: ELIMINATION OF THE COMLEX USA
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WHEREAS, the COMLEX USA is a licensing exam series that is currently required by the Commission on Osteopathic College Accreditation (COCA) to be taken by all osteopathic medical students in order to graduate from a COCA accredited medical school1; and
WHEREAS, the United States Medical Licensing Exam (USMLE) is a licensing exam series that is currently taken by MD medical students, many osteopathic medical students, international and foreign medical graduates; and
WHEREAS, in 1997, 363 osteopathic medical students took the USMLE Step 1 or Step 2 CK. By 2018, this figure had increased to 7212, a nearly 20-fold increase, this increase outpaced growth in osteopathic medical school enrollment2,3; and
WHEREAS, between 1997 and 2018 the percentage of osteopathic medical students taking the USMLE Step 1 and USMLE Step 2 CK has increased by over 10%2,3; and
WHEREAS, there is a growing trend of osteopathic medical schools requiring their students to take the USMLE4,5; and
WHEREAS, osteopathic medical students on average face $256,562 in debt upon graduation, this is on average greater than MD students who on average have $196,520 in debt upon graduation, and the continued increase in students taking Step further contributes to osteopathic medical student debt burden6,7; and
WHEREAS, In 2014, the American Osteopathic Association, American Association of Colleges of Osteopathic Medicine, and the Accreditation Council of Graduate Medical Education (ACGME) agreed to transition to a single accreditation system for both allopathic and osteopathic residency programs. Among other things, this single accreditation system was intended to eliminate unnecessary duplication.8 Yet for osteopathic medical students seeking to match at ACGME-accredited programs, this change has thus far only increased the wasteful redundancy in licensure examinations; and
WHEREAS, the AOA has recognized the importance of modernizing board certification exams, and are offering a new pathway of board certification that does not require Osteopathic Manipulative Treatment, recognizing that osteopathic physicians are not defined by a single exam or OMT9; and
WHEREAS, there is evidence that ACGME programs have discriminated against osteopathic medical school graduates in the past within the context of both residency selection and 4th year undergraduate rotation eligibility10; and
WHEREAS, nearly 20% of ACGME program directors do not utilize the COMLEX as part of the residency selection process, and as a result those osteopathic medical students that do not take USMLE are at a significant disadvantage11; and
WHEREAS, many ACGME program directors, and a majority of program directors in certain specialties such as Emergency Medicine, consider it to be important for DOs to have USMLE scores, and prefer USMLE scores over the COMLEX scores. In these specialties, DO students that take the USMLE fare significantly better than those that do not take the exam, with over a 20% better match rate12,13; and
WHEREAS, many ACGME programs require USMLE scores from DO applicants for consideration for rotations and residency14,15; and
WHEREAS, a significant proportion of DO students feel USMLE scores keep their options open, lack of a USMLE score leads to discrimination in the residency application process and a majority of DO students believe that DO students should take the USMLE16; and
WHEREAS, despite an AMA resolution in 2018 calling for equal recognition of the COMLEX to the USMLE, the AMA has no jurisdiction over the ACGME and individual program directors; and
WHEREAS, there is a positive correlation with USMLE and COMLEX scores, those students that do well on COMLEX tend to do well on USMLE17; and
WHEREAS, the USMLE Step 1 will go to a pass/fail scoring system by 2022 and the NBOME is also considering making the COMLEX USA series pass/fail, however the USMLE Step 2 CK will remain a scored exam18,19; now, therefore, be it
RESOLVED, that SOMA adopt an official position that the COMLEX USA series no longer be required prior to graduation of osteopathic medical school; and, be it further
RESOLVED, that SOMA adopt an official position that the USMLE exam series should become the licensing exam required prior to graduation of osteopathic medical school; and, be it further
RESOLVED, that SOMA advocate to COCA to adjust their continuing accreditation standards such that Element 6.12 no longer requires COMLEX USA series to be passed prior to graduation from an osteopathic medical school; and, be it further
RESOLVED, that SOMA advocate to COCA to adjust their continuing accreditation standards such that Element 6.12 require the USMLE exam series to be passed prior to graduation from an osteopathic medical school.
In 2014, the American Osteopathic Association, American Association of Colleges of Osteopathic Medicine, and the Accreditation Council of Graduate Medical Education (ACGME) agreed to transition to a single accreditation system for both allopathic and osteopathic residency programs. Among other things, this single accreditation system was intended to eliminate unnecessary duplication. Yet for osteopathic medical students seeking to match at ACGME-accredited programs, this change has thus far only increased the wasteful redundancy in licensure examinations.
Attempts by parent organizations of the USMLE and COMLEX-USA to share data, provide score conversion scales, and/or adopt a uniform numeric scale have been unsuccessful. New and innovative approaches must be explored such as consolidation at the level of licensing exams, with revenue being a major barrier to doing so. Incentives are not aligned currently for there to be a single licensing exam system, despite the potential benefits for students. We call upon the “house of medicine” to address this issue and improve the system for all.
To the point of revenue, we feel that the NBOME’s financial viability should not be considered as relevant to this discussion. Additionally, the NBOME will maintain revenue streams through the COMAT examination series. Further, the NBOME may develop an osteopathic specific subject test to be taken by osteopathic medical students in addition to the USMLE series. This subject test could cover unique and exclusive osteopathic content. Elimination of the COMLEX USA series in COCA accreditation standards is the first necessary step towards licensing exam reform.
Regarding the theoretical question of previous graduates and state laws, all previous osteopathic physicians that were licensed as osteopathic physicians through the COMLEX USA series could be grandfathered in, meaning that those osteopathic physicians that were licensed up until the year the COMLEX series ended would remain fully licensed physicians.
- American Osteopathic Association. (2018). Commission on Osteopathic College Accreditation (Element 10.4). https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf
- USMLE.org. (2018). Performance Data. Retrieved February 22, 2020, from https://www.usmle.org/performance-data/
- American Association of Colleges of Osteopathic Medicine. (2019). AACOM Reports on Student Enrollment. Retrieved from https://www.aacom.org/reports-programs-initiatives/aacom-reports/student-enrollment
- Rocky Vista University. (2020). Rocky Vista University Student Handbook. Retrieved from http://www.rvu.edu/wp-content/uploads/2020/01/DO-NOT-SAVE-OVER_RVU_Catalog_Handbook_2019-2020-1.pdf
- Lake Eerie College of Osteopathic Medicine. (2020). Lake Eerie Student Handbook. Retrieved from https://lecom.edu/content/uploads/2020/01/2019-2020-Academic-Catalog-COM-Updated.pdf
- American Association of Colleges of Osteopathic Medicine. (2019). Graduating Seniors Summary Report. Retrieved February 25, 2020, from https://www.aacom.org/docs/default-source/data-and-trends/aacom-2018-2019-academic-year-graduating-seniors-survey-summary-report.pdf?sfvrsn=b5310e97_4
- American Association of Medical Colleges (2018). Retrieved February 25, 2020, from https://store.aamc.org/downloadable/download/sample/sample_id/240/
- Buser BR, Swartwout J, Gross C, Biszewski BA. (2015). The single graduate medical education accreditation system. J Am Osteopath Assoc 2015; 115: 251-255.
- American Osteopathic Association. Frequently Asked Questions (2020). Retrieved Match 5th, 2020 from https://certification.osteopathic.org/faqs/
- Harris, G. (2011, October 01). When the Nurse Wants to Be Called ‘Doctor’. Retrieved February 24, 2020, from http://www.nytimes.com/2011/10/02/health/policy/02docs.html
- National Osteopathic Board of Examiners. (2019). COMLEX USA for Residency Program Directors. Retrieved March 3rd, 2020, from https://www.nbome.org/Content/Exams/COMLEX-USA/COMLEX-USA_Residency_Program_Directors_Guide.pdf.
- Weizberg, M., Kass, D., Husain, A., Cohen, J., & Hahn, B. (2014). Should osteopathic students applying to allopathic emergency medicine programs take the USMLE Exam? The western journal of emergency medicine, 15(1), 101–106. https://doi.org/10.5811/westjem.2013.8.16169H324-A/14, AOA HOD Cong. (2014) (enacted)
- Weizberg M, Kass D, Husain A, Cohen J, Hahn B. Should Osteopathic Students Applying to Allopathic Emergency Medicine Programs Take the USMLE Exam? West J Emerg Med. 2014;15(1), 101–106.
- EMRA Match for Clerkships (2020). Retrieved from https://webapps.acep.org/utils/spa/match#/search/map
- American Medical Association. (2020). Retrieved from https://freida.ama-assn.org/Freida/#/
- Hasty RT, Snyder S, Sucui GP, Moskow JM (2012). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22331802
- Jeanne M. Sandella, John R. Gimpel, Larissa L. Smith, and John R. Boulet (2016) The Use of COMLEX-USA and USMLE for Residency Applicant Selection. Journal of Graduate Medical Education: July 2016, Vol. 8, No. 3, pp. 358-363.
- USMLE.org. (2020). USMLE program announces upcoming policy changes. Retrieved March 5th, 2020, from https://www.usmle.org/announcements/
- National Board of Osteopathic Examiners (2020). IMPORTANT UPDATES: COMLEX USA Examination Program, Retrieved from https://www.nbome.org/news/important-updates-comlex-usa-examination-program/
Harris Ahmed, OMSIV- Burrell College of Osteopathic Medicine at New Mexico State University
Christian von Gizycki, OMSIV, Lake Eerie College of Osteopathic Medicine – Bradenton
Alana Castro-Gilliard, OMS II, Edward Via College of Osteopathic Medicine- VA
John Rajala – OMSIV Burrell College Osteopathic Medicine at New Mexico State University
Furzan Azam, OMSII, AT Still University College of Osteopathic Medicine
Nancy Phu OMS III, Burrell College of Osteopathic Medicine at New Mexico State University
Walid Moughabel, OMS-III, Burrell College of Osteopathic Medicine at New Mexico State University
Hannah Niehaus, OMS-IV, Burrell College of Osteopathic Medicine at New Mexico State University
Matthew Mansour, OMS I, Burrell College of Osteopathic Medicine at New Mexico State University
Effective Time Period: Ongoing
David Ashley<br>WesternU-COMP PomonaGuest
Hello, my name is David Ashley and I am speaking on behalf of myself. While I empathize with the concerns raised within this resolution, I am interested in hearing about how this resolution was developed. This is a somewhat contentious issue and thus, I am concerned about how it would be received – both by the stakeholders mentioned herein, and the AOA House of Delegates.
What consultative processes did the authors of this resolution take with relevant stakeholders (NBOME, NBME, ACGME, COCA, AACOM, COM Deans, etc.), and how was the general concept received by them?
To be clear – I am not necessarily in favor or against this resolution. Rather, I am concerned that the appropriate due diligence still needs to be done.
Thank you for your time, and I look forward to hearing more about this resolution’s development process.
This is Heidi Dreher, OMS-II ICOM. I am writing in support of this resolution. With the combined residencies, it makes sense to only require one board exam for both allopathic and osteopathic students. It would relieve additional stress and financial burden on osteopathic students.
This is Heidi Dreher, OMS-II ICOM. I am writing on behalf of myself in support of this resolution. With the combined residencies, it makes sense to only require one board exam for both allopathic and osteopathic students. It would relieve additional stress and financial burden on osteopathic students.
I am writing on behalf of myself in support of this resolution and commend the authors who wrote this resolution. Osteopathic medical students have to spend 16+ more hours to sit for 2 exams and have to pay $1200+ more than our allopathic counterparts. While my support lies in what was mentioned in the resolution, I would like to add that primary care specialties are also requiring that there is a Step 1 score for elective rotations and for residency applications. While the argument may be that OMM would not be incorporated in the unified exam, I suggest that NBOME create an hour long exam that would be for the sole purpose of OMM questions that would be covered in COMLEX Level 1 as before, testable and experimental questions, to help in the development of osteopathic medical education. For years we have tried to use the converting system but program directors have verbally stated that they do not use this; as more residency programs are switching to have more MD program directors, I believe that the converting system argument will become obsolete. Governing bodies from the allopathic field are in support of creating an unified exam. It is time that we join forces in the creation of a workforce that comes together that begins with medical education; to show that there is no difference in the education between allopathic and osteopathic education.
Hello, my name is Alyssa Mathew-Joseph, OMS-III. I fully support this resolution as it follows the same approach we have already taken in creating a unified match system. In my opinion, it would be the next logical move to make in order to create a unified medical educational system. It would also greatly help in lowering costs for osteopathic medical students whether it be for the actual additional exams and/or additional test prep material. This would aid in reducing our financial burden overall. This decision would also allow us for more opportunities to apply to programs that require STEP scores. I feel that it would also make things easier for program directors to refer to one test scoring system, instead of having to compare and convert scores. I really hope this resolution is approved so that we can make better strides to creating an integrated medical education system that everyone can follow and understand.
I fully support this resolution. We need less division between us and allopathic physicians. I do not understand the redundancy for step 1 and level 1. A test does not a DO make. We chose the route because of the philosophies that make us a DO.
I write in support of this resolution and thank the authors for bringing a pragmatic solution to a pertinent issue that plagues the financial and mental state of DO students across the nation. Unified board exam not only allows us to focus on a single set of exams to prepare for, but also halves the fees as test-takers. It allows simplifies our profile for programs to assess, thus strengthening our competitiveness in residency match overall. I implore SOMA delegates to consider this issue in the interest of DO students, and vote to open a brighter future to our profession.
My name is Rahim Methani and I am writing on behalf of myself in support of this resolution and commend the authors who wrote this resolution. Osteopathic medical students have to spend 16+ more hours to sit for 2 exams and have to pay $1200+ more than our allopathic counterparts. While my support lies in what was mentioned in the resolution, I would like to add that primary care specialties are also requiring that there is a Step 1 score for elective rotations and residency applications. While the argument may be that OMM would not be incorporated in the unified exam, I suggest that NBOME create an hour-long exam that would be for the sole purpose of OMM questions that would be covered in COMLEX Level 1 as before, testable and experimental questions, to help in the development of osteopathic medical education. For years we have tried to use the converting system but program directors have verbally stated that they do not use this; as more residency programs are switching to have more MD program directors, I believe that the converting system argument will become obsolete. Also, program directors receive thousands of applications a year from US MD, US DO, and IMG students, of which 2 of those 3 students are only required to have USMLE Step scores. Program directors will either look to see if the US DO student has a Step score to compare; if not, I believe that they will not take the additional time to plug in the COMLEX score into a converter.
Additionally, Comlex scores are considered highly variable percentiles for one year to another. For example, from May 2017 to April 2018, a 600 on Comlex Level 1 was considered 68th percentile, while from May 2018 to April 2019 a 600 was considered 80th percentile. Governing bodies from the allopathic field are in support of creating a unified exam. It is time that we join forces in the creation of a workforce that comes together that begins with medical education; to show that there is no difference in the education between allopathic and osteopathic education. One unified exam removes the double jeopardy that D.O students have to take part in.
My name is Alexandra Maningat and I am a rising OMS-III. I fully support this resolution, especially in the face of a single residency/fellowship accreditation. This will decrease the financial and mental pressure put on osteopathic medical students by having to take two board exams.
Harris Ahmed, DO, MPH<br>BCOM at New Mexico State UniversityGuest
I am the author. Responding to David Ashley
What consultive processes did I take?
– I am on the COCA SRC
– I worked for 2 months for AACOM
– I have been speaking with FSMB leadership for months (owners of the USMLE)
– I have been on multiple national AOA Taskforces and committees
– I was your former VP/Speaker of the House, Parliamentarian and Chair of Resolutions Committee
We are all looking to SOMA for guidance on this. What do the students want? When single accreditation happened, DO leadership was hesitant but when students and SOMA supported it then everyone got on board.
I can tell you I have been in constant communication with FSMB leadership who have communicated to me and many others (such as in their webinar with SOMA recently) that if SOMA passes this resolution that they will reach out to the NBOME to work on a single licensing exam.
– Proud DO
Harris Ahmed, DO, MPH
Resident Physician PGY-1
Loma Linda Ophthalmology
I fully support this resolution. This would decrease the financial burden placed on DO students that comes with preparing/registering for COMLEX, as well as lessen the stress that comes with taking double the board examinations. A possible change could be to create a separate, single examination focused only on OMM that osteopathic medical students would take.
I’m not sure how I feel about this. Osteopathic and allopathic tend to have a bit different curricula and saying that the usmle would cover the full amount of what we learn would not be accurate. I have taken the usmle’s and while I don’t like that I had to pay extra to take them Not all the programs required for me to use a usmle. I think to make it more unified the allopathic programs should learn how to fairly evaluate our exams and not us change our way. This is just my opinion but I don’t know that the coca will ever actually change their minds.
To whom it may concern,
I am a 4th-year DO student and have seen the negative repercussion of having two sets of licensure exams first hand. Students applying to certain residencies understand that they must take the USMLE exams. This places an undeserved financial and time burden on those students an places them at a disadvantage that is unfair and unnecessary. I feel that this serves no tangible purpose for students and only serves to support a testing organization. I am not advocating for the elimination of osteopathic principals and practice from the DO profession. Rather, I propose that we are tested separately on that portion of our education. We already have COMATs which incorporate these principals into our evaluations. Plus, there is an entire COMAT dedicated to OMM. My point is that OMM will not be forgotten or lost by unifying the licensure exams. In fact, it will only help to demonstrate our equality with our allopathic colleagues. The time has come to move forward and let go of antiquated practices that hold us back. Change, while sometimes painful, is also a necessary part of growth. I ask that those in charge allow our profession to grow and flourish.
Timothy Counce<br>UIW SOMGuest
I am an OMS-lll, and just completed my first set of board exams. I am thrilled at the notion that DO students would no longer have to pay double what our MD colleagues pay for licensure by taking both Step 1 and Level 1. I believe in OMT and it’s usefulness, and would appreciate its inclusion into the USMLE. My suggestion would be to have an extra section of OMT, either at the end or throughout, with 40 of the ungraded questions taken out. This of course would continue with the pass/fail precedent for both the USMLE and its OMM portion.
My name is Reshma Pinnamaneni and I am a rising OMS-II at AZCOM. I fully support this resolution and I believe it will go a long way in easing the financial and academic stress that Osteopathic medical students currently face. In addition, it will help standardize the parameters of evaluation between Allopathic and Osteopathic applicants in regards to combined residencies.
I am a fourth year medical student and I fully support this resolution. In lieu of the single accreditation amongst osteopathic and allopathic residencies, having one licensing exam is the most sensible option. The distinctiveness and importance of being a D.O. is not proven by the exam taken rather by the principles by which we practice and I do not see this resolution as diminishing those principles whatsoever. Being a D.O. is very important to my identity and yet I find it paradoxical to have to take one set of exams to graduate and another set of exams to match into residency.
David Ashley<br>WesternU-COMP PomonaGuest
Replying to Dr. Harris Ahmed:
Thank you for clarifying! That additional information is greatly appreciated.
Mustafa Basree<br>Kentucky College of Osteopathic MedicineGuest
This is Mustafa Basree, OMSIV at Kentucky COM, and I support this resolution to eliminate redundancy and streamline medical education for all students.
Redundancy and inefficiency plague many large bureaucratic industries, and medical education is a perfect example of that. Osteopathic and allopathic education and practice have converged over the past decades. Most recently, the ACGME Single Accreditation System was implemented successfully with DOs matching at record high across many specialties. With post-graduate education being the similar to Osteopathic and allopathic colleagues, I’m not sure I see benefits of keeping testing separate in OMS (Level 1/2) or PGY (Level 3).
Single GME was not the first time we made bold (or controversial) changes in the profession. The AOA added another route for board certification that does not have OMT; it allows physicians who want to incorporate osteopathic principles in their practice but not necessarily desire to do OMT (for time constraints, personal choice, etc.). The new route is also open for allopathic physicians who would like to learn about osteopathic principles. This should incentive us to share our principles with allopathic colleagues and unify our tests with an extra section of OMT for DO students given that it is an important aspect of our education. Unifying COMLEX and Step series will streamline medical education and physician licensure across states. This starts with shedding 1 of the 2 tests.
Common argument against unifying the tests is that COMLEX series are unique with Osteopathic principles incorporated in the questions. Osteopathic approach to patient care found in COMLEX exams can be incorporated into the Step series. Osteopathic medicine was developed in response to old medical practices that have long been gone. As DOs we take pride in our holistic, empathetic, and personable approach to medicine. However, today, most if not all allopathic medical schools practice holistic care, value preventative medicine, and preach empathy and inclusiveness in healthcare. Given that both DO/MD students share the same goal of providing holistic care, it is only appropriate to impart some of that wisdom unto our NBME colleagues. Organizations such as NBME and NBOME can share what worked for their respective student population to streamline testing and improve medical education for ALL students. Lastly, in 2019, Dr. Seger Morris, AOA trustee and chair of BEL, published a timely article wondering what it means to be a DO today. It is not our exams. Worth the read: https://www.kevinmd.com/blog/2019/05/its-time-to-rethink-what-it-means-to-be-a-do.html.
Once passed, I hope that SOMA and resolution writers will work on incorporating our unique principles into the Step series, as alluded to in Dr. Ahmed’s comment above.
Mustafa Basree, OMSIV
I am a rising OMSIII and am in support of this resolution.
Hello SOMA members,
My name is Sidra Ali, a rising OMS-II, and I am the BCOM NLO. I am speaking on behalf of myself. I would first like to point out just like Student Doctor Dreher that we should stream lines things so there is no question that MD and DO’s have the same level of knowledge. As far as decreasing Osteopathic autonomy, I do not think this exam will affect that. OMM is a key to our learning and to our practice, however the reality is less than the majority actually use OMM/OMT in their practice. That being said, while we do learn OMM in class and I think it is important for DOs to learn, I think that having an additional OMM subject exam can suffice with the elimination of COMLEX. Also, just like Student Doctor Matthew-Joseph explained, since USMLE Step 1 is pass/fail I can only imagine the confusion for residencies when they see a COMLEX score. Although it may be a benefit for us to keep a COMLEX Level 1 score, we all acknowledge some Residency Programs still do not know how to properly interpret COMLEX. Instead of hoping that they will open their minds to COMLEX, wouldn’t it be much easier for them to only see one exam so there is absolutely no confusion or discrimination?
Bringing in another resolution (S-20-33), imagine if MD and DO schools had one exam and could give and share resources with one another. This could help schools that may be struggling to provide resources to help their students pass (especially new schools). Imagine the collaboration we could have with our MD peers as we could make sure that these organizations and institutions are being held accountable to ensure when a student is accepted, the retention rate is high and that student does not have to worry about the making it through medical school.
DO School on average has a higher cost of attendance than MD schools. Why not ensure financially students all have the same advantage and don’t have to take an additional exam just to be as competitive as an MD candidate? Create a single accreditation process provides a space of no question that DOs are equally capable as MD medical students. Just like Student Doctor Basree mentioned, MD’s can get OMM training and take exams for ceritification and gain our skills and be appreciated equal to us but we are not considered equal to some residency programs and I believe elimination of COMLEX can help eliminate some of this stigma.
Speaking on behalf of myself and as an OMS-III, I support this resolution to come to a more unified physician force. I agree with the contentions made in the body of the resolution and support decreasing added financial burden and stress of osteopathic students. Without taking away what sets us apart, it is possible to come together as many have mentioned above, via a specialized portion of the exam catered to assessing OMM education. I hope and trust that organization leads will take the nation’s student body voice into account to bring about reasonable change on this matter.
Brandon Davis (OMSIII)<br>UIWSOMGuest
First, I want to thank the authors for their hard work and research in the pursuit of advocacy for osteopathic medical student exam hardship. I do, however, stand in opposition of the current resolution due to foreseeable consequences to the osteopathic curriculum. I also took COMLEX level 1 as well as STEP 1, and I spent a significant amount of financial resources and stress in preparation for the two board exams. Despite the NBME being an optional exam, I took it anyway against advice of the school. You would be reasonable to suggest I would agree with this resolution due to the aforementioned stress, but I can’t do so. It is because of the difficulties in comparison between allopathic and osteopathic curriculum. You should not compare apples to oranges, and that stands true for different medical training. Osteopathic curriculum includes osteopathic manipulative treatment (OMT), which is quite complex in both its study and its practice. Since OMT is a cornerstone of the osteopathic curriculum, a singular test that omits OMT from the exam would nullify and/or underestimate the depth of the osteopathic medical student’s true education in medicine. Additionally, removing one of said cornerstones from the requirement to pass an osteopathic medical school would essentially disrupt the foundation of learning of an osteopathic student. It is true that allopathic medical school find difficulty in comparing the STEP 1 and COMLEX 1 scores, but I support a resolution that finds another way around this challenge without disrupting the core of osteopathic medical education. Indeed, OMT is not the only difference in medical training between the two schools of learning, and there needs to be a way to rectify these differences without discrimination in regards to residency and elective rotation acceptance. Thank you again.
My name is Richa Nathaniel, I am an OMS-III and I am in full support of this resolution.
My name is Sneha Aidasani, I am an OMS-III and I am in full support of this resolution.
Harris Ahmed DO, MPH<br>BCOM at New Mexico State UniversityGuest
– MD and DO Education is NOT apples to oranges.
– the AOA recognizes that OMT is not a cornerstone to being a DO, they have board pathways that don’t include OMT.
– We all train under the ACGME now, does that ignore our unique training? Do you believe we should reverse SAS?
– the Subject test to be taken in addition to the single exam would cover OMT
Alexander Paiva OMS-III<br>UIWSOMGuest
My name is Alexander Paiva, a rising OMS-III, at UIWSOM, speaking on behalf of myself, and I am torn about this resolution. I recognize the importance of streamlining the evaluation process under a single accreditation system. I also recognize that DO students have the undue burden of having to take two exams, the burden of studying for two exams, the extra cost it entails, the mental taxing, and the concerns of having to schedule two exam dates, especially after this year’s exam season with multiple cancellations. I also appreciate the concerns of my fellow DO student doctors about the concerns of having to take an USMLE exam to seem competitive for residency programs. However, I recognize that I am in the gross minority in being a student that ONLY took a COMLEX, in being under the impression that a COMLEX would be accepted by residency programs, 80% of programs in fact, in contradiction to the 20% as noted in the resolution that focuses on the programs not taking a COMLEX. So, unless I’m grossly misinformed about the actuality of acceptance by program directors, I believe that my COMLEX should be considered as equal to the USMLE. Furthermore, for some students, taking the Step exam is not required but rather a choice they make to become equally competitive to their MD counterparts in certain specialties, whereas other schools require it regardless of future specialty. I also recognize there is much overlap between the content of the exams, and even the resources used for studying tend to be identical. So, logically, it makes sense to have one exam to clarify applications for program directors. Yet, the structure of the separate exams and the formatting of questions are different, with my basing being solely on practice exams I have taken for both COMLEX and USMLE.
I believe that if the resolution is accepted, there should not just be an automatic default to the USMLE. There should be a new exam created from a merger of both exams in order to to ensure a fairness of blend of curriculums between allopathic and osteopathic medical schools. I also support the idea as been previously mentioned that there should be a separate OMM exam, on a smaller scale, to ensure our proficient knowledge content for that particular training. I am a proud future DO and I do not want to lose the identity of what makes us different from my allopathic colleagues by defaulting to solely an allopathic exam. I thank you for your consideration of my opinion on this resolution.
I am actually confused. I was told once usmle step 3 is passed , usmle door is closed forever . So how EPPs are going to retake it ? I could not find any specific source for retaking possibility with new AOA ID. If anyone has please give me a link.
I understand all of your concerns but you have to understand our (EPPs) pain too. We are enduring this struggle of going through medical education twice only to come back to clinical life. Because at the end of the day we ( EPPs) want to live as doctors, that is our passion ,that is everything we dream about, taking breath as a physician is blended in our existence. I don’t know what benefits eliminating COMLEX might bring for some ( May be one less exam to worry about ) , it is for sure will close the door of possibilities to return to clinical life for many.
Harris Ahmed DO, MPH<br>BCOMGuest
Here are the new amendments. They address concerns brought up by the minority.
1. A new title
New Title: “Single Licensing Exam”
2. Strike all Resolved
3. New resolved are
RESOLVED, SOMA adopt an official position that there should be a single licensing exam for all medical students attending a medical school accredited by the LCME or COCA
RESOLVED, that SOMA work with the NBOME, NBME, and FSMB to develop a single licensing exam for all medical students attending a medical school accredited by the LCME or COCA, with the option for an additional Osteopathic specific subject test for osteopathic medical students
RESOLVED, SOMA advocate to the COCA to adjust their continuing accreditation standards such that Element 6.12 no longer requires the COMLEX USA Series to be passed prior to graduation from an osteopathic medical school, rather osteopathic medical students must pass a new single licensing exam developed by the NBOME, FSMB, and NBME.
@ Dr. Ahmed. I thank you for your consideration of the opinion minority and I support the resolution with the proposed amendments and changes.
Jonathan Shen<br>WesternU COMPGuest
My name is Jonathan Shen. I am an OMS IV and I fully support this resolution
Briana C. Rodriguez<br>UIWSOMGuest
My name is Briana Rodriguez, I am an OMS-III at University of the Incarnate Word School of Osteopathic Medicine, and I support this resolution.
There is, without a doubt, a systemic belief that USMLE exams must be taken with COMLEX exams in order for an osteopathic student to be matched with a competitive residency as we would rather accept the burden of additional testing than speak out against the discriminatory residency admission practices transparent to all in the medical community.
This resolution is a much needed step towards confronting the dissonance that exists from the recent union of MD and DO residency programs.Thereby ensuring osteopathic students be given the same opportunities, respect, and acknowledgment from a system that currently allows residency programs to unabashedly dismiss COMLEX scores and require USMLE scores from every applicant.
This irrefutable inequity between MD and DO students continues as third year osteopathic students are required to take the COMLEX Level-2 Cognitive Examination (CE), COMLEX Level-2 Performance Evaluation (PE), and ostensibly the USMLE Step 2.
Furthermore, due to current restrictions put in place to stem the spread of COVID-19 there is undue burden placed on osteopathic students to complete a predominantly out-of-state COMLEX Level-2 PE regardless of interstate travel restrictions.
This resolution highlights the clear conflict of interest that exist between the financial interests of NBOME and the health/safety of osteopathic students during this pandemic.
I believe this to be an appropriate resolution, one which seeks to amend a system that knowingly allows osteopathic students to work twice as hard, pay twice as much, and test twice as often as our allopathic peers for the same opportunities.
I support this resolution.
My name is Ayesha Quraishi. I am an OMS II and I fully support this resolution
I am writing in support of this resolution; the redundancy in exams and content leads to additional, unnecessary stress and financial burden.
Thanks for your work on this.
I would like to ask since this has been mentioned in several comments: what does AOA consider to be the cornerstone of being a DO if it is not OMT?
The fundamental tenets we are taught early in medical school includes:
1. The body is a unit, and the person represents a combination of body, mind and spirit.
2. The body is capable of self-regulation, self-healing and health maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
A holistic approach is what we like cite as what differentiates DOs, but I have worked with plenty of MDs who follow this philosophy. While all DOs do not use OMT due to their own choice, it is a fundamental aspect of our training, and the tenets allude to OMT. Yes, it is applicable to other treatment modalities as well, but then what makes us any different from our MD counterparts?
I think with a unified exam, some program directors will still discriminate against DOs because they do not understand or choose not to understand our training. I agree that there is an unfair financial burden to DOs who must take both exams for specialties who require USMLE, but that is a specialty specific issue. In addition, the question styles of USLME vs. COMLEX and the cases on the PE vs CS are different, especially since OMM makes up a large aspect of it. The medical school curriculum would have to change to focus on a USMLE style exam.
In addition, an OMM COMAT (or an OMM “addendum”) is likely not adequate to demonstrate competency in the breadth that is OMM and OMT. It could also put DOs at a disadvantage to MDs who take a shorter exam. At the school I attend, there is really no incentive to do well on the OMM COMAT because it is really just Pass/Fail and not associated with a core rotation grade.
If anything, it would be beneficial first to advocate for a Pass/Fail COMLEX 1.
I strongly support this resolution.
Spencer Christensen<br>ATSU SOMAGuest
I would like to voice my approval of this resolution. Osteopathic medical students must be allowed to participate on an even playing field. Separate board exams perpetuates a divide within the profession more than it preserves osteopathic distinctiveness. It is not realistic to expect that AMA resolutions encouraging program directors to consider COMLEX equal to USMLE will change our competitiveness and the data clearly indicate that a significant disadvantage is incurred by not taking USMLE.
statistics project help isn’t the subject I major in, but it’s still important for my overall academic performance. Everyone says I must ignore it and focus on more valuable subjects, but I can’t. I want to be a straight-A student, so this approach isn’t working for me. Recently I was assigned a complicated statistics project. It became a huge problem for me as a student who understands nothing about mathematics, huge volumes of data, and its processing.