JAOA • Vol 106 • No 9 • September 2006 • 568-569
How to Predict USMLE Scores From COMLEX-USA Scores: A Guide for Directors of ACGME-Accredited Residency Programs
Philip C. Slocum, DO;
Janet S. Louder
From the Kirksville (Mo) College of Osteopathic Medicine of A.T. Still
University of Health Sciences.
Address correspondence to Philip C. Slocum, DO, Kirksville College of
Osteopathic Medicine of A.T. Still University of Health Sciences, 800 W
Jefferson St, Kirksville, MO 63501–1443. E-mail:
pslocum{at}kcom.edu
Context: Graduates of colleges of osteopathic medicine (COMs)
frequently apply to residency training programs accredited by the
Accreditation Council for Graduate Medical Education. However, students who
have taken the Comprehensive Osteopathic Medical Licensing Examination
(COMLEX-USA) rather than the United States Medical Licensing Examination
(USMLE) may encounter a selection bias when applying to allopathic residency
programs.
Objective: To evaluate the correlation between scores on COMLEX-USA
and USMLE by COM students who took both examinations.
Methods: Scores were analyzed from a cohort of COM students who took
COMLEX-USA Level 1 and USMLE Step 1 and a cohort of students who, during the
same time, took COMLEX-USA Level 2 and USMLE Step 2.
Results: At the Kirksville (Mo) College of Osteopathic Medicine of
A.T. Still University of Health Sciences, 155 students took both COMLEX-USA
Level 1 and USMLE Step 1 and another cohort of 56 students took COMLEX-USA
Level 2 and USMLE Step 2. The Pearson product moment correlation of the scores
from COMLEX-USA Level 1 and USMLE Step 1 was 0.83 (P<.001) and for
COMLEX-USA Level 2 and USMLE Step 2 was 0.70 (P<.001). Scores on
USMLE are predicted by the corresponding COMLEX-USA scores using the equations
USMLE Step 1 = 67.97 + 0.24 x COMLEX-USA Level 1
(R2=0.68); and USMLE Step 2 = 102.2 + 0.18 x
COMLEX-USA Level 2 (R2=0.46).
Conclusion: A method of estimating USMLE scores from COMLEX-USA
scores is provided for residency directors of institutions accredited by the
Accreditation Council for Graduate Medical Education for the evaluation of COM
applicants.
Graduates of colleges of osteopathic medicine (COMs) frequently apply to
residency programs approved by the Accreditation Council for Graduate Medical
Education
(ACGME).1,2
These residency programs commonly use United States Medical Licensing
Examination (USMLE) scores among their selection
criteria.3–5
Osteopathic medical students take the Comprehensive Osteopathic Medical
Licensing Examination (COMLEX-USA) at the time USMLE is given, during the
second and fourth years of medical school. Osteopathic medical students who
apply to ACGME residency programs must either take USMLE in addition to
COMLEX-USA or face a potential selection bias. A correlation between the two
examinations would afford ACGME residency directors the opportunity to place
osteopathic standardized tests into a frame of reference. In addition, it
would allow a measure of confidence for COM students to understand how they
compare with their allopathic counterparts. To our knowledge, ours is the
first study to evaluate the correlation between scores on COMLEX-USA and
scores on USMLE by COM students who took both examinations.
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Methods
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We analyzed the test scores of all students who took both COMLEX-USA Level
1 and USMLE Step 1 and those who took both COMLEX-USA Level 2 and USMLE Step
2. We compared scores using the Pearson correlation and regression analysis.
The study was granted institutional review board exemption.
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Results
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The mean±SD scores were as follows: COMLEX-USA Level 1,
549±73; USMLE Step 1, 201±22; COMLEX-USA Level 2, 575±86;
and USMLE Step 2, 200±22. The Pearson product moment correlation
coefficient of the scores on COMLEX-USA Level 1 and USMLE Step 1 was 0.83
(P<.001), and for COMLEX-USA Level 2 and USMLE Step 2 was 0.70
(P<.001). The USMLE Step 1 score is predicted by the COMLEX-USA
Level 1 score using the following equation:
The USMLE Step 2 score is predicted by the corresponding COMLEX-USA Level 2
score using the following equation:
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Comment
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Graduates of COMs make up an ever-increasing number of applicants to
allopathic residency programs. From 1996–1997 to 1999–2000, the
number of COM graduates filling allopathic residency programs rose
17.7%.1 In the
2001–2002 academic year, 2316 COM graduates were in graduate medical
education programs approved by the American Osteopathic Association, while
4658 were in ACGME-accredited
programs.2 Scores on
USMLE are very influential in residency selection for allopathic
programs.3–5
Graduates of COMs must either apply for positions in allopathic medical
residency programs using their COMLEX-USA scores or take USMLE in addition to
COMLEX-USA. We have shown a correlation between the scores on COMLEX-USA
Levels 1 and 2 and the corresponding scores on USMLE Step 1 and Step 2. Part
of COMLEX-USA, unique to COMs, involves osteopathic theory and technique. It
could be that differences in scores may relate to this additional content;
however, the exact content of each examination was not available for
comparison. A COM student's COMLEX-USA Level 1 and Level 2 scores can
reasonably and accurately predict USMLE Step 1 and Step 2 scores. Our formulas
provide a method of comparison for residency directors in ACGME-accredited
institutions as they evaluate applicants from COMs. Further research is
necessary to evaluate the use of these formulas on a prospective basis.
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Acknowledgment
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The authors thank Dixie Tooke-Rawlins, DO, Dean and Vice President of
Edward Via Virginia College of Osteopathic Medicine in Blacksburg, and Jane C.
Johnson, MA, Director of Research Support, Kirksville (Mo) College of
Osteopathic Medicine of A.T. Still University of Health Sciences. Without
their insight and assistance, this project would never have been
successful.
Submitted October 26, 2005;
revision received March 3, 2006;
accepted March 27, 2006.
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References
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1. Brotherton SE, Simon FA, Etzel SI. US graduate medical education,
2001–2002: changing dynamics. JAMA.2002; 288:1073
–1078.[Abstract/Free Full Text]2. 2002 Annual Report on Osteopathic Medical Education. American
Association of Colleges of Osteopathic Medicine Web site. Available at:
http://www.aacom.org/data/annualreport/annualreport2002.pdf.
Accessed May 25, 2006.
3. Berner ES, Brooks CM, Erdmann JB. Use of the USMLE to select
residents [review]. Acad
Med.1993;68:753
–759.[Medline]
4. Taylor CA, Weinstein L, Mayhew HE. The process of resident
selection: a view from the residency director's desk. Obstet
Gynecol. 1995;85:299
–303.[Abstract]
5. Paolo AM, Bonaminio GA. Measuring outcomes of undergraduate medical
education: residency directors' ratings of first-year residents.
Acad Med. 2003;78:90
–95.[Medline]
This article has been cited by other articles:
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P. C. Slocum
Response
J Am Osteopath Assoc,
June 1, 2007;
107(6):
213 - 214.
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