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Response to “Comments on ‘Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020’”

  • Dhimitri A. Nikolla ORCID logo EMAIL logo , Chad V. Stratford and Kaitlin M. Bowers
Published/Copyright: June 17, 2022
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 122 Issue 10

To the Editor:

We would like to thank Dr. Boulet and coauthors [1] for their comments on our article [2] in their Letter to the Editor. The letter’s authors raise some important points regarding our study’s limitations and the value of the United States Medical Licensing Examination (USMLE) for osteopathic applicants to post-graduate training programs [2].

As discussed in our article, our study had some limitations. First, USMLE completion was self-reported by applicants; however, 89% of Step 1 scores were verified with the applicants’ osteopathic medical schools by the National Residency Match Program (NRMP) [2]. Additionally, osteopathic students who take the USMLE may be more competitive than those who do not take the examination [3]. Therefore, we mitigated this potential bias by repeating the analysis with a cohort of senior osteopathic students who obtained low scores on the USMLE Step 1 [2]. Also, although many programs disclose their preference for osteopathic applicants to complete the USMLE, many do not [4]. Therefore, osteopathic applicants who did not complete the USMLE may unknowingly apply to programs that prefer it. The prevalence of these discordant applications is unknown and may be an unmeasured variable confounding our results. Lastly, we analyzed available specialty-level data [2], and applicant-level data are best to adjust for confounding variables like Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) scores or extracurricular activities.

Nevertheless, we disagree with the letter’s authors that our conclusions are “not well supported by research.” [1] Our study found that reported completion of the USMLE Step 1 was associated with matching into a senior osteopathic student’s preferred specialty for six of the 10 most popular specialties [2]. Additionally, the association remained significant for three of the 10 specialties after limiting the study cohort to senior osteopathic students with low USMLE Step 1 scores [2]. Furthermore, we did not observe any harm regarding match outcomes with completion of the USMLE, even for those with low scores [2]. These results are corroborated by published research suggesting that USMLE completion by the osteopathic applicant may improve match outcomes [5, 6], improve applicant competitiveness [6, 7], and open opportunities at post-graduate training programs that specifically require the USMLE for osteopathic applicants [8, 9].

In the context of this evidence, wouldn’t discouraging osteopathic students from completing the USMLE be detrimental to their match success?

Corresponding author: Dhimitri A. Nikolla, DO, Department of Emergency Medicine, Allegheny Health Network - Saint Vincent Hospital, 232 West 25th Street, 16544, PA, Erie, USA, E-mail:

  1. Research funding: None reported.

  2. Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval for the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  3. Competing interests: None reported.

References

1. Boulet, J, Gimpel, JR, Sandella, JM, Turner, MD. Comments on “Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020”. J Osteopath Med 2022;122:535–6. https://doi.org/10.1515/jom-2022-0080.Search in Google Scholar PubMed

2. Nikolla, DA, Stratford, CV, Bowers, KM. Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020. J Osteopath Med 2022;122:347–51.10.1515/jom-2021-0262Search in Google Scholar PubMed

3. Smith, T, Kauffman, M, Carmody, JB, Gnarra, J. Predicting osteopathic medical students’ performance on the United States medical licensing examination from results of the comprehensive osteopathic medical licensing examination. Cureus 2021;13: e14288. https://doi.org/10.7759/cureus.14288.Search in Google Scholar PubMed PubMed Central

4. FREIDA™ AMA Residency & Fellowship Programs Database. Available from: https://freida.ama-assn.org/ [Accessed 19 May 2022].Search in Google Scholar

5. 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;15:101–6. https://doi.org/10.5811/westjem.2013.8.16169.Search in Google Scholar PubMed PubMed Central

6. Mitsouras, K, Dong, F, Safaoui, MN, Helf, SC. Student academic performance factors affecting matching into first-choice residency and competitive specialties. BMC Med Educ 2019;19:241. https://doi.org/10.1186/s12909-019-1669-9.Search in Google Scholar PubMed PubMed Central

7. Heard, MA, Buckley, SE, Burns, B, Conrad-Schnetz, K. Identifying attitudes toward and acceptance of osteopathic graduates in surgical residency programs in the era of single accreditation: results of the American College of Osteopathic Surgeons medical student section questionnaire of program directors. Cureus 2022;14:e22870. https://doi.org/10.7759/cureus.22870.Search in Google Scholar PubMed PubMed Central

8. Hasty, RT, Snyder, S, Suciu, GP, Moskow, JM. Graduating osteopathic medical students’ perceptions and recommendations on the decision to take the United States Medical Licensing Examination. J Am Osteopath Assoc 2012;112:83–9.Search in Google Scholar

9. Nikolla, DA, Jaqua, BM, Tuggle, T, Jarou, ZJ. Differences between emergency medicine residency programs that accept the Comprehensive Osteopathic Medical Licensing Examination of the United States and those that prefer or only accept the United States Medical Licensing Examination. Cureus 2022;14:e22704. https://doi.org/10.7759/cureus.22704.Search in Google Scholar PubMed PubMed Central

Received: 2022-05-03
Accepted: 2022-05-20
Published Online: 2022-06-17

© 2022 Dhimitri A. Nikolla et al., published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  3. Case Report
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  7. Reactivation of minimal change disease after Pfizer vaccine against COVID-19
  8. Innovations
  9. Original Article
  10. At-home ECG monitoring with a real-time outpatient cardiac telemetry system during the COVID-19 pandemic
  11. Medical Education
  12. Original Article
  13. Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine
  14. Neuromusculoskeletal Medicine (OMT)
  15. Brief Report
  16. Osteopathic manipulative treatment use among family medicine residents in a teaching clinic
  17. Public Health and Primary Care
  18. Original Article
  19. Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders
  20. Clinical Images
  21. Recurrent bronchiolitis and stridor in an infant
  22. Bilateral idiopathic superior ophthalmic vein dilation
  23. Letters to the Editor
  24. Comments on “Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020”
  25. Response to “Comments on ‘Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020’”
https://doi.org/10.1515/jom-2022-0089
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Cardiopulmonary Medicine
  3. Case Report
  4. Propionibacterium acnes: an uncommon cause of lung abscess in chronic obstructive pulmonary disease complicated with bullous emphysema
  5. General
  6. Case Report
  7. Reactivation of minimal change disease after Pfizer vaccine against COVID-19
  8. Innovations
  9. Original Article
  10. At-home ECG monitoring with a real-time outpatient cardiac telemetry system during the COVID-19 pandemic
  11. Medical Education
  12. Original Article
  13. Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine
  14. Neuromusculoskeletal Medicine (OMT)
  15. Brief Report
  16. Osteopathic manipulative treatment use among family medicine residents in a teaching clinic
  17. Public Health and Primary Care
  18. Original Article
  19. Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders
  20. Clinical Images
  21. Recurrent bronchiolitis and stridor in an infant
  22. Bilateral idiopathic superior ophthalmic vein dilation
  23. Letters to the Editor
  24. Comments on “Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020”
  25. Response to “Comments on ‘Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020’”
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