How Do Usmle Scores Upload to Eras
In 2018, 21,611 examinees from Dr.-granting medical schools in the U.S. and Canada took USMLE Footstep one. They didn't have whatsoever choice. Encounter, the USMLE is a licensing exam – and then if yous desire to practice as an allopathic medico in the Us, you lot've got to take it.
But at that place were also iv,136 osteopathic medical students who took the USMLE. Exactly null of those students were required to take the test. In fact, they're required to take a dissimilar test – the Comprehensive Osteopathic Medical Licensing Exam, or COMLEX – to graduate from medical schoolhouse and obtain a medical license.
These students were taking the USMLE to ameliorate their application for residency. Considering, despite the consolidation of osteopathic and allopathic residency programs under a single accreditation system run by the ACGME, many residency program directors (PDs) are not comfy using COMLEX scores to evaluate applicants. This is especially true for more competitive programs and specialties, and DO students know it: in one survey, 70% of osteopathic medical students recommended that hereafter students have the USMLE to maximize their prospects of finding a residency.
Accordingly, osteopathic medical students have been taking the USMLE in increasing numbers, every bit shown below.
The number of DO students taking USMLE Step i has increased 13-fold since 1997. This rise is simply partially explained by the increased number of Practice students.
Taking 2 sets of licensing examinations isn't inexpensive. Almost DO students who take the USMLE take both Step 1 and Step 2 CK – significant that they pay $1260 for the privilege of taking a licensing test that won't fifty-fifty help them get licensed.
Last yr, the American Medical Association passed a resolution saying that Exercise and MD licensing exams should exist viewed equally. This is an beauteous motility that seems probable to change zero. So what should be washed? How tin we preclude osteopathic students from being fleeced on their licensing exams?
Permit's take a look at five options.
1. Make #USMLEPassFail
Do away with USMLE scores, and the number of DO students who cull to take the USMLE volition instantly drop to zippo. Trouble is, I don't see it happening.
The idea of a laissez passer/neglect USMLE was considered at the March 2019 InCUS meeting, and although the terminal determination on score reporting won't be publicly released for another few weeks, my reading of the tea leaves is that Step 1 scores aren't going anywhere.
There are multiple reasons for this – including the one I pointed out here. But it's also important to remember that the National Lath of Medical Examiners has significant financial incentives to maintain score reporting. And this is one of them.
Terminal year, the NBME took in $4,399,320 from osteopathic students who took Step 1 and Footstep 2 CK. Think they're eager to get by without that revenue?
Me neither.
In other words, if we desire to go along Do students from getting fleeced, we've got to do something different. We've got to make COMLEX scores more interpretable for PDs who aren't used to seeing them.
There are a few ways this could exist done.
2. "Convert" COMLEX to USMLE scores.
Several authors accept analyzed the human relationship between COMLEX and USMLE scores. Probably the most authoritative assay is this one, which included 1016 students at the Higher of Osteopathic Medicine of the Pacific who took both the COMLEX and the USMLE.
Unsurprisingly, at that place was a linear human relationship between scores on COMLEX and the USMLE.
In that location is a strong linear human relationship between COMLEX and USMLE scores (R2 = 0.696). Effigy from Lee As et al., J Grad Med Educ 2014. PubMed
The authors derived the following formula to "convert" COMLEX to USMLE scores:
USMLE Step 1 = (0.2392)*(COMLEX Level i) + 82.563
Using this equation, a 600 on COMLEX Level 1 predicts a USMLE Step ane score of 226.
However, there are obvious limitations with this approach.
First, even though the correlation between COMLEX and USMLE is strong, it's not perfect.
Expect closely at the spread of data the scatterplot above. For a student who scores a 600 on COMLEX, the range of observed USMLE Step one scores goes from around 200 to over 250. (This is not surprising – even a student who takes USMLE Step i two times on sequent days may accept scores that differ by 24 points. But for all the PDs out there who mistakenly believe that the USMLE provides a perfectly precise prediction of an applicant's aptitude for residency, such a wide range is problematic.)
2d, the data in the Lee paper were nerveless from 2006 to 2012. Although they provide a useful snapshot, they probably won't produce valid predictions for contemporary exam-takers. Why? Not merely is the population of COMLEX/USMLE examination-takers changing, just the mean score for USMLE Stride 1 is also increasing by around 0.ix points/year.
USMLE "score creep". Note the rightward shift of the score distributions from 2015-2017 to 2016-2018.
Score creep ways that, the older the formula, the more likely it is to nether-predict USMLE scores.
Take, for example, this newspaper from 2006, which also establish a linear relationship between COMLEX and USMLE scores. But using their formula, a 600 on COMLEX Level 1 predicts a USMLE Step 1 score of simply 211.
Instead, to ensure that PDs are evaluating electric current data, nosotros could try something different. Nosotros could…
three. Encourage PDs to calculate COMLEX percentiles.
The COMLEX score reports that students receive do non include a percentile. However, the National Lath of Osteopathic Medical Examiners (NBOME) does make available an online tool that PDs could use to calculate the percentile for a given COMLEX score. (A link to this tool now appears in the ERAS Program Directors' Work Station for osteopathic applicants.)
Using the NBOME tool, we tin can see that an applicant with a COMLEX Level one score of 600 did pretty well – scoring at the 80th percentile of all test-takers.
Current distribution of COMLEX Level one scores, based on the NBOME percentile reckoner.
But there are at least two major bug with this approach, too.
The offset is practicality. Do we really think that PDs are going to take the time to expect up a COMLEX percentile? Remember, the very reason most PDs use licensing examination scores is for screening – to make a quick, yes/no determination almost whether to interview a candidate or not. The idea that these PDs will accept the time to go to a separate website – especially a clunky i that requires several inputs to spit out the data you want – seems hopelessly naive.
The 2d trouble is meaning. Some PDs similar USMLE scores because they provide a universal measuring stick. Knowing that an bidder has a 80th percentile COMLEX is dainty – simply it nonetheless doesn't tell you how that applicant compares to those who took the USMLE.
Only maybe nosotros could partially become effectually these concerns if we…
iv. Convert COMLEX percentiles to USMLE percentiles.
Before getting into the nuts and bolts of this, let's be clear: COMLEX and USMLE are different tests.
They have different content specifications and formats, and are taken past groups of test-takers whose demographics and prior standardized test scores differ systematically.
Merely all that aside – what if PDs could see, at a glance, what a COMLEX score would exist if it were a USMLE score at the same percentile? What if we put the conversion on a single tabular array so that PDs wouldn't have to go into the NBOME website and look up a percentile every time they come up upon a DO bidder?
It would exist easy to make this kind of affair. And then easy, in fact, that I went ahead and did it.
Comparison of COMLEX and USMLE percentile scores. (Data extracted from here and hither.)
Is this unscientific? Sure.
But then is using USMLE scores to select residents. And so if we're gonna exist unscientific, allow'southward simply have students pay once for their licensing exams while we're at information technology.
However, there's an easier solution – one that doesn't rely on the NBME to act confronting its fiscal best interests, and one that doesn't involve PDs using a clunky website or press out the table in a higher place on a laminated menu.
5. Alter the COMLEX score reporting scale.
The scale for COMLEX goes from 0 to k. The calibration for the USMLE goes from 0 to 300.
Why?
PDs accept an intuitive sense of what'southward a 'good' USMLE score for their specialty. Why not capitalize on that intuition by reporting COMLEX results using the numbers that most PDs are more familiar with? Make me president of the NBOME, and the outset thing I'll practice is start reporting COMLEX scores on the same calibration used past the USMLE.
Make me the King of Medical Education, though, and the first matter I'll do is need that we stop relying so much on any i-time, betoken-estimate of basic scientific discipline memorization that measures and then niggling of what PDs and patients truly care almost. Simply until then…
___
ADDENDUM: Several readers have asked why I didn't discuss the idea of getting rid of COMLEX and having all osteopathic medical students take the USMLE instead. It'due south a good idea – but one that seems unlikely to occur. For one thing, in some states, COMLEX is protected by law, and then getting rid of information technology would require amending the medical practice human action. Many states do allow DOs to be licensed by taking the USMLE – but this seems to be an option few DOs pursue. In 2018, only 21 DOs took USMLE Footstep three, despite the thousands who took Steps one and 2 CK. Let'south too not forget that the NBOME has a vested interest in maintaining COMLEX – with acquirement of over $thirty 1000000 and a CEO who took in $635,943 in reportable bounty in 2017. It'due south difficult to imagine them willingly allowing themselves to be legislated out of existence. Getting rid of COMLEX and providing a single licensure exam for DOs and MDs is a commendable goal – but information technology won't exist easy.
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Source: https://thesheriffofsodium.com/2019/12/13/the-usmle-for-dos-how-to-stop-fleecing-osteopathic-medical-students/
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