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Understanding COMLEX-USA Level-1 as a Pass/Fail examination: impact and opportunities.

Ashley Gerhardson1, Melissa Efurd1, Patricia Sexton2

  • 1Office of Academic Affairs and Institutional Research, 506528 Arkansas Colleges of Health Education , Fort Smith, AR, USA.

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|March 10, 2025
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Summary

Many osteopathic medical students and recent graduates view the transition to Pass/Fail scoring for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Level 1 negatively. This shift has decreased motivation for the COMLEX-USA Level 1 and increased stress for the COMLEX-USA Level 2CE, impacting residency matching.

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Area of Science:

  • Medical Education
  • Licensing Examinations
  • Residency Admissions

Background:

  • The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Level 1 and United States Medical Licensing Examination (USMLE) Step 1 transitioned to Pass/Fail scoring.
  • This change prompted residency program directors to rely more on other metrics like COMLEX-USA Level 2CE, USMLE Step 2CK, school prestige, and letters of reference.

Purpose of the Study:

  • To investigate the perceived impact of the transition to Pass/Fail scoring on osteopathic medical licensing examinations.
  • To examine how this scoring change affects students' and graduates' perspectives on residency applications and competitiveness.

Main Methods:

  • A cohort study utilizing two surveys distributed to osteopathic medical students, recent graduates, academic advisors, and curriculum committee members.
  • Responses were collected using a Likert Scale, with standard descriptive statistics and thematic coding of qualitative data for analysis.

Main Results:

  • Respondents indicated a mean score of 2.35 for increased chances of matching into residency and 2.71 for Pass/Fail being a positive change (on a 1-4 scale).
  • A significant portion (46%) expressed negative sentiments, citing decreased motivation for COMLEX-USA Level 1, increased emphasis on COMLEX-USA Level 2CE, and perceived disadvantages in the residency match process.
  • Respondents believed clinical skills (mean 2.60) would be more strongly considered, but doubted new score reports offered robust analysis of basic science strengths (mean 2.24).

Conclusions:

  • A notable portion of respondents, particularly students, perceive the Pass/Fail scoring change unfavorably.
  • Key concerns include diminished motivation for COMLEX-USA Level 1 and heightened stress regarding COMLEX-USA Level 2CE performance.
  • The scoring change is perceived to negatively influence audition rotations and overall residency competitiveness.