The Use of COMLEX-USA Performance When Considering DO Applicants to General Surgery Residency Programs

Area of Science:

• Medical Education
• Surgical Residency Admissions
• Licensing Examinations

Background:

• Osteopathic medical students complete the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) for licensure.
• General surgery residents take American Board of Surgery (ABS) in-training (ABSITE) and board certification examinations.
• The relationship between these two examination series is not fully understood.

Purpose of the Study:

• To quantify the predictive relationship between osteopathic medical students' COMLEX-USA performance and their subsequent performance on ABSITE and ABS board certification examinations.
• To inform surgical residency program directors on the utility of COMLEX-USA scores in evaluating osteopathic candidates.

Main Methods:

• Utilized descriptive statistics, Pearson correlations, and logistic regression analyses.
• Examined historical data from 2300 osteopathic medical school graduates participating in general surgery residency programs.
• Included performance data from COMLEX Level 1 and Level 2-Cognitive Evaluation (CE), ABSITE (PGY1-PGY5), and ABS Qualifying Examination (QE) between 2016 and 2023.

Main Results:

• Both COMLEX Level 1 and Level 2-CE scores demonstrated a significant positive correlation with ABSITE performance (r = 0.42-0.51).
• Osteopathic students who failed COMLEX Level 1 or Level 2-CE had significantly lower first-attempt ABS QE scores.
• COMLEX Level 2-CE scores explained 28% of the variance in first-attempt ABS QE scores, with a score of 550 predicting a 0.91 probability of passing the ABS QE.

Conclusions:

• COMLEX-USA performance is a significant predictor of success in ABS in-training and board certification examinations.
• Program directors should consider COMLEX scores in the holistic review of osteopathic medical school graduates applying to surgical residency programs.
• Requiring osteopathic graduates to take the United States Medical Licensing Examination (USMLE) Steps may not provide additional predictive value for surgical board certification given the strong association with COMLEX Level 2-CE.