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Osteopathic Student Matriculation Trends in Surgical Subspecialties (2016-2024): A Systematic Review
Bridgette Kielhack1, Selena K Cholak1, Virgil K DeMario1
1Department of Clinical Affairs, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA.
Background:
There is a paucity of data on trends of osteopathic medical students (OMS) matriculating into surgical specialties since the installation of the single U.S. graduate medical education (GME) accreditation system, which concluded in June 2020. This study examines the impact of major policy changes, particularly the transition of COMLEX Level 1 and USMLE Step 1 to Pass/Fail, on OMS match outcomes, with the goal of guiding current students pursuing surgical careers.
Methods:
A systematic literature review was conducted using Rayyan, with bias assessed via the Cochrane risk of bias tool. National Residency Matching Program (NRMP) data from 2016, 2018, 2020, 2022, and 2024 were reviewed to document the number of OMS applicants and post-match statistics. Surgical specialties analyzed included General Surgery, Vascular Surgery, Neurological Surgery, Otolaryngology, and Orthopedic Surgery. NRMP pre-merger data were available for General Surgery, Neurological Surgery, and Orthopedic Surgery; Vascular Surgery and Otolaryngology data were available for 2020 and 2022 only.
Results:
COMLEX-USA Level 1/2 and USMLE Step 1/2 scores generally decreased across the ACGME merger, with notable exceptions: Neurological Surgery reported higher COMLEX Level 2-CE scores; Orthopedic Surgery reported higher USMLE Step 2 CK scores; Vascular Surgery reported a higher Step 2 score between 2020 and 2022, though data were limited to a single applicant. Otolaryngology also demonstrated an increase in mean Step 2 scores. General Surgery, Neurological Surgery, and Orthopedic Surgery showed increased mean numbers of abstracts, presentations, and publications, while Vascular Surgery and Otolaryngology showed declines between 2020 and 2022.
Conclusions:
The most consistent trend was an increase in research productivity among successful OMS matriculating into General Surgery, Neurological Surgery, and Orthopedic Surgery. While licensing scores generally declined, this may reflect applicant pool expansion post-merger. Ongoing research is needed to evaluate trends beyond 2024, particularly following the implementation of Pass/Fail Step/Level 1.
