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

Objective: The purpose of this investigation was to quantify the relationships between performance on the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), administered to osteopathic medical students, and performance on American Board of Surgery (ABS) in-training (ABSITE) and board certification examinations.

Design: Descriptive statistics, Pearson correlations, and logistic regression were employed to investigate the relationships between performance on COMLEX (Level 1, Level 2-cognitive evaluation [CE]) and the ABSITE, ABS qualifying examination (QE). Scaled scores and pass/fail status were available for COMLEX Level 1 and Level 2-CE. Scaled scores were also available for all 5 ABSITE examinations (PGY1-PGY5) and ABS QE.

Setting: The investigation was based on historical data shared between the National Board of Osteopathic Medical Examiners (NBOME) and ABS.

Participants: The study cohort included 2300 graduates of osteopathic medical colleges who were currently enrolled in or had completed a general surgery residency program. All participants had taken at least one ABSITE examination between 2016 and 2023. Of these, 654 had attempted the ABS QE at least once.

Results: Both COMLEX Level 1 and Level 2-CE scores were predictive of ABSITE performance (r = 0.42-0.51). Osteopathic students who failed Level 1 or Level 2-CE had significantly lower first attempt scores on ABS QE. The COMLEX Level 2-CE first attempt score explained 28% of the variance of the ABS QE first attempt score. Based on the logistic regression analysis, a score of 550 on Level 2-CE was associated with a predicted probability of passing ABS QE of 0.91.

Conclusions: The results from this investigation indicate that COMLEX performance is predictive of ABS in-training and board certification performance. If program directors continue to use licensing examination performance as part of holistic review of potential residency candidates, they should reference COMLEX for osteopathic medical school graduates. Given the strong association between Level 2-CE scores and first attempt passing probability on ABS QE, requiring osteopathic graduates to take United States Medical Licensing Examination Steps does not add value.