Program Director Survey Determining Effects of Single Accreditation and Pass/Fail Licensing Exams on Osteopathic Medical Students Applying for Surgical Residency

Purpose

Prior to the single accreditation system (SAS), some residency programs were accredited by the American Osteopathic Association (AOA), rather than the Accredited Council for Graduate Medical Education (ACGME) and trained osteopathic (DO) graduates only. Recently, United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level-1 transitioned from numeric scores and pass/fail outcomes to pass/fail only. The purpose of this survey was to examine the effects of these changes on DO students applying for surgical residency.

Methods

A voluntary, anonymous survey was distributed five times over 9.5 weeks to 1539 surgical program director (PD) emails collected from the Fellowship and Residency Electronic Interactive Database (FREIDA). 302 responses were received (response rate 19.6%) and 244 survey responses were included in statistical analyses. 58 responses were excluded because of incompletion, the respondent was not a PD, or the respondent disqualified DO students from matching.

Results

For DO applicants, most former-AOA programs recommend Step 1 while most non-AOA programs require it. The majority of both program types require Step 2 CK. When deciding whom to interview, former-AOA programs significantly preferred Level-2 scores and completion of an acting-internship at the program while non-AOA programs significantly preferred the Medical Student Performance Evaluation and clerkship grades/evaluations. Both program types highly valued Step 2 CK scores and letters of recommendation.

Conclusion

Based on this study, DO applicants should almost certainly take both Step 1 and Step 2 CK (in addition to Level-1 and Level-2) to be considered competitive. Additionally, the results underscore the importance of identifying surgical residency programs as former-AOA or non-AOA– particularly when prioritizing where to complete acting-internships. Despite the SAS, former-AOA and non-AOA surgical residency programs differ in their preferred medical licensure examination and metrics for determining competitiveness. DO students should consider these differences to improve osteopathic surgical match rates.