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Factors Affecting Osteopathic Medical Students’ Specialty Choice in Light of a Future Pass/Fail COMLEX Level 1 and USMLE Step 1
Kiernan, R. N. [2]
Keever, K. [2]
Monaco, A. [3]
Pino, M. [5]
Saggio, G. [5]

Journal: Journal of Osteopathic Medicine Date: 2021/12, 121(12):Pages: A63-A65. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2021-2000/html)

Keywords:

cross sectional study [662]
exams [14]
medical students [448]
osteopathic medicine [1631]
residency [226]
specialization [16]
USA [1166]

Abstract:

Context: Osteopathic medical students (OMS) continue to pursue medical specialties outside of primary care.1,2 One factor crucial to OMS pursuing these fields is COMLEX Level 1/USMLE Step 1 scores. With changes to pass/fail grading of these exams, it is unknown how this may affect OMS. Studies have shown that factors such as medical school hospital affiliations, mentorship, and research will become increasingly important, potentially putting OMS interested in these fields at a disadvantage. Objective: To investigate differences in perceived barriers of OMS applying to residency between residents and current medical students before the new COMLEX Level 1 and USMLE Step 1 pass/fail grading format. Results from this study can serve as a tool for medical school administrators to better advise OMS when applying to residency in the future and aid in the development of a curriculum that enhances OMS interests. Methods: This is a cross-sectional study of OMS from the classes of 2022 - 2024 and recent medical school graduates from New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) from both the New York and Arkansas campuses. From March-June 2021, 1,525 OMS and recent graduates were asked to complete a survey regarding perceptions of factors that impact medical students’ ability to match into their desired residency program. Following the initial email, three follow-up reminders were sent to all participants. The survey was administered electronically on Red Cap (Nashville) and institutional review board (IRB) approval was obtained from NYIT-COM. The survey consisted of 49 questions covering aspects of the residency application including residency interest, medical board exam results, clinical grades, mentorship, medical school reputation, clinical affiliations of the medical school, and research. Responses were rated on a 4-point Likert scale ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). Other variables such as demographics, board exam scores, and match year/anticipated match year were also collected. Respondents from the classes of 2022 - 2024 were labeled as “Prospective” and respondents from the classes of 2021 and earlier were labeled as “Retrospective” having already matched into a residency program. Statistical analyses were calculated using IBM SPSS, ver. 27 and p-values less than or equal to 0.05 were considered significant. Descriptive statistics for categorical variables are reported as absolute frequencies/percentages and were analyzed by a chi-square test. Continuous variables are reported as medians/interquartile ranges and are analyzed by a student’s t-test. This study is important for the osteopathic medical community to gain a better understanding of factors that OMS perceive as being important to the residency match process and to allow medical schools to better cater curriculums towards OMS needs. Results: A total of 221 completed surveys were received (15% response rate) with 35% of responses being from the Prospective group and 65% of responses from the Retrospective group. Respondents were split almost evenly between male (49%) and female (51%) with the distribution of males and females in both the Prospective and Retrospective groups being nonsignificant. The majority of respondents were White (61%), Asian (25%), or Black (5.0%) and 3.6% were Hispanic or Latino. When comparing perceptions of various factors that influence OMS residency decisions between Prospective and Retrospective groups, both groups found USMLE Step 1/COMLEX Level 1 (82% vs. 84%; p= 0.84) and USMLE Step 2/COMLEX Level 2 (78% vs. 94%; p=0.20) as being important factors in an individual’s ability to match. Both groups agreed that pass/fail USMLE Step 1/COMLEX Level 1 would have put them at a disadvantage to match to their residency of choice (49% vs. 59%; p= 0.19) with the majority of respondents agreeing that this change will make the medical school attended and its hospital affiliations more important when matching to a residency program (93% vs. 92%; p= 1.00). The majority of the Prospective group agreed their institution helped them find a mentor in their field of interest (64% vs. 16% in Retrospective, p<0.05) and had a research mentor (57% vs. 34% in Retrospective, p<0.05). The majority of the Prospective group also agreed that the number of publications on their residency application was important to match at their residency of choice, while less than half of the Retrospective group agreed (66% vs. 41% in Retrospective, p<0.05). No significant differences were found between the Prospective and Retrospective groups perceiving boards scores, clinical grades, school affiliations, school reputation, Sigma Sigma Phi status, and clinical exposure as being important factors that influence students’ decision to pursue a particular residency. Conclusion: Our study confirms that in light of a pass/fail COMLEX Level1 and USMLE Step 1, there has been a shift in the factors that are perceived as important for residency by current and future OMS as compared to graduates. The most significant differences included the perceptions of research and mentorship, with more of the Prospective group agreeing these factors are important when deciding which residency to apply to. We speculate that this difference can be attributed to the recent change to a pass/fail COMLEX Level 1 and USMLE Step 1 with both groups agreeing board examination scores are an important component when choosing a residency and this change would have or will put them at a disadvantage with the residency match process. Because these scores will no longer be part of their decision-making process for choosing a residency, other factors such as COMLEX Level 2 and USMLE Step 2, which both groups agreed were important, as well as mentorship, research, and hospital affiliations will become increasingly important to OMS based on these preliminary results. This study had several limitations. First, it was administered to only one medical school and its branch campus and excluded the opinion of allopathic medical students. Second, this study did not include perceptions of residency directors. Future studies comparing both allopathic and OMS as well as opinions from residency directors should be evaluated to determine the implications of a pass/fail USMLE Step 1 and COMLEX Level 1. We believe this study may encourage osteopathic medical schools to establish formal mentorship programs for OMS and arrange for students to participate in research electives to improve their chance of securing their residency of choice.

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