To the Editor,
We would like to comment on “Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020,”  which was published in March 2022 in Journal of Osteopathic Medicine. We acknowledge the importance of analyses of factors that affect matching to graduate medical education programs. A better understanding of these predictors can inform faculty and students on strategies for success in matching to their preferred specialty. However, we need to be careful when making broad suggestions that are not well supported by research.
The authors presumed that if a student took the United States Medical Licensing Examination (USMLE), he or she reported it. However, this could potentially bias results by including poor performers in the non-takers group. Moreover, some students who do not take (or report) USMLE performance may be less likely to be successful in the Match for reasons other than licensing examination performance. Finally, the group of osteopathic students who take the USMLE, albeit large, self-select.
For pediatrics, the match rate with a reported Step 1 score (∼98%) was only 5% greater than that for those with no reported USMLE score. Because other factors may have contributed to match success, and because USMLE scores (including failing performance) may be underreported, is it really a good strategy, given the cost and stress, to take a second licensing examination?
Developing a better understanding of the things for which program directors screen (e.g. availability of USMLE scores, attending an LCME school) could provide additional insights as to why there are differences in match rates between students who report taking the USMLE and those who do not, at least for some specialties. Ultimately, we believe that providing better education to program directors about the content, structure, and scoring of COMLEX-USA will go a long way toward leveling the playing field and allowing osteopathic students to be just as competitive in securing residency positions across all specialties.
The suggestion that the majority of DO seniors can improve their odds of successfully matching to some specialties by taking the USMLE adds stress, is financially burdensome, and propagates existing biases in the selection process. Efforts to increase the use of the USMLE Step 1 by DO applicants fail to acknowledge holistic applicant review  and the transition of COMLEX-USA Level 1 and USMLE Step 1 [3, 4] to pass-fail scoring. Advising osteopathic students to take an examination, or examinations, not aligned with their educational pathway is not the answer.
Research funding: None reported.
Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests: All authors are affiliated with the National Board of Osteopathic Medical Examiners.
1. Nikolla, DA, Stratford, CV, Bowers, KM. Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020. J Osteopath Med 2022;122:347–51.10.1515/jom-2021-0262Search in Google Scholar PubMed
3. National Board of Osteopathic Medical Examiners. COMLEX-USA Level 1 to Eliminate Numeric Scores; 2022. Available from: https://www.nbome.org/news/comlex-usa-level-1-to-eliminate-numeric-scores/ [Accessed 7 Apr 2022].Search in Google Scholar
4. United States Medical Licensing, Examination. USMLE Step, 1 updates on score reporting and standard setting; 2021. Available from: https://www.usmle.org/usmle-step-1-updates-score-reporting-and-standard-setting [Accessed 7 Apr 2022].Search in Google Scholar
© 2022 John R. Boulet et al., published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.