Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

The USMLE Step 1 and COMLEX Level 1 Became Pass/Fail: How Does This Affect DO vs. MD Residency Applicants? Jessica Cefalo MS OMS III 1 , Nichole Tackett DO 2 , David Redden PhD 3 , Artem Boyev DO 4 , Kristine Lombardozzi MD 1 1. VCOM-Carolinas, Spartanburg, SC 2. Spartanburg Regional Healthcare System, Spartanburg, SC 3. VCOM-Auburn, Auburn, AL 4. University of Texas Health Sciences Center at Houston, Houston, TX Introduction Results Discussion

• DO match rates before and after the transition were similar for general surgery . • DO match rates were higher after the transition in otolaryngology , plastic surgery , thoracic surgery , and vascular surgery . • DO match rates were lower after the transition in orthopedic surgery and neurosurgery . • MD candidates had substantially higher match rates in all surgical residencies before and after the transition compared to DO counterparts. Conclusions Conclusion: Most specialties had similar or increased match rates for DOs after the transition to pass/fail. Orthopedic surgery and neurosurgery were the only specialties to have lower match rates after the transition. This showing that Step 1/Level1 becoming pass/fail did not hurt DOs but increased their likelihood of matching in most surgical specialties. Future Research: Trending data each year to gain a larger sample size of applicants with pass/fail scores and looking at the impact of each section in applicant selection. Limitations: Pass/fail data was only available for 1 year and it is unknown how additional years would have affected this data.

Historically, numerical scores have played a pivotal role in determining an applicant's ability to match into a competitive surgical residency program. On January 26, 2022, the United States Medical Licensing Exam (USMLE) transitioned to a pass/fail system, followed by the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) on May 10, 2022. Interest and research on the effects of this change continues to grow and impact current and future medical students 1,2 . The current literature lacks studies specifically analyzing the impact of the shift from a numeric score to pass/fail on Doctor of Osteopathic Medicine (DO) students applying to competitive surgical residency programs. Research Question: Will surgical residency match rates for osteopathic applicants become lower after Step 1/Level 1 became pass/fail due to less objective data to compare DO’s to MD counterparts? • Total numbers of candidates who applied and matched ACGME-accredited categorical general surgery, neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, thoracic surgery, and vascular surgery were obtained from the National Resident Matching Program (NRMP). • 2024 was the first year applicants had pass/fail Step 1/Level 1 scores. Numbers of DO and MD candidates who applied and matched in 2020 - 2023 were compared to candidates who applied and matched in 2024 by using the Breslow Day Test. • The Cochran Mantel Haenszel Test compared DO and MD applicant match rates within each surgical specialty. Methods

• General Surgery: DO match rates were similar before (885/1536; 58%) and after (274/461; 59%; p-0.34) pass/fail transition. • Otolaryngology: DO match rates were higher after transition(26/43; 60%; p=0.72) than before (77/145; 53%). • Plastic Surgery: DO match rates were higher after transition (3/16; 19%; p=0.10) than before (2/48; 4%). • Thoracic Surgery: DO match rates were slightly higher after the transition (1/5; 20%; p=0.84) than before (4/24; 17%). • Vascular Surgery: DO match rates were higher after the transition (8/13; 62%; p=0.18) than before (13/56; 23%). • Neurosurgery: DO match rates were lower after the transition (3/15; 20%; p=0.72) than before (21/68; 31%). • Orthopedic Surgery: DO match rates were lower after the transition (117/256; 46%; 0.01) than before (449/791; 57%). • 73% of MD’s matched before and 72% matched after the transition compared to 58% of DOs who matched before and 59% who matched after the transition in general surgery.

References

1. Belovich, A.N., Bahner, I., Bonaminio, G. et al. USMLE Step-1 is Going to Pass/Fail, Now What Do We Do?. Med.Sci.Educ. 31 , 1551 – 1556 (2021). https://doi.org/10.1007/s40670-021-01337 2. Ozair A, Bhat V, Detchou DKE. The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators. JMIR Med Educ. 2023 Jan 6;9:e37069. doi: 10.2196/37069. PMID: 36607718; PMCID: PMC9862334 .

Acknowledgement s

Figure 1. DO and MD Match Rates By Surgical Specialty Before and After Step 1/Level 1 Became Pass/Fail.

We would like to extend a special thanks to Dr. David Redden for his assistance with the statistical analyses for this study. His expertise greatly contributed to the accuracy of our results.

2025 Research Recognition Day

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